Chelsea and Westminster Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.
Services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice, and continuity of care.
People and communities were at the centre of how care was planned and delivered. People were actively involved in planning care that met their needs. People could access care in ways that met their personal circumstances and protected equality characteristics.
At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients were regularly involved in planning and making decisions about their care and treatment. They understood their condition, care and treatment options (including any associated risks and benefits) and any advice provided.

Patients received the most appropriate care and treatment for them as the service made reasonable adjustments where necessary. For example, staff completed individual care plans which addressed specific needs for each patient. Results from the NACEL family bereavement survey (2025) showed that 88% of patients who died had an individualised plan of care addressing their needs at the end of life. This was better than the national average. The NACEL family bereavement survey (2025) showed that 77% of respondents rated overall care and support as excellent or good, consistent with national performance.

Family members were involved in decision‑making. Relatives told us they were included in the person’s care and felt that the patient’s preferences were respected. We reviewed patient records which showed that staff recorded when family members had been involved in discussions or decisions.

There were processes to ensure rapid discharge of patients to their preferred place of death (PPD). The trust carried out audits to review patients preferred place of care against their discharge destination. The audit outcome showed varying levels of achievement over a 12-month period. The highest level of achievement for PPD was in November 2025 (88%), December 2025 (83%) and April 2026 (86%). However, the service achieved lower scores for the rest of the months with the lowest scores in March 2026 (50%), January 2026 (53%), October 2025 (55%) and September 2025 (52%). The trust informed us the predominant reason why PPD was not achieved was due to rapid deterioration in clinical condition. In addition, a significant number of patients did not achieve their PPD due to delays in the discharge process or hospice beds being unavailable. The trust informed us they have implemented improvement actions which included the digitisation of fast-tack continuing healthcare funding processes. In addition, they were working with other trusts to develop enhanced end of life care bed capacity across North West London.

The service consistently monitored performance against standards and implemented actions to improve patient care. We saw that audit results, including the NACEL family bereavement survey audit were consistently reviewed by the EOLC steering group and action plans were monitored to improve the service. Examples of improvements identified in the minutes of the steering group meetings included regular check-ins with families, staff education and room refurbishments to enhance privacy and dignity.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service understood the diverse health and social care needs of the patients that used their service and the local communities and tailored its support to meet those needs. Staff had a proactive approach to meeting the care needs of the local community and worked with other healthcare professionals to ensure continuity of care. They worked as part of multidisciplinary teams with patients from broad diagnostic pathways including cancer, hepatology, critical care, respiratory, neurological, dementia, and frailty.

Advanced care planning was integrated into the assessment process with the use of the universal care plan and inclusion within comprehensive geriatric assessment processes. This ensured that patient preferences were identified early and care decisions reflected individual priorities.

There was continuity in patients’ care and treatment. Information was appropriately shared with community teams including GPs and specialist teams. Staff could access wider information about patient’s health records via electronic systems.

Services were delivered and co-ordinated with appropriate consideration of patient’s needs and preferences, including those with protected characteristics under the Equality Act and those at higher risk of a poorer experience of care. The wards were easily accessible by people using wheelchairs or those with reduced mobility.

The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff provided patients, their families, and carers with information that was accessible, safe, secure, and supported their rights and choices. Patients were provided with relevant information about their health, follow up care and treatment as required. This included information about care in the last days of life.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. This included making reasonable adjustments for people with disabilities, interpreting and translating for people who did not speak English as a first language and for deaf people who used British Sign Language. People who had difficulty with reading, writing, or using digital services were supported with accessible information.

People could receive written information in their preferred language for all correspondences, including appointment letters, clinical correspondence, patient information leaflets, general information, and other trust communications or promotional materials. This supported equitable access to information and helped ensure that patients were able to understand and engage with their care.

The service had developed the “uncertain recovery” communication guide. This was important as people previously complained that they had not expected their relative was going to die. The palliative team identified the need to communicate the possibility of uncertain recovery earlier on in care and treatment in order to manage people’s expectations.

The 2025 NACEL bereavement audit results showed that the hospital scored above national average with 55% of respondents reporting that a member of staff explained to the person that they were likely to die in a few days compared to the national average of 41%.

Staff were sensitive to family needs. They explained that some families felt it was culturally unacceptable to talk about dying. However, staff tried to engage in discussions about uncertainties within the boundaries of people’s cultural expectations.

The trust provided an information booklet guide and support to help people and carers navigate care at the end of life. This included information about coping with the news, planning ahead, getting financial help, and the last days of life.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Staff involved people in the decision making process about their care and took time to understand their concerns. Patients, their families and carers felt staff listened to them and cared. We observed the staff were friendly and compassionate and communicated well with people.

People knew how to give feedback about their experiences of care including how to raise any concerns or issues and could do so in a range of accessible ways. We found information on wards visited informing people about how to make a complaint. Feedback was generally positive. The 2025 NACEL audit bereavement survey showed that 77% of bereaved relatives would rate care as good or excellent compared to the national average of 75%.

There were 3 formal complaints related to end of life care in the last 12 months. One of the complaints was upheld, 1 was partially upheld and 1 was not upheld. The complaints were related to patient care and treatment, communication and patient transfer. The service identified and disseminated learning to staff. For example, following a complaint about a late night transfer of a patient from a ward to the discharge ready unit, the service reiterated the need for staff to communicate out of hours transfers to the SPCT and to complete the checklist and guide for transfer of patients who may be in the last months to weeks of life.

Senior staff informed us they worked hard to bring all data sources together. The EOLC steering patient group and mortality group collated data from various sources and worked together to identify learning to improve the service. The medical examiner scrutinised all deaths and identified any complaints, concerns and compliments. The medical examiner provided feedback on potential learning and positive feedback about care to the trust’s clinical governance team and to the clinical teams involved.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients had equal and timely access to care, treatment and support. The service considered the needs of people with different protected characteristics and made reasonable adjustments to ensure patient’s individual needs could be met.

Data from the trust indicates that 93% of patients referred to the SPCT were seen within the required timeframe. This provided assurance that patients requiring specialist input at the end of life were assessed promptly, supporting timely clinical decision-making and care planning.

We observed prompt review of a patient who had suddenly deteriorated by the palliative care medical team. The medical team adjusted symptom management, prescribed medication via a syringe driver and staff administered medication appropriately.

There was adequate medical cover during both day and night shifts on the wards. Staff told us they could access a doctor in an emergency, and we observed good levels of medical staffing during our assessment.

Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators. They assessed patients and determined whether their home or discharge location was suitable. Staff worked well with the discharge team in line with patient discharge preferences. The service supported fast track and rapid discharge to patients’ preferred place of death. This enabled individuals to spend their final days or weeks in a comforting environment in line with their preferences.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Patients and those close to them told us they were actively engaged and involved in decision-making. They told us they were treated in a non-discriminatory way.

Staff told us they treated people equally and without discrimination. They were able to give examples of how they respected the individual wishes of people with protected characteristics, such as race, gender and people with communication or language difficulties. Patients were given a wide choice of food to meet their cultural and religious preferences.

We reviewed patients’ notes which showed patients received a comprehensive assessment incorporating their physical health needs, psycho-social assessments and spiritual needs. Patients with mobility needs were assessed by physiotherapists and occupational therapists who engaged them in activities to improve their mobility. A learning disability nurse also supported patients with learning disability.

Staff had completed equality and diversity training as part of their mandatory training requirements. The trust policies outlined the process for diversity, equality, and inclusion. This ensured staff were provided with relevant training, knowledge and guidance to avoid discrimination, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions.

Members of the SPCT had also completed specialist training on learning disability and autism (to provide safe, compassionate and informed care to autistic people and people with learning disability) which aligned with national priorities to reduce health inequalities.

Information about the outcomes of people’s care and treatment were routinely collected and monitored. The service regularly reviewed the effectiveness of care and treatment through local and national audit. Evidence from the audits showed that outcomes were positive and met both clinical expectations and the expectations of people themselves.

Staff supported patients to make decisions about their care and treatment and their future. For example, all DNACPR records reviewed reflected discussions held with patients and/or their relatives.

We saw that end of life care agreements for the last hours of life were completed in the notes we reviewed. Staff referred patients to specialist services for ongoing care or follow up where necessary. Relevant information about patient’s care and treatment was shared with their GP to ensure their specific care needs and wishes were known.

The service used advance care planning to help people plan their future care while they had the capacity to do so.

The service had systems to manage patients at the end of their life. A multidisciplinary team of staff including the SPCT, ward staff, speciality teams, therapy staff, butterfly volunteers, chaplains and the bereavement team supported patients and those close to them.