Chelsea and Westminster Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained. There were enough staff with the right skills, qualifications, and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care.

At our last inspection we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The trust had a clear process for reporting and learning from incidents. Staff reported incidents on the trust’s electronic reporting system. Staff we spoke to knew how to report an incident. They confirmed they discussed learning from incidents during staff meetings and at handovers. Between April 2025 and March 2026, staff across clinical wards reported 27 incidents related to the care of patients at the end of life. Most incidents reported resulted in either no harm or low harm. Managers investigated incidents and shared lessons learned with the whole team.

We saw evidence in the minutes of end of life steering committee meetings that learning was discussed. For example, the specialist palliative care team (SPCT) collaborated with the pharmacy team to review syringe driver related incidents. A syringe driver is a small, portable, battery-operated device that is used for delivering measured doses of medication. The SPCT delivered training on wards for staff, and uploaded training videos on the “end of life matters” intranet page and trust learning platform. Learning from the syringe driver incidents were included in the medicine safety bulletin.

Staff understood their responsibilities relating to duty of candour and when this should be applied. The service followed the duty of candour policy by disclosing incidents to patients and providing feedback on investigation outcomes when necessary.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Patients approaching end of life were identified on admission through clinical review and multidisciplinary assessment. Staff ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Staff reviewed patient electronic records for patients known to the trust or other northwest London services including checks for universal care plans and documented patient preferences. The service maintained strong working relationships with community palliative care teams to ensure timely information sharing and notification of impending admissions. Staff within the emergency department had established processes for recognising appropriate patients at presentation and referring them to the SPCT.

The service worked together with internal colleagues and external partners to maintain patients’ safety. Continuity of care was maintained by effective handover of patients and their individual needs. Alerts on the electronic patient record enabled staff to be aware of and follow specific care plans if a patient had needs that required additional support or there were signs of deterioration. Staff could access patients records from any terminal and therefore specialist teams were able to identify patients who may require their specific expertise.

Ward staff informed us that the SPCT responded to referrals promptly. The SPCT aimed to see referrals within 24 hours and information from the SPCT dashboard showed that 93% of patients referred to the SPCT were seen within the required timeframe. Staff confirmed the team were proactive, reachable and present. They said patients were seen daily by the palliative care team.

The service received support from therapy staff based on Ron Johnson ward, an oncology and HIV specialist ward. Therapy staff worked to facilitate discharges from the hospital. 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. There was ongoing work to digitalise paperwork to aid fast track discharges via the electronic system.

There was continuity in patients’ care and treatment. Information was appropriately shared with community teams including GPs, local hospices and specialist teams. Staff could access wider information about patient health records via electronic systems. This meant staff could instantly access a patient’s previous notes when assessing a patient and allowed the service to instantly share notes with other services.

Staff informed us that deceased patients were transferred to the mortuary within the 4 hour guideline set for care of patients after death. This ensured that deceased patients were treated with utmost dignity and respect.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff we spoke with knew how to identify people at risk of, or suffering, significant harm or abuse and the service worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff received training specific for their role on how to recognise and report abuse. All staff had completed the right level of safeguarding training for both adults and children. The service achieved 100% compliance rate for the required level of safeguarding training. All members of the SPCT had completed level 1 and 2 safeguarding training for both adults and children. In addition, relevant senior staff had completed level 3 safeguarding adult training.

The trust had a safeguarding policy for adults and a separate policy for children which were up to date and available on the intranet. The safeguarding policies were comprehensive and reflected national guidance. The policies identified various forms of abuse including child sexual exploitation and female genital mutilation. The policies outlined actions staff should take when they identified a safeguarding concern. Staff we spoke with were aware of the policy and how to access it. The trust had a safeguarding lead, and staff knew how to contact members of the safeguarding team. They referred to using dedicated safeguarding sections in the electronic system to record concerns.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Individualised risk assessments and care plans were developed in collaboration with each patient to ensure their specific needs and preferences were reflected in the treatment plan. Evidence from patients’ records showed that individual plan of care (IPOC) for end-of-life care (EOLC) patients had been discussed with both patients and their families.

Staff used the National Early Warning Score (NEWS) tool to identify patients at risk of deterioration. NEWS observations were recorded in all patients’ records we reviewed, and we saw information which confirmed monitoring of staff’s completion of these assessments was carried out regularly. There were clear guidelines for the escalation of deteriorating patients.

During our assessment, we reviewed 7 sets of patient records. Staff identified potential risks such as allergies. We saw evidence of sepsis screening, skin integrity assessments and pain assessments in the records reviewed.

Staff recognised deterioration in a dying patient, and we observed an instance when staff escalated the care of a patient who had suddenly deteriorated. Medical staff from the SPCT attended and provided clinical input in line with the patient’s treatment escalation plan.

Ward staff informed us they had completed resuscitation training as part of their mandatory training. The SPCT achieved 100% completion rate for resuscitation training to manage life threatening emergencies.

The trust had an up-to-date policy for the identification and treatment of sepsis. They had a sepsis pathway for the management of patients whose condition met the criteria. This included the administration of antibiotics in line with trust guidelines. All members of the SPCT had completed sepsis training. The trust informed us ward staff had also completed sepsis training as part of their clinical induction.

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

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People reaching the end of their life were nursed on the main wards in the hospital. Where possible EOLC patients were cared for in a side room. There were designated “butterfly rooms” to provide privacy, dignity and a calm environment for patients and their families during the last phase of life. The butterfly rooms were equipped with recliner chairs, fridges and other comfort facilities. There were 6 butterfly rooms on various wards in the hospital, and the trust had identified priority areas for new butterfly rooms.

During our inspection, EOLC patients were also nursed on the Ron Johnson ward, an oncology and HIV ward which accommodated all patients in individual side rooms. Ron Johnson ward had a spacious, glass ceiling conservatory were staff, patients and relatives could spend time in a relaxed environment.

Staff had received competency-based training for the use of syringe drivers. The trust had a standard operating procedure for the use of syringe drivers and staff completed checklists for syringe drivers.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The SPCT included two specialist palliative care (SPC) consultants (1.1 Whole Time Equivalent, WTE), 0.5 WTE lead nurse SPC, 4.45 WTE SPC clinical nurse specialists (CNS), 1 WTE specialty registrar and 1WTE foundation year 2 doctor. The team received SPC therapy support from oncology therapists based on Ron Johnson ward. The SPCT did not use agency or locum staff but used bank staff limited to existing substantive team members where required.

At the time of our assessment, members of the SPCT worked 6 days a week. Staff have been recruited into a band 6 development post scheduled to commence on 1 June 2026 to enable the team to provide cover 7 days a week.

A multidisciplinary team of nursing, medical and allied health staff delivered care to people reaching the end of life across inpatient wards and clinical areas in the hospital. Each ward visited provided nursing and medical cover 24 hours a day, 7 days a week. Members of the SPCT supported ward staff by providing specialist advice on pain and symptom control and direct clinical input.

Staff working within the SPCT had completed a trust corporate induction and mandatory training (as required for all trust staff). This included time with key internal teams for example, oncology, pain and frailty and community partners, supporting understanding of the full patient pathway.

Staff had received and were up to date with appropriate mandatory training. Mandatory training modules included safeguarding, Mental Capacity Act and Deprivation of Liberty Safeguards (MCA and DoLs), sepsis, medicines management, resuscitation, conflict resolution, equality and diversity, fire safety, health safety, infection control, information governance and moving and handling.

Members of the SPCT were 100% compliant with all mandatory training modules except MCA and DoLS training. While 100% of doctors were compliant with MCA and DoLS training, 91% of nurses were compliant with the training which was above the trust’s target of 90%.

In addition to mandatory training, SPCT members had completed advanced communication skills training and psychological support training. They had also completed specialist training on learning disabilities and autism which aligned with national priorities to reduce health inequalities. Information from the trust indicated staff had undergraduate and post graduate qualifications in palliative care and had completed specialist modules in symptom control, pain management and end of life care. Training records showed that relevant trust staff had completed training to verify death to ensure this was done in line with national guidance.

A team of volunteers called butterfly volunteers supported EOLC patients. All butterfly volunteers had gone through a robust training program and selection process.

The service conducted comprehensive training programs for ward staff including syringe driver training, advance care planning, simulation training, communication skills training for nurses, and pop-up training based on identified staff needs. The service also supported the training and execution of the butterfly volunteer program and the ambassador nurse program. All newly employed staff receive end of life care training at the corporate welcome (trust induction), delivered by the Specialist Palliative Care Team. Palliative and end of life care education and training was available to staff across the trust, relative to their role. This included the bi-monthly EoLC study day for nursing staff.

We reviewed training materials for the palliative and end of life care training day and saw that it was comprehensive and provided case studies covering recognition of dying, communication with patients and relatives, delivering individualised end of life care and verification and certification, advance care planning and discharge and community services.

The service had developed education and training programs for medical staff. This included regular teaching on the foundation programme for internal medicine trainees, the international medical graduate’s induction training and EOLC training program for surgeons. For example, the service identified low compliance with treatment escalation plan documentation for surgical patients. The EOLC training program aimed to support resident surgical doctors in identifying adult patients who are dying, creating treatment escalation plans and communicating with patients and relatives. Feedback from staff showed that 100% of participants believed the course would positively influence their approach to end-of-life care.

Staff we spoke with were positive about the training received to care for patients at the end of their life. They spoke confidently about their capacity to use syringe drivers and hold difficult conversations. They felt able to recognise when a patient might need pain relief, and other symptoms. Staff recognised deterioration in a dying patient and could described symptoms such as changes in breathing, increasing loss of consciousness, and increased agitation.

Trust data showed high levels of compliance with palliative care/EOLC training rates for trust staff. Overall, 92% of trust staff across 6 divisions had completed the training against the trust target of 90%.

All members of the SPCT have had an appraisal in the last year. This reflected high level of supervision and support provided to staff to carry out their role.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All wards and clinical areas visited were visibly clean. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.

Staff were ‘bare below the elbow’ and adhered to infection prevention and control (IPC) precautions throughout our assessment, such as hand washing and using hand sanitisers when entering and exiting the unit and wearing personal protective equipment when caring for patients.

There were handwashing sinks available. Soap and disposable hand towels were available next to sinks and instructions on how to effectively decontaminate hands were displayed above the sinks. We observed staff wash their hands in-between patient contact.

We observed equipment was visibly clean during our inspection. We observed staff clean equipment used for patients.

We observed that patients who had infectious diseases were cared for in side rooms. There was signage on the door to alert people and prevent unauthorised entry. Staff conducted deep cleaning of bed spaces and side rooms after patient use in line with IPC protocols. This included spaces previously occupied by deceased persons.

There were adequate arrangements for handling, storage and disposal of clinical waste, including sharp instruments. During our assessment we observed sharps bins were correctly assembled and labelled in line with national guidelines.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed systems and processes to prescribe and administer medicines safely. The service had a medicines management policy, which described the handling, storage, prescribing, recording, safe administration, and disposal of medicines.

Staff completed medicines records and kept them up to date. We reviewed patient records which showed prescription charts were completed, signed, and dated. There were no gaps or unexplained omissions in medicines records reviewed. Staff recorded information about patient allergies.

Staff prescribed medicines appropriately in line with policy and end of life care guidance. Anticipatory medications were prescribed and utilised for patients in the records reviewed.

Ward staff were required to complete medicines management training and competencies before administering medication. They had to complete annual refresher training. All SPCT members had completed medicines management training.

Staff had completed training to use syringe drivers. Syringe drivers are portable battery-operated medical devices used to deliver regular doses of medicines to patients with the aim of providing them with continuous symptom relief for pain, sickness, or agitation when oral medication becomes difficult to use.

We saw prescriptions for syringe drivers with clear documentation of drug names, doses, volume and duration. The prescriptions were reviewed regularly. Syringes were correctly labelled with details of the drugs, time added and medicines serial number. Site or line of insertion was regularly checked for redness, leaking and swelling.

Patients and their relatives or carers were appropriately involved in decisions and reviews about their medicines and the level of support they needed to manage their medicines safely. People told us staff were very careful to ensure patients were on the right medicines and dosages to keep them pain free and control their symptoms.