Chelsea and Westminster Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

The service had a clear vision and plans to achieve it. Leaders had the skills, knowledge, experience and credibility to lead well. They were visible and approachable, and supported staff to develop their skills. There was a clear system of governance and risk management based around delivering safe care and treatment. Leaders also supported innovation both internally and with system partners. This improved the patient experience and access to services.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a vision that “every person, and those important to them, approaching the end of their life will receive compassionate and individualised care when and where they need it.” The strategy was structured across four core pillars: patients, staff, organisation and partners. The strategy commits to delivering individualised, holistic care addressing physical, psychological, social and spiritual needs; equitable access to end of life care across diverse populations; and improved advance care planning and shared decision-making.

The service’s strategic priorities included early recognition of deterioration and uncertain recovery, and routine use of advance care planning and universal care plans. The service set strategic goals to be achieved by 2029 with the aim to ensure all patients approaching end of life are offered advance care planning discussions and documentation and improve communication about uncertain recovery early in admission.

Specialist palliative care staff were aware of the vision and strategic priorities for end of life care. The service had developed the “uncertain recovery” communication guide. The palliative team identified the need to communicate the possibility of uncertain recovery early to manage people’s expectations. The service was working on the digitisation of fast-track applications for continuing healthcare funding. This aimed to support patient preference around place of care.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

End of Life Care (EOLC) was a trust wide service and was managed through the emergency and integrated division. The divisional leadership team included a medical director, director of nursing and director of operations. A hospital medical director chaired the quarterly EOLC steering group meetings across both hospital sites.

A lead consultant and a lead nurse led the Specialist Palliative Care Team (SPCT) in Chelsea and Westminster Hospital. Leaders had the skills, knowledge, and experience required for their roles. They demonstrated a clear understanding of the service they managed and could explain how their teams worked to deliver high-quality care, including managing patients’ symptoms and providing emotional support for patients and relatives. Leaders demonstrated strong oversight of governance and operational performance, and we saw evidence of this in minutes of meetings and from our discussions with staff. Senior staff could clearly describe the top risks facing the service and had processes to monitor and mitigate these.

Leaders demonstrated a compassionate and inclusive approach. They made reasonable adjustments to accommodate staff needs, including flexible working arrangements. They understood the context in which care, treatment and support were being delivered and they embodied the culture and values of their workforce and organisation.

SPCT staff were positive about the leadership of EOLC. They felt leaders were visible, approachable and supportive. Staff informed us they felt supported, respected and valued and are proud to work at the trust.

Other staff within the hospital including ward staff, chaplains, volunteers and bereavement officers spoke positively about their leadership team and felt they were part of the wider trust. Some staff had been working at the hospital for a considerable period and had progressed through the grades. All staff across the hospital spoke positively about the SPCT and their ability to deliver specialist support on the ward.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had a freedom to speak up policy which highlighted internal and external options available to staff as well as wellbeing support for staff. The Trust had a freedom to speak up guardian who acted independently and impartially to provide advice to staff at any stage of raising a concern. All staff we spoke with felt they could escalate concerns and knew about the freedom to speak up guardian.

All staff we spoke with informed us there was a positive culture in the hospital. Members of the SPCT worked collaboratively with ward staff to care for patients at the end of their lives. Most of the staff we spoke with informed us they had been working in the service for significant lengths of time and they enjoyed working there.

Patients and carers had opportunities to provide feedback on the service in ways that reflected their individual needs, including through patient satisfaction surveys and bereavement surveys. Managers and staff had access to this feedback and used it to make improvements. For example, the “uncertain recovery” communication guide was developed in response to feedback from families about communication received during the period of their family member’s care.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders acted to continually review and improve the culture of the organisation in the context of Equality, Diversity and Inclusion (EDI). The trust had a diverse range of staff which was reflective of the local population.

The SPCT had implemented training programs specifically tailored to internationally qualified staff to enable them to perform well in their role. Training in equality and diversity was provided to all staff members as part of the mandatory training syllabus.

There were policies and processes to ensure the service was inclusive and fair. These included directions to ensure all staff and patients were treated equally regardless of age, gender, ethnicity, sexuality and religious beliefs.

Staff confirmed they had access to flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

The trust used the WRES to monitor and improve the experience of black and ethnic minority staff. The SPCT had a small team compared to the wider trust, however, recent workforce race equality standard (WRES) data showed that the number of ethnic minority staff had increased from 1 to 3 staff within the last year.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a governance framework which was supported by a structured programme of meetings that provided oversight of safety, quality, and operational performance. Minutes demonstrated that meetings were well attended by senior clinicians, operational leaders and governance staff, with clear agendas covering audit results, butterfly volunteers, end of life care education, compliments, incidents and complaints. Information from these meetings, including changes in practice or additional learning was disseminated down to staff in various ways. For example, at handovers, meetings and via emails. Staff were able to tell us key information shared from these meetings. This included information about incidents, trends, complaints and compliments.

The trust EOLC steering group met quarterly and was chaired by the hospital medical director. Standing members of the steering group included the chair, lead clinician, lead nurse, EOLC ward champions, SPCT representatives, representatives from a cancer support charity, chaplaincy, corporate nursing team representatives, representatives from a local hospice, quality and clinical governance representative, acute medical consultant and butterfly volunteer lead amongst others. There were also invited members including clinical nurse specialists, bereavement staff, head of therapies, representatives from local hospices, community teams and system partners amongst others. The EOLC steering group reported into the executive management board, providing a formal route for escalation, assurance, and strategic oversight.

The steering group presented the end of life annual report to the board. The report provided a comprehensive overview of end of life care delivery and developments across the trust, including governance arrangements, quality improvement initiatives, evaluation of the butterfly service and associated volunteer support, care after death, mortuary services, and education and training.

The service had clear performance measures, which were recorded and monitored by the service and wider trust. There was a programme of internal and external audits to monitor quality, and operational processes in the department. This assisted leaders to understand and analyse performance issues and implement measures to address them. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

There were clear and effective processes for identifying, recording, managing and mitigating risks. Leaders used a risk register to manage risks. There were 6 risks on the SPCT risk register. Of these, 5 were cross site risks which pertained to two locations including Chelsea and Westminster Hospital. There were controls to mitigate the risks and the risks were regularly reviewed by senior staff.

We reviewed the risk register and could see risks highlighted to us were captured on the risk register, for example risk relating to the sustainability of specialist palliative care provision across a 7-day period. During our assessment, specialist palliative care cover was provided 6 days a week. However, 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.

The trust had an emergency preparedness, resilience and business continuity policy with multiple incident response plans for various scenarios.

There were effective arrangements for the availability, integrity and confidentiality of data, records and data management systems. Staff could access relevant information about patients’ care and treatment.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The trust worked effectively with a wide range of partners and community organisations to help meet the diverse needs of people using the service. Evidence showed effective relationships with commissioners, local trusts, hospices, GP services, charitable organisations and patient experience groups.

The trust worked collaboratively with other trusts within the North West London Acute Provider Group (NWL APG) to raise care standards in the region. The NWL APG is a formal partnership of four acute NHS across northwest London. The group served a local population of 2.2 million people across 12 hospital locations.

Staff within the SPCT have taken on leadership roles in EOLC groups across North West London and nationally, thereby contributing to the development of expertise and care locally and more widely.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

Staff and leaders within the SPCT worked in partnership with key organisations to support care provision, service development and joined-up care. Staff signposted people to cancer focused voluntary services, counselling services and the chaplaincy service to help people maintain wellbeing beyond the hospital environment. The SPCT worked collaboratively and held multidisciplinary team meetings with speciality teams such as haematology, liver and cancer to improve patient care.

The service worked with patient experience groups to obtain feedback and implement actions to improve the service. For example, the service engaged with a patient experience group to record interviews sharing patient stories about EOLC. The service informed us they planned to incorporate this into EOLC study days for staff.

The service engaged effectively with butterfly volunteers, providing training and advice to the team when required. This equipped butterfly volunteers with the skills and knowledge to provide emotional support and companionship to patients and their families.

The trust worked closely with ‘The friends of Chelsea and Westminster hospital’ a voluntary organisation and registered charity, which supported the work of the hospital for the benefit of patients, their families and staff.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The SPCT used quality improvement projects (QIP) to identify areas of improvement, implement change and measured the impact of interventions to support continuous learning and improvement. Following an observed increase in incidents related to syringe pumps across the trust, the specialist palliative care team carried out a review of all incidents. A quality improvement plan was developed which included a series of ‘pop up’ teaching sessions on the wards and a new ‘syringe driver set up’ training video was made available on the trust ‘End of Life Matters’ page. In April 2026, the syringe pump e-learning module was added to the trust e-learning hub. The module incorporated guidance on correct set‑up, troubleshooting, and staff knowledge assessment. Successful completion of the module was assessed, and a certificate was automatically issued upon passing.

The SPCT was actively involved in the education and training of staff at all levels to enable them to deliver high-quality care on the ward. This included EOLC induction for new staff, and specialist training for nursing and medical staff.

Nurse training included bi-monthly EOLC simulation study days, student nurse placements, training of EOLC ambassadors, preceptorships and syringe driver training. Medical staff training included simulation training using life cast mannequins, SPC placements, international medical graduate (IMG) EOLC training, and surgical EOLC simulation course. The service also provided a 2-week training programme for middle grade doctors and a mandatory half day simulation training program.

The service identified a gap in learning for surgical staff from the annual cardiopulmonary resuscitation audit which showed a difference between the medical and surgical wards. As a result, the service developed a bespoke simulation course in EOLC for surgical residents. The surgical residents training programme was presented at the developing excellence in medical education conference (DEMEC).

The service had also developed a bespoke EOLC training for IMGs which was presented nationally at the association for palliative medicine (APM) webinar. Feedback on the training was positive and staff said they developed new insights into EOLC.

The trust established a butterfly volunteer programme as a bespoke companionship programme to support patients and those important to them in the last hours/days of life. In 2025/2026, the butterfly service supported over 356 patients and families and made over 1480 visits spending 700 hours at the bedside of patients. The butterfly programme has been adopted across the NWL APG.

The service had developed digital systems to deliver safe and effective care. This included electronic systems for specialist palliative and end of life care developed in partnership with the NWL APG. The service had a dedicated EOLC intranet site, training videos, and an electronic specialist palliative care (SPC) dashboard. At the time of our assessment there was an ongoing digitisation of fast-track applications for continuing healthcare funding with the aim to support patient preference around place of care.

The SPCT had developed the uncertain recovery communication guide with the Royal College of Physicians (RCP) to support healthcare professionals to have honest conversations with patients and those important to them, about realistic treatment goals and uncertain recovery. This guide had also been included in recent NHSE guidance (model acute care pathway and the urgent community care: clinical decision-making framework). 

Staff within the SPCT were working with other clinical staff and academic colleagues at a university and the RCP to conduct a survey of physicians to explore attitudes to communicating uncertain recovery.

The palliative care team had been awarded team of the year at the trust staff awards event. The EOLC simulation study day was put forward for an award in the trust at the nursing away day scheduled for May 2026.

Several wards or departments received accreditation awards for end of life care in 2026. The emergency department, Edgar Horne ward, Lord Wigram ward and Rainsford Mowlem ward had received the gold standard accreditation for end of life care, while the acute assessment unit received the silver award and St Mary Abbotts ward received the bronze award.

Chelsea and Westminster Hospital was recognised by the European Society for Medical Oncology (ESMO) as an ESMO designated centre of integrated oncology and palliative care. This is an accreditation awarded to a limited number of centres demonstrating established integration between oncology and palliative care services.