Chelsea and Westminster Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service provided care and treatment based on national guidance and evidence of effectiveness. National Institute for Health and Care Excellence (NICE) guidance was routinely discussed and reviewed at clinical governance and team meetings. Leaders told us NICE guidance was followed during pre‑assessment and throughout the care pathway. Staff used up‑to‑date policies to plan and deliver high‑quality care in line with best practice. The trust had a policy in place for implementing NICE guidance and quality standards.

Children, young people and their families were actively involved in pre‑operative assessments. Staff communicated clearly about risks, treatment options and expected outcomes. Assessment processes supported staff to identify and respond to individual health, wellbeing and communication needs. Families were encouraged and supported to be involved in their child’s care.

Leaders supported joined‑up team working. The service used clinical outcomes, audit findings and performance data to identify areas for improvement and develop action plans.

We have not awarded this service a score for Effective.

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

The service made sure children and young people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff told us that children and young people received an initial consultation to identify their care needs, preferences and care pathway. Children and young people undergoing surgery were also provided with information about their procedure as part of this process.

Children and young people were assessed on the day of surgery to confirm their suitability for the procedure, gain informed consent and review individual needs. This was in addition to the pre assessment completed before admission. Staff completed comprehensive health assessments in a timely way, in line with the service’s admissions policies.

Children booked for surgery received an illustrated poem before arrival, helping them understand their journey in a simple, reassuring format. Families reported that this improved preparedness and reduced fear and anxiety. These initiatives collectively enhanced emotional safety, reduced anxiety and improved the overall experience for children, young people and families accessing care.

The 9 care records we reviewed were completed appropriately, included details of initial consultations and preoperative assessments. Records contained relevant information such as contact details, clinical history, risk factors and identified needs. The care plans we saw were up to date, with clear goals and objectives, and included assessments of nutrition, hydration and pain management. Audits of patient’s records completed in the 12 months prior to the inspection, showed compliance rates between 95% and 98%.

The service planned and delivered children and young people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation, national guidance and current evidence-based good practice and standards.

Care and treatment were provided in line with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance was routinely discussed and reviewed at clinical governance and team meetings. The lead paediatric consultant told us that NICE guidance was followed during pre-assessment, and staff used up to date policies to plan and deliver high quality care. The trust had a policy in place for implementing NICE guidance and quality standards, this ensured care was delivered in line with the most recent guidance.

We reviewed a sample of the service’s policies and guidelines and found they reflected national guidance, were in date and had clear review dates. The CYP service had access to the full range of specialist input required to meet patient needs. We reviewed nine patient records and found evidence of multidisciplinary input, including from allied health professionals such as speech and language therapy (SALT).

Care plan documentation for CYP pathways were clear and well structured. Care plans included guidance for use and links to relevant supporting policies. All care records contained relevant risk assessments, including mobility and airway assessments, which were reviewed throughout the care pathway from recovery to post discharge follow up.

The CYP team contributed to national clinical audits as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). These included the national paediatric diabetes audit and national emergency laparotomy audit. Audit outcomes and trends were analysed and shared with staff to reinforce good practice. The audit showed the trust was performing within the national expected range.

The service worked well across teams and services to support children and young people. Staff shared information effectively so that children, young people and families did not need to repeat their story when moving between services.

Staff held regular multidisciplinary meetings and told us there were positive working relationships across teams. We observed good communication and collaboration between staff from different professions and grades who were involved in the care and treatment of children and young people.

Information was shared during shift handovers, safety huddles and bed meetings. Staff also used daily huddles to identify risks, review patients requiring close monitoring and discuss safeguarding concerns. We observed a safety huddle and handover meetings, which were well attended and supported shared decision‑making.

The CYP service had weekly multidisciplinary team (MDT) meetings to discuss complex pre‑operative patients and reduce the risk of cancellations We were told these meetings had reduced cancellation of surgeries.

Children and young people were supported by a dedicated play specialist who worked alongside clinical staff. They used structured distraction therapy to reduce anxiety, encourage cooperation and improve each child’s overall experience of care.

Children and young people who spent extended periods in hospital had access to suitable education provision. The service had access to a dedicated hospital school room and ensured bedside teaching was also available for those unable to attend the hospital school room. Clinical staff worked closely with hospital teachers and external education providers to help children remain up to date with their learning. Where required, children were supported to sit and write their formal examinations during their hospital admission. This approach helped maintain educational progress and reduced the long‑term impact of prolonged hospital stays.

The care of young people transitioning to adult services was assessed and delivered in line with relevant NICE guidance and standards. There was evidence of systems in place to support young people from the age of 13 as they prepared to move to adult services. The service had clear processes to identify and support children and young people who required additional help, specialist intervention or structured planning for transition to adult services. There was joint working with the medical teams taking over the young person’s care, this facilitated a smooth transition to the adult services and managed expectation of what and how services would be delivered.

The service supported children and young people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service aimed to reduce future healthcare needs through prevention, early intervention and education. This was demonstrated through their active engagement with children, young people, and their families in community initiatives, such as the project they had at Chelsea Football Stadium where more than 250 children and their families attended. This event was to obtain views of what children wanted to see provided- how and inform service development not health promotion

The service provided information and advice on health promotion and healthy lifestyles. We saw posters displayed on the wards and relevant information available to support families. Staff assessed individual health needs on admission and provided appropriate advice and support, including dietary advice and exercises.

The service routinely monitored children and young people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of children and young people themselves.

The service monitored care and treatment through clinical audits to support continuous improvement. Staff used clinical audit and outcome monitoring to ensure care was effective and met clinical and patient expectations. The CYP service had a quarterly audit programme as part of the trust’s annual audit schedule. The service submitted data to national audit programmes, which enabled benchmarking against other organisations and identification of outliers. Positive outliers were shared as examples of good practice within the trust. The outlier report showed the service performed better than the national average hip fractures and diabetes.

To ensure children and young people received timely care and treatment and reduce waiting times, the service introduced the 18 months to 18 weeks referral to treatment (RTT) improvement programme in October 2024. This improvement programme had resulted in significant improvements in the timeliness of elective care delivered to children and young people. These improvements included the service reducing the number of 52-week waiters from April 2025 to March 2026. It had improved RTT compliance for 18 week wait from 69% at the start of the programme to over 77% receiving treatment within 18 weeks by the end of March 2026.

The CYP service was in the highest quartile nationally for total paediatric clinical output, measured in weekly average users (WAUs). The cost per WAU remained in line with both national and peer‑group medians, which was notable given the breadth of tertiary and specialist services delivered at Chelsea and Westminster Hospital. As a result of this activity, the service was in the top‑performing quartile nationally for the proportion of outpatient attendances that were first appointments. The service achieved 65.8%, compared with a peer average of 59.7% and a national average of 48.8%. Performance in the first‑to‑follow‑up ratio was similarly strong.

The service continued to convert high‑cost Waiting List Initiative (WLI) activity into lower‑cost, substantively delivered activity. This improved efficiency and supported long‑term financial sustainability because the high cost waiting list initiative was now provided by in house permanent staff.

Paediatric length of stay was an area of improvement during 2025/26. Non‑elective length of stay remained consistently below four days across West London Children’s Healthcare for most of the financial year. Paediatric wards also reported a consistently low number of long‑stay admissions, which supported effective patient flow and timely access to beds.

Emergency readmission rates remained consistently low, indicating that children and young people were discharged safely with appropriate follow‑up arrangements in place. These outcomes reflected the effectiveness of the service’s discharge planning processes.

The service was improving the timeliness for paediatric discharges by discharging patients’ home with community support. While more than 20% of children were discharged before midday on a consistent basis, work was ongoing to increase this proportion to support improved flow, reduce delays and enhance the overall discharge experience for children, young people and families.

Staff described a culture where learning from mistakes was valued and used to drive improvement. Initiatives such as the “Risky Business Newsletter” publication supported shared learning from incidents. Leaders encouraged staff to contribute ideas for improvement and staff reported that leaders actively listened to their feedback. There was a strong sense of trust between leadership and the clinical teams. This was demonstrated though the half day governance awareness sessions.

Activity delivery in children and young people services at the hospital was in line with the trust’s agreed plan. Data demonstrated that more children were treated within waiting‑time standards and that elective activity continued to progress as expected. The service achieved several key successes in delivering its elective activity plan, such as continuing to improve the proportion of outpatient attendances which are first appointments through one-stop clinics and diagnostic reporting virtually when appropriate. The service continued to increase the number of procedures performed as day‑case activity. This approach increased efficiency and improved the child and young person’s experience.

The service also continued to increase the proportion of outpatient attendances that were first appointments. This had been achieved through one‑stop clinics and virtual diagnostic reporting where appropriate. These approaches enabled children to be treated in a timely way and more efficiently, with fewer visits to hospital required.

We were told to improve access and efficiency, as there had been an increase in the percentage of follow‑up appointments, the service had implemented patient‑initiated follow‑up (PIFU). Patient Initiated Follow Up is an approach where patients and their families book their own hospital appointments only when needed, rather than attending routine appointments. This approach for those with long term conditions, allows direct access to specialists when symptoms worsen or flare up, saving time, travel, and stress. Data seen showed that the numbers of children, young people and their families accessing these appointments had increased from 3.2% to 4.5% during the financial year. This represented a positive achievement and supported a more responsive, personalised approach to follow‑up care.

The service told children, young people and their families about their rights around consent and respected these when delivering person-centred care and treatment. Staff gained consent for care and treatment in line with legislation and guidance. They understood how to support children and young people who lacked capacity or who were experiencing mental ill health. Patient records we reviewed included evidence of appropriate mental capacity assessments.

Children, young people and families were given clear verbal and written explanations of procedures, including risks and benefits. We observed staff taking time to explain treatments and ensure understanding before consent was obtained. Staff gained verbal consent for treatments and documented written consent where required. When children and young people or their families were unable to give consent, decisions were made in their best interests, taking account of wishes, culture and traditions.

Staff followed structured processes for obtaining consent and adhered to national guidance. They demonstrated an understanding of Gillick competence and Fraser guidelines and how these were applied these in practice.

Clinical staff completed training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Training data showed 99% compliance. Staff knew how to access policies and obtain advice when required, including support from the mental health liaison team. We were told these teams were responsive and supportive.

The Children and Young People (CYP) service at Chelsea and Westminster Hospital was one of the first trusts to introduce Martha’s Rule. They had set up a Martha’s Rule escalation pathway, by taking a collaborative approach with the other acute trusts in North West London, they were able to access paediatric intensive care (PICU) expertise for second opinions. This approach ensured young people and their families had access to a second opinion and the trust could implement this approach in a timely way as it required no additional funding, as they worked in collaboration with other providers and local partners.