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

At the last inspection, this key question was rated as good. At this assessment, the rating remained good. This meant services were responsive to people’s needs and delivered in a way that supported flexibility, choice and continuity of care.

Children, young people and their families were at the centre of decisions about care and treatment. Staff worked in partnership with families to respond to changing needs and ensure care was coordinated and person‑centred.

Leaders and staff demonstrated an understanding of the diverse needs of the local population. They used this information to identify and address inequalities and to deliver care that was joined up, flexible and responsive. Children and young people were also supported to plan for important life transitions, enabling informed decision‑making about their future care.

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 children and young 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 their needs.

Children and young people who used the service reported that their needs and preferences were considered. Clinical staff supported them in making decisions about their care and treatment, ensuring care was person‑centred and responsive to individual needs. For example, we observed a child with a learning disability (LD) and their family being directed to a purpose‑built sensory waiting room prior to their appointment, this area provided them with a calm, quiet room that met their specific needs and reduce their stress levels.

Staff discussed treatment options with children, young people and their families during pre-operative assessments. This supported informed decision making about surgical treatment and ensured patients specific needs were identified and met. Staff also provided children, young people and their families information about waiting times and the need for ongoing treatment while awaiting surgery. Individualised care and treatment plans were developed, and children were signposted to additional support, such as community children’s nursing services, where required to ensure their needs were met.

Clinical staff assessed children and young people against the service’s suitability criteria to ensure care could be appropriately provided by the service. Staff completed risk assessments for each child and young person on their admission to the service, using a recognised risk assessment tool, and these were reviewed at regular intervals, including when needs changed. During our onsite visit, we observed care plans for patients on the ward that incorporated detailed risk assessments and demonstrated how these were systematically reviewed over time. We also reviewed records that included mental health risk assessments, which directly informed decisions regarding each patient’s staffing allocation. This approach was underpinned by the trust’s enhanced observation policy for the CYP service, ensuring that risk management processes were consistent, robust, and aligned with organisational standards.

The care plans for children with long term conditions, learning disabilities or autism were informed by their ‘patient passports” to ensure their specific needs were met. The service used assessment documentation and care plans to describe individual needs, reasonable adjustments. The nine care records we reviewed all had clear evidence of person-centred planning and involvement of children and young people in decision making. Staff tailored communication approaches to individual needs that was suitable for the child or young person to ensure they could contribute to their care and communicate with staff. to them.

Facilities were available for families, including access to kitchens and hot drinks. Families told us they were offered meals so they could eat with their children or were able to bring food from home if they preferred. Parents were also supported to stay overnight, the service provided temporary beds beside the child’s cot or bed for parents to sleep in enabling them to remain with their child throughout their hospital admission. The service had clearly defined guidelines and restrictions for parents and siblings visiting the children’s ward. To promote safety, siblings were permitted to visit the wards only when accompanied by their parent or guardian. Staff consistently adhered to established safety procedures for children visiting the ward.

Families of children and young people told us they had consented to treatment based on all the information provided to them by clinicians and felt fully informed. We noted that clinical staff clearly recorded consent in the children and young people’s records. Parents we spoke with stated that they had been given a copy of the consent.

The service developed environments and models of care that supported the different and evolving needs of children and young people. For example, Neptune ward had recognised that adolescent patients required a different environment to younger children and had identified an increasing trend of patients with mental health needs. The redevelopment of the ward was co‑designed with young people and incorporated features tailored to this group. This included breakout areas and day rooms designed for adolescents which supported family visiting, individual rooms to improve privacy and dignity and support neuro‑diverse patients or those needing quieter environments, and age‑appropriate artwork reflecting a more mature design.

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

Staff ensured children and young people with mental health needs, learning disabilities or long-term conditions received care that met their needs. Managers and staff told us that all patients’ needs were assessed as part of initial assessments, which we saw reflected in the records reviewed.

Staff used transition plans to support young people moving to adult services. Transition planning was tailored to individual needs and took place over several years where required. This was supported by the service’s transition into adulthood policy. The standard operating procedures for transition services we reviewed was in date and reflected national transition guidelines.

Staff understood and applied policies relating to information and communication needs for children and young people with disabilities or sensory loss. The service had policies on equality, diversity and inclusion, interpreting and translation, and the accessible information standard to support staff ensure individual needs were met. Staff knew how to access these policies and arrange support.

WLCH worked hard to design and deliver care that met the diverse needs of its patient population. An innovative example was the Providing Assessment and Treatment for Children at Home (PATCH) service, a Hospital at Home model that enabled children and young people who would previously have required admission or a prolonged hospital stay to receive specialist assessment, treatment and monitoring in their own homes. The service was delivered through a nurse‑led, consultant‑supported model across North West London. The PATCH service improved patient flow, reduced avoidable admissions, prevented re‑attendances and supported earlier discharge, reducing unnecessary bed days while maintaining clinical safety. The service enabled patients and families to receive care in a familiar environment and reduced disruption to family life, resulting in socioeconomic benefits such as allowing parents/carers to continue working, enabling siblings to attend school and reducing travel and food costs associated with hospital admission.

Families consistently reported excellent experiences of care, describing the service as “incredible” and a “game changer”. Feedback highlighted the benefits of receiving hospital‑level care at home, reduced disruption to family life, and reduced pressure on acute hospital beds. Families also reported that receiving care in a non‑acute setting was particularly beneficial for those who struggled in a hospital environment.

Interpreting and translation services were available when required. Information leaflets were available in languages spoken by the local community and were accessible within CYP areas. Staff also had access to communication aids, including hearing loops and sign language support, to help children and families become partners in care.

Children and young people who required palliative care input were referred to palliative care service partner for assessment and care provision. This meant their care and treatment were safely transferred to an appropriate team of specialists to be dealt with.

Children and young person with neurological difference such as autism or attention deficit hyperactivity disorder (ADHD) received appropriate and responsive support, care and treatment. The service had a range of neurodiversity‑specific toys and equipment available to meet the sensory and developmental needs of neurodivergent patients.

All CYP staff had completed the mandatory training, this ensured that, they had the knowledge and skills required to provide safe, informed and inclusive care to children and young people.

The service provided accurate, up‑to‑date information in formats tailored to individual needs. Information was available in different formats, and translation services were used to support effective communication.

Where required, communication plans were agreed to support children and young people who needed additional help to understand information. Children, young people and their families told us staff explained care and treatment clearly and answered their questions.

The service had effective systems and processes to make sure patient information was handled in a way that supported timely and responsive care, while still meeting all confidentiality, data‑protection and information‑governance requirements. These systems meant that staff accessed, recorded and shared information appropriately, using secure methods that always protected patient privacy. They also ensured that important clinical information was available when needed, helping staff make safe decisions and maintain continuity of care across the service.

Staff followed information governance principles and policies to maintain confidentiality. We observed staff communicating discreetly in public areas. Patient records were electronic, up to date, with a focus on patient outcomes. Authorised staff were able to access records promptly when patients moved between teams, supporting continuity of care. The service electronic records were accessible by authorised personnel through password access.

Information leaflets were available in different languages for people whose first language was not English. CYP staff gave families information leaflets to help them after discharge. We were told translation service was available for people using CYP services.

The CYP 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.

The service had established processes for children, young people, families and carers to provide feedback. Feedback was reviewed routinely, to identify trends, concerns, to improve services and recognise good practice.

WLCH recognised that traditional feedback tools were not designed around the needs of children and young people and therefore undertook a co‑design programme to the Friends and Family Test (FFT). The trust collaborated with children and young people across both inpatient and outpatient services, youth settings, parents and carers and other stakeholders, Feedback was used to inform the development of age‑specific surveys that used child‑friendly language, visual response formats, creative drawing options and improved digital access. This helped ensure children’s voices were heard in ways that were meaningful, accessible and developmentally appropriate. The engagement activities also contributed to co‑designing research projects, recruitment campaigns and materials, testing visual response (VR) tools and shaping the play strategy. This work demonstrated that WLCH listened and learned from routine feedback mechanisms and actively sought to engage patients and families to drive improvements.

Concerns were responded to in an open and transparent manner. Action was taken on feedback, for example, the burns unit had increased access to psychological support, with five psychologists available to provide specialist input for children and young people following a burn injury. This support was also extended to the families and relatives of patients to ensure their emotional and psychological needs were met.

Families were encouraged to raise concerns through staff on the wards or to Patient Advice and Liaison Service (PALS). PALS supported families to navigate the complaints process. Staff responded promptly to issues and involved families in discussions about improvements. There were examples of service co-design with children, young people and their family’s input, for example parental involvement in the refurbishment of the Neptune ward and the redesign of the Saturn ward were cited as examples of patients or family involvement within the CYP service.

Leaders told us that families received timely responses to complaints, with clear explanations of actions taken, this was demonstrated by the complaint response we had seen. The Friends and Family Test was available, allowing families and, where appropriate, children and young people to share their experiences. Feedback was used to identify trends, improve services and recognise good practice.

The service took part in wider patient‑experience initiatives in partnership with other local trusts. These included peer reviews, engagement events and the use of the “15 Steps Methodology” to capture the lived experience of children and young people and inform service improvement. These initiatives had a positive impact by strengthening the service’s understanding of what mattered most to children, young people and families, and by directly shaping changes that improved the quality, accessibility and overall experience of care.

The service ensured children and young people could access care, support and treatment when it was needed.

Care was delivered in line with evidence‑based practice and recognised quality standards. During the inspection, we found that clinical practice reflected national guidance and established good‑practice principles. Service leaders monitored the effectiveness of care and treatment through ongoing local and national audit activity. Regular reviews of performance and outcome data were undertaken to ensure the service continued to meet the needs of children and young people. This included benchmarking and peer‑review processes with other NHS hospital trusts, with which the service compared favourably.

Reasonable adjustments were made for children and families with disabilities. For example, we observed the availability of sensory rooms and a ligature‑light room for patients who required these facilities. The premises we visited operated a controlled‑entry system, which provided an additional level of security for patients, families and staff.

Leaders and staff understood how discrimination and inequality could affect access to care. They were knowledgeable about the needs of the local population and worked to ensure equitable access for all children and young people. This approach had a positive impact by reducing barriers to care, improving inclusion, and ensuring that children and young people from diverse backgrounds received timely, appropriate and responsive support.

Staff and leaders actively listened to information about children and young people who were most likely to experience inequality in experience or outcomes, and they tailored care, support, and treatment in response to this. There was an effective multidisciplinary team (MDT) working environment within children and young people’s services and with external partners to support children’s health and wellbeing. This approach ensured that children and young people received care that was responsive to individual risk factors and reduced the likelihood of unequal outcomes.

Children, young people, and their families were able to give their views on their experience and outcomes of care and treatment. Staff took these views into account when seeking to provide the best possible outcomes for all patients. Where discrimination or inequality was identified, staff addressed this to improve care and eradicate poor outcomes. The service had protocols and policies in place to comply with legal equality and human rights legislation. This meant that feedback directly informed service improvement and strengthened the organisation’s compliance with statutory equality duties.

Staff demonstrated a good understanding of the diversity within the local community. They worked closely with external agencies to provide a service that met the diverse needs of children and young people and promoted equity in experience and outcomes. This collaborative approach ensured that children and young people from all backgrounds had equitable access to appropriate care and support.

The CYP service had undertaken equality impact assessments on all policies and procedures to ensure they did not place vulnerable people or those with protected characteristics at a disadvantage. This systematic review process reduced the risk of organisational policies contributing to inequality or discriminatory practice.

Staff reported having a good working relationship with Allied Health Professionals (AHPs), particularly speech and language therapy (SALT). They told us that SALT input enabled prompt discharges and prevented bed blocking, meaning that patients with swallowing difficulties did not experience delayed discharge.

Staff understood and could give examples of groups most likely to experience inequality in experience or outcomes within their community. Staff were trained in equality, diversity, inclusion, and human rights, with CYP staffing at 98% compliance. This high level of competence and interprofessional collaboration ensured timely, safe discharge planning and reduced the risk of avoidable delays for vulnerable patients.

The flow within children and young people’s services from admission through theatres, wards, and discharge was mostly managed effectively, and children and young people were transferred from the theatre recovery area to the ward without unnecessary delays. This initiative made the environment more child‑friendly and welcoming for young people.

The service provided a wide variety of child‑friendly food and snacks, including menus that reflected specific cultural and religious needs. Effective patient flow and culturally responsive provision improved the overall experience of children and young people, and reduced anxiety associated with hospital stays.

A collaborative programme of work across North Thames had resulted in an agreement that Chelsea and Westminster Hospital (CW) would provide torsion assessment and treatment for children under five from the west of the North Central London Integrated Care Board (ICB). The pathway was implemented as planned and operated safely, with no reported incidents. Staff understood the pathway and their responsibilities, supported by targeted communication and education. This ensured children received timely access to specialist assessment and treatment.

The collaborative approach reduced disputes between teams and sites by establishing shared expectations and clearly defined roles. The pathway operated within a financially sustainable model, ensuring resources were used efficiently while maintaining high‑quality care. System partners reported that the arrangement strengthened coordination across organisations, reduced operational friction and supported consistent, safe care for young children requiring torsion assessment. The clarity in responsibilities improved professional relationships across the CYP services, and the cost‑effective model supported long‑term sustainability. Overall, the pathway contributed to a more reliable, equitable and well‑organised service for children under five who required torsion assessment and treatment.

Children, young people and their families were supported to plan for important life changes, including preparation for discharge, so they had sufficient time to make informed decisions about their future care. Children, young people and families told us that staff provided clear information to help them plan for the period following discharge. The service worked collaboratively with other health and social care professionals, including GPs, community teams and social services, to support effective future‑care planning. Multidisciplinary working, involving nursing, medical and pharmacy staff, contributed to safe and well‑coordinated discharge processes.

Staff used transition plans to support young people moving to adult services. Transition planning was tailored to individual needs and took place over several years where required. This was supported by the service’s transition into adulthood policy. The standard operating procedures for transition services we reviewed was in date and reflected national transition guidelines.

Pre‑assessment staff arranged appointments in line with individual needs, such as pain management or psychological assessment, and documented discussions and agreed actions. This included offering early appointments to minimise time away from school. Children and families were kept informed about future appointments through regular communication and correspondence from the hospital.

Where children required ongoing support after discharge, such as district nursing or community nursing input, this was clearly recorded in the discharge summary. A discharge‑planning document was completed as part of the admission process, outlining post‑care needs, required services and the discharge address. This structured approach ensured that children and young people experienced a safe, timely and appropriate discharge.

This coordinated planning had a positive impact by improving continuity of care, reducing delays, and ensuring that children, young people and their families felt prepared, supported and confident about the next stage of their care.