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

At the last assessment, we rated this key question as good. At this assessment, it remained good. This meant people were safe and protected from avoidable harm.

The service had appropriate staffing levels, and a suitable skill mix to deliver safe, high‑quality care. This was supported by extensive specialist input from NHS clinicians.

The service worked closely with patients and partners to maintain safe systems and ensure continuity of care. Staff understood how to report incidents, felt confident to raise concerns and described an open, no‑blame culture.

The service supported people to understand and manage risks in a holistic way. Equipment and technology were well maintained, and infection risks were consistently assessed, managed and controlled. Medicines and treatments were managed safely and were aligned with people’s needs and preferences.

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 safety culture that was based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Learning was used to identify and embed good practice, for example the service educator had lunch time bite size teaching sessions on the ward to support staff, we were told staff could also suggest topics and teaching sessions to be provided by the education team.

Staff had a good understanding of how to report incidents and told us they received feedback from managers on outcomes and learning identified. The service held daily safety huddles and handovers where incidents were discussed, including discussion on the delayed diagnosis of coronary artery aneurysms in an infant. Following this incident the service developed a successful business case and appointment of a paediatrician with expertise in cardiology to the team. During the assessment, we joined daily bed meetings, which were well attended by staff of all levels, this demonstrated good teamwork by the service.

Incidents were reviewed for seriousness and themes to identify opportunities for improvement or learning when things went wrong. Most incidents reported were no‑harm incidents, they predominantly related to staffing. Between 1 September 2025 and 28 February 2026, the Children and young people (CYP) service reported 35 low‑harm incidents and three moderate‑harm incidents. The hospital provided evidence that these incidents, which related to hospital acquired moisture lesion, had been reviewed through an after‑action review (AAR) process. Learning from these reviews had been shared with staff to improve outcomes for this type of incidents.

WLCH was noted as having a matured and proactive learning culture in which safety events were viewed as opportunities to understand system risks and drive sustainable improvement. Staff were encouraged to raise concerns, and incidents were investigated using structured methodologies that focused on learning rather than individual blame. Learning from incidents was considered alongside wider safety intelligence to identify underlying risks, inform service development and improve patient outcomes. This approach reflected a culture where safety was everyone’s responsibility and where leaders actively invested in improvements arising from learning.

For example, following a delayed diagnosis of coronary artery aneurysms in an infant with Kawasaki disease, a multidisciplinary ‘After Action Review’ (AAR) was undertaken to understand contributory factors and identify opportunities to strengthen the pathway. The review highlighted the need for greater local specialist cardiology expertise and improved access to timely clinical input. Rather than focusing solely on the individual incident, the service used the findings proactively to address a broader system risk and appointed a Paediatrician with Expertise in Cardiology (PEC) at the trust. This strengthened local specialist provision, improved access to expert assessment and follow‑up, and enhanced the safety and resilience of cardiology pathways for children and young people.

The service worked proactively to identify hazards, for example, in response to recurring torsion‑related incidents with unclear pathway ownership and increasing service variation across London, WLCH worked with adult and paediatric surgical teams to redesign the pathway and eliminate avoidable serious incidents. A key development was the introduction of a dedicated paediatric surgical consultant support model across all sites, while maintaining the adult registrar as the first point of emergency response.

In parallel, a cross–North Thames agreement enabled the hospital to provide torsion assessment and treatment for children under five from the western part of North Central London, delivered safely with no reported incidents. Since implementation in March 2024, there were no further severe harm events related to the pathway, alongside improved role clarity, reduced disputes between teams, enhanced education, and a more consistent, cost‑effective model of care.

The CYP team produced a regular newsletter called “Risky Business Newsletter”, which included learning from incidents and reviews. They also shared learning from incidents, complaints, and concerns through bite‑size teaching sessions on the ward.

All staff understood their responsibility to be open and honest with patients and their families when things went wrong. Staff were able to give examples of duty of candour being applied and demonstrated a good understanding of when this duty was required. They understood that this included offering an apology and completing an investigation into the incident if appropriate.

The service worked with people and healthcare partners to establish and maintain safe systems of care, where safety was monitored and managed effectively. Staff ensured continuity of care, including when people moved between services. Children, young people and their families participated in discharge planning, and safety and continuity of care were prioritised throughout the care journey.

There were effective systems to support patient pathways. The service had effective links with community health teams and other NHS providers to support coordinated care. This was demonstrated by their involvement with the local football teams in the area in terms of the usage of their facilities for meetings.

Staff had access to support from mental health teams, safeguarding teams and occupational therapy services to meet individual patient needs. They were able to identify the designated service leads for these teams and told us they were accessible and responsive when support was required. The service worked well with other hospital departments and the other NHS trusts in the provider group, to support patient care, this had resulted in shared learning and increased consistency across the group to improve the quality of care.

The service had an education provider who oversaw children’s education to facilitate the children and young people’s education while in hospital. This was provided either as bedside learning or if children and young people were able to go to the school room. This minimised the amount of learning children and young people missed and provided them with an opportunity to continue their education, which for those in hospital for long periods of time this was essential.

There was evidence of systems in place to support young people from the age of 13 years in their transition to adult services. The transition from child to adult services was planned and managed effectively to ensure continuity and consistency of care. Staff thoroughly prepared children, young people, and their families in advance by working collaboratively to fully understand each individual’s unique needs, preferences, and aspirations. Personalised transition plans were co-produced with input from all members of the multi-disciplinary team, including social workers, health professionals, and adult service providers, ensuring a holistic and integrated approach.

The service worked with children, families and healthcare partners to understand what being safe meant to them and how best to achieve this. Staff focused on improving children’s lives while protecting their right to live safely, free from abuse, neglect, bullying, harassment, and discrimination. Safeguarding concerns were shared by the lead investigator promptly and appropriately through the safeguarding lead, with direct contact to the local authority.

Staff knew how to recognise, report, and escalate safeguarding concerns. There was a designated safeguarding lead who supported staff to raise safeguarding alerts to designated authorities and provided a consistent and coordinated approach to reporting and oversight. Staff were observed discussing safeguarding concerns during handovers, demonstrating a proactive and embedded approach to safeguarding within the service.

The trust had an up-to-date safeguarding children and young people policy, which reflected current legislation and guidance. The policy provided clear guidance on identifying potential abuse and the processes for raising concerns. The staff we spoke with knew how to access this policy.

At the time of inspection, all CYP staff had completed the appropriate level of safeguarding training. Managers and safeguarding leads required to complete level 4 safeguarding training were fully compliant. Staff received targeted communications reminding them of the need to complete their mandatory safeguarding training and were encouraged to complete this in a timely way.

Access to CYP ward areas was secure via a door‑buzzer system. Entry was granted by staff following a brief interaction, and staff used electronic passes to gain access. This approach prevents unauthorised access to the ward areas.

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

To ensure children and young people received surgical care in an environment that could meet their specific needs, there were clear, well‑defined inclusion criteria for which children and young people would be admitted to the service and for those who would be referred to another hospital within the West London Children’s Healthcare consortium, who provided the specific surgery they required. This approach ensured children and young people accessed the service that met their specific needs and care was delivered by staff who specialised in the surgery they required.

The sample of patient risk assessments we reviewed, which had been completed in line with the hospital’s CYP admission criteria, demonstrated the majority of children and young people met the admission criteria. We noted that one young person had been admitted but did not meet the admission criteria, but staff had reviewed the young person and made a clinical decision that as the young person had complex needs, a life limiting condition, was known to the service and had not yet transitioned to adult services, the best place for the individual to receive care was in the children and young people’s service. This rationale was clearly documented and took into account the service’s ability to deliver safe and effective care that met the individual’s need in the most suitable care environment.

Staff completed risk assessments during the child or young person’s pre-operative assessment, on admission and reviewed these regularly throughout the child’s admission. The pre-operative assessment team that included surgeons and nurses met weekly with the anaesthetist to discuss all children and young people scheduled for surgery the following week to ensure they were suitable for surgery and to identify if there were any specific post operative requirements such as the need for a high dependency bed. As the hospital did not provide paediatric critical care, if this service was required post operatively the child or young person would be referred to another hospital in the acute provider group who could provide this level of support post operatively.

The service had systems and process in place to recognising and escalate deteriorating patients. Staff used the National Paediatric Early Warning System (NPEWS) to identify children and young people at risk of deterioration and escalated concerns appropriately. There was a clear policy to guide staff on managing deteriorating patients. All clinical staff including paediatric nurse practitioners were trained in intermediate life support. This training facilitated meeting the needs of children and young person’s needs in an emergency, as timely appropriate action was taken. Practice educators also provided bite size lunch time learning session for staff on incident reporting, escalation of deteriorating patients, ward based audits, etc. This ensured staff were appropriately trained to identify and take action if a child or young person deteriorated.

Paediatric theatre staff said they attended the daily theatre huddle to discuss the patient lists, ongoing investigations and any recently reported incidents. Each operating theatre team also completed a team brief before starting the operating list to clarify roles and responsibilities and any specific patient needs. All surgical procedures had a World Health Organisation (WHO) surgical safety checklist completed. The WHO Surgical Safety Checklist is a simple, standardized tool developed by the World Health Organization to reduce surgical complications, lower mortality rates, and improve communication among operating room teams. Audit data of WHO checklists showed 100% compliance in the six months prior to inspection.

The service identified and controlled potential risks in the care environment. Equipment, facilities and technology supported the delivery of safe care. The environment was children and young people user friendly and was designed in line with national guidance.

The service had created a child‑centred environment, with staff designing clinical areas around the needs and preferences of children and young people. Spaces incorporated thoughtful features such as age‑appropriate artwork, calming colours and well‑positioned baby cubicles, all shaped through direct engagement with children.

The physical environment across children’s theatres, recovery areas, and met the needs of the children and young people who used the service. The design of the environment followed national guidance with safety consideration. For example, the children theatres we visited met HBN 00/09 standards, meaning the facilities were designed and maintained in accordance with best practice for surgical environments. Saturn theatres redesign had established a dedicated children’s operating theatres, with all elements from artwork to lighting developed collaboratively with children and young people to create a safe and reassuring surgical environment.

We observed that specialist sensory rooms and adapted pre‑operative areas, supported children with autism, learning disabilities and sensory needs. These spaces helped reduce anxiety and enabled smoother preparation of children and young people for clinical procedures.

The Neptune ward refurbishment had created dedicated adolescent and mental health spaces, co‑designed with young people and recognised through several external award nominations. This strengthened privacy, dignity and emotional wellbeing for children and young people. The mental health space was separated by doors that could be closed providing a ligature light area that promoted safety for the young person using the room.

Environmental risk assessments were completed for all CYP areas and wards. When risks, such as falls or moisture lesion were identified, mitigating actions were implemented. Ward access was secure and controlled via a door‑buzzer system, with entry provided by staff following an initial assessment to ensure unauthorised people did not gain access to the wards or paediatric environment.

There were appropriate infection control measures in place and staff followed infection control protocols. All clinical areas we visited were visibly clean and well-maintained. For example, the flooring, including skirtings and edgings were compliant with Health Building Notes (HBN) 00/10, which enabled effective cleaning.

Waste management systems in place. These included effective management of clinical waste, such as sharps, being appropriately segregated, and disposed of in line with the trust’s sharps policy.

Staff told us they had enough suitable and appropriate equipment and storage to help safely care for children and young people. Staff knew where to locate equipment and had received appropriate training in the use of equipment used in children’s wards and theatres. Staff reported faulty equipment through the medical devices team and told us replacement equipment was provided promptly when required.

Call bells were in place at patients’ bed side and in all cubicles to ensure children, young people and their families could call for assistance when required. We noted that staff answered call bell swiftly when the bell rung during our visits to the wards and other clinical areas.

Resuscitation equipment was readily available and accessible. Systems were in place to ensure equipment was fully stocked, regularly checked and ready for use. The resuscitation equipment checklists we reviewed had all been consistently completed, signed and dated ensuring this equipment was ready for use. The service had a resuscitation officer and paediatric advanced nurse practitioner who provided support, training and guidance to staff.

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 children and young people’s individual needs.

The March 2026 workforce report showed children and young person’s services employed approximately 365 over and above the funded establishment was 320 whole time equivalent (WTE).

The service had not used any agency staff since October 2025 and minimal bank staff, in March 2026, 35 WTE bank staff had been used to cover registered nurse shifts to maintain planned staffing levels. The workforce report demonstrated that the workforce was over establishment and no vacancy rates and sickness absence rates were less than 1%. The service used the workforce report to analyse capacity and demand.

Clinical staff received support, supervision and development through monthly one‑to‑one meetings and daily and weekly reflective practice. Providing staff opportunities to reflect on their practice, identify learning opportunities and deliver high standards of care.

Children, young people and families told us there were enough staff on the wards. They said staff communicated well, were professional and friendly, and responded promptly to their needs. This ensured care and treatment were provided by a sufficient number of skilled staff.

Staff told us workloads were manageable and that they received good support from managers. They were positive about learning and development opportunities and told us managers supported them to develop professionally and progress in their careers, for example a band 6 nurse was supported to complete a course to become a practice development nurse. While other nurses had been supported to develop into leadership roles. The practice education team also supported staff development by delivering bite size training sessions, supporting new staff and responding to training requests. This demonstrated service commitment of skilled workforce for the provision of safe care and treatment.

Staff completed mandatory training through eLearning programmes relevant to their role. Training targets for mandatory training including infection prevention and control, information governance, manual handling, intermediate life support and consent were met. Data demonstrated that 98% of CYP staff had completed their mandatory training, this was above the trust’s target of 90%.

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 clinical areas we visited were visibly clean. Families and young people we spoke with told us they were satisfied with cleanliness and had no concerns about IPC. The patient survey data from November 2024 to November 2025 showed consistently high satisfaction with cleanliness, with 99% of responses rated as excellent or very good.

Staff we spoke with understood their IPC responsibilities and were knowledgeable about the trust’s IPC guidance and how to access support. They had access to training, shared learning and policies relating to IPC, including aseptic non touch technique, hand hygiene and waste management. These policies are in date and in line with national guidance. They stated they could access the IPC team easily when required and the IPC team provided them with guidance, training and support as needed.

We observed staff followed hand hygiene and PPE protocols. Children and young people with infections were cared for in side rooms, with appropriate signage and protective measures in place. This reduced the risk of cross contamination. Overall compliance of IPC mandatory training was 98%, exceeding the service target of 95%. This knowledge and training facilitated the prevention and control of infections through effective practice.

The service demonstrated effective processes for monitoring infection prevention and control (IPC). These included annual audits, monthly local audits and quarterly corporate audits. Audit data showed compliance with IPC standards. Recent environmental audits scores ranged from 95% to 98%, and hand hygiene audits demonstrated 100% compliance across theatres, HDU and inpatient areas. Annual audit results exceeded the service target of 95%. We observed staff washed their hands in between patients and wore gloves when necessary. Alcohol gel was available at all entrances to the department and in the department. We observed staff and visitors using this on entering the department.

CYP clinical staff told us between January 2024 and December 2025, there were two hospital acquired clostridium difficile (C. diff) infections. The service had investigated these and implemented actions to prevent recurrence. Since then, there had been no outbreaks of C. Diff in the same period.

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

Children and young people were supported to receive their medicines in a way that met their individual needs. Staff provided counselling and training to children, young people and their families on medicines management, including support to manage long term conditions where long term medication use is required.

There were clear systems and processes for the management of medicines, including reporting medicine related incidents. Staff we spoke with knew how to access relevant medicines policies, procedures and guidance. The review of medicines policies seen, were in date and followed national guidance.

Medicines were stored safely in line with national guidance. Medicine storage room temperatures were monitored by nurses on the wards to ensure medicines were stored at the correct temperatures to maintain its effectiveness. Controlled drugs were stored securely with access restricted to authorised staff. Stock checks were completed and recorded twice daily by two staff members. A review of these checks showed that they were consistently completed.

Emergency medicines followed Resuscitation Council (UK) guidance and were stored in tamper evident containers. Daily checks ensured medicines and equipment were readily available and safe for use.

A dedicated CYP pharmacist supported prescribing, medicines optimisation and audit activity. Pharmacy staff completed medicines reconciliation on admission and ensured accurate medicine histories were recorded in the patient’s records. Discrepancies with medicines optimisation were quickly resolved. We noted medicines reviews and recommendations were clearly documented in patient’s records.

Patient weights and allergy status were consistently recorded to support safe prescribing. Medicines for discharge were planned in advance, checked by pharmacy staff for accuracy and ready prior to discharge to minimise delayed discharges.

TThe WLCH Nursing Quality Assurance Committee meeting, worked to optimise safe medicine administration practice by designing posters for display on Workstations on Wheels (WOW) computers. These posters reminded staff to co‑sign drugs requiring two checks.