Chelsea and Westminster Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question outstanding. At this assessment the rating remained as outstanding.

This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

We have not awarded this service a score for Caring.

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

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Patients were overwhelmingly positive about their care and treatment in all areas of the department visited. Staff treated people with kindness, compassion and dignity throughout their care. People described staff as caring, respectful and attentive, and said staff listened to them and involved them in decisions about their care. Staff communicated clearly and in a way people understood, taking time to explain investigations, treatment options and next steps.

We observed staff interact with patients with kindness and compassion. For example, we observed staff being aware of patient’s individual needs and supported continuity of care where needed.

People were kept informed in a sensitive and timely manner, including updates on test results and changes to their treatment plan. When people were discharged, they were supported to understand their diagnosis and any ongoing treatment, including when to seek further help. This supported safe and informed decision-making.

Triage was undertaken in areas where conversations could not be overheard. We observed staff undertaking triage in specific triage rooms. Staff consistently respected peoples’ privacy and dignity during physical examinations we noted they took time to draw curtains around the bed space for privacy.

Clinical areas supported confidential conversations, and private spaces were available for sensitive discussions, such as breaking bad news. Staff maintained confidentiality of people’s information and were mindful of sharing information appropriately.

We observed efficient patient flow through the ED with patients being treated in clinical areas appropriate for their care and had their privacy and dignity maintained. We did not observe any patients being treated in corridors, staff told us that corridor care was never provided and that flow through the department was actively managed to ensure this.

Staff supported people to remain as independent as possible, helping where needed while promoting autonomy and choice. People reported that staff responded promptly to their needs, particularly when they were in pain, discomfort or distress, which contributed to a positive experience of care.

The service considered people’s individual communication needs and ensured reasonable adjustments were made where required. Interpretation services were available and used to support people who did not speak or understand English. Staff demonstrated awareness that some people required additional time or support to understand information, including those with learning disabilities or cognitive impairment, and adapted their approach accordingly. There were systems in place to support diverse communication needs, including the use of accessible information and staff trained in supporting people who communicate differently.

Young people were supported to have appropriate control over their privacy and involvement of parents or carers, in line with good practice.

Staff understood and respected people’s personal, cultural, social and religious needs, and incorporated these into treatment planning and delivery where possible. Relevant information was recorded and shared appropriately to ensure continuity of person-centred care. Staff followed clear policies and processes to support people using the service and families in sensitive situations, including providing appropriate environments and trained staff when a family member died unexpectedly, with compassion and respect, taking account of cultural and religious considerations.

People presenting with mental health needs received compassionate and appropriate support. Psychosocial assessments were completed by suitably trained staff promptly to ensure peoples’ needs were fully understood. People presenting with self-harm received comprehensive biopsychosocial assessments and care planning at each attendance. This ensured care was tailored to their individual circumstances, and admission was not the default response. The service strengthened links with community services and people with lived experience to improve pathways and people’s experience, supporting more holistic and person-centred care.

Ambulance staff we spoke with were positive about the care provided. The interactions we observed between patients and staff during handover from the ambulance staff were kind and considered any patient concerns, providing reassurance.

We observed efficient patient flow through the ED with patients being treated in clinical areas appropriate for their care and had their privacy and dignity maintained. We did not observe any patients being treated in corridors, staff told us that corridor care was never provided and that flow through the department was actively managed to ensure this.

The trust participated in the NHS urgent and emergency care survey benchmark report for accident and emergency departments (2024). Results for the department were extremely positive in several areas including for care and dignity. The results showed continuous improvement. The trust received one of the highest scores for questions regarding respect and dignity and was rated “ “better than expected”.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

People’s individual needs and preferences were at the heart of the service, which delivered a fully-tailored, holistic care experience. Staff responded promptly to people’s immediate needs by identifying and managing individual risks as part of delivering compassionate care. Staff demonstrated awareness of specific risk factors such as falls and pressure ulcers and ensured these were assessed on arrival and throughout the person’s journey.

Care was planned and adapted to reflect these risks, with preventative measures embedded into routine care. This included supporting people with mobility and comfort needs. This maintained dignity and reduced the risk of avoidable harm while people were in the department and ensured peoples’ basic care needs, including comfort and safety, were consistently met.

Staff consistently identified and responded to changes in people’s conditions, ensuring care remained responsive to individual needs. Staff used regular observations and clinical judgement to recognise when peoples’ risks increased and took timely action to escalate concerns or provide additional support. People waiting in clinical areas were monitored and not overlooked, particularly when their condition or level of dependency changed. Deteriorating people received prompt attention, and their immediate needs, including pain relief, comfort and safety, were addressed without unnecessary delay. This meant people received attentive, responsive care that met their changing needs.

There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which was accessible and promotes equality. This included people with protected equality characteristics, people who may be approaching the end of their life, and people who are in vulnerable circumstances or who had complex needs. For example, to deliver care to patients with learning disabilities, hospital passports were used, these documented specific needs such as how the individual liked to be communicated with. Patients and their families we spoke with told us they felt safe, were confident they would be listened to, and their specific needs would be met.

The trust provided services to veteran and the Royal Hospital Chelsea, a facility for veterans was based near the hospital. To prepare staff meet these individual’s needs, the department had systems in place to identify veterans presenting to ED. This included flagging on the patient record and providing additional support from dedicated veterans champions to them during their ED visit and if they were transferred to the wards. The trust had been veteran aware accredited and was rated a gold defence employer.

There was an in-date chaperone policy, posters informing patients of this service and we were told chaperones were offered for sensitive examinations and discussions. However, we did not observe any patient requesting a chaperone during our visit.

We observed that there was a trolley offering food and drink and that hot food could be ordered 24 hours a day, 7 days a week from the hospital kitchen with sandwiches available in the department’s fridge. However, we were told when the department was busy, drinks may not be offered at frequent intervals as there was no designated staff member or volunteer who took the drink’s trolley round the department.

Results of the NHS patient experience survey showed that the trust performed better than the national average for patients and their families being provided with clear explanations about their condition and treatment and felt the staff explained their condition and treatment in a way they could understand. The trust also performed better than the national average for feeling that hospital staff did all they could to help control their pain, if they were in pain.

The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff were supported to maintain their wellbeing through access to appropriate facilities and structured support systems. There were dedicated staff rest areas that were of an appropriate size and provided access to seating and facilities for breaks, which enabled staff to rest during and after demanding shifts. Staff reported they were generally able to take breaks and said these areas supported their physical wellbeing. Access to a designated wellbeing space and basic amenities helped staff manage the pressures of working in an urgent and emergency care environment.

The service provided a range of wellbeing initiatives to support staff. These included access to wellbeing teams, staff networks and support services such as counselling, emotional resilience training and debrief processes. Staff described opportunities to access psychological support, including structured debriefs following challenging incidents, and informal peer support. Initiatives to promote team cohesion and morale included team-building activities, social events and recognition schemes, which fostered a supportive working environment. Staff had access to wellbeing champions and listening services, which promoted awareness of mental and physical health and encouraged staff to seek support when needed.

Staff had access to training and development opportunities to support their wellbeing. This included training in resilience and wellbeing awareness, which helped staff recognise and manage the impact of their roles. Processes were in place to ensure staff received appraisals, supervision and ongoing professional development, which contributed to staff feeling valued and supported in their roles. The data provided demonstrated that 97% registered nurses, 100% of unregistered staff and 85% of medical staff had participated in an appraisal. For those staff who had not participated in an appraisal there were clear actions to improve and monitor compliance. Educational and mentorship programmes further supported staff development and wellbeing by promoting confidence and professional growth.

The service promoted flexible and supportive working arrangements where possible. Staff reported that their individual needs were considered and there were opportunities for flexible working arrangements, including adjustments to shifts where required. Staff described feeling supported by their managers and said leaders were approachable and responsive to requests for support. This contributed to a positive working environment where staff felt able to raise concerns and discuss their wellbeing openly.

Leaders demonstrated they understood the link between staff wellbeing and the quality of care. There was an inclusive and respectful culture within the department, and staff described feeling valued and listened to. Feedback mechanisms were in place, including staff surveys and opportunities for discussion, which allowed staff to contribute to service improvement and wellbeing initiatives. Positive feedback was given both formally and informally, and staff reported that their contributions were recognised. Regular opportunities for debrief and reflection supported continuous learning and emotional wellbeing. Staff gave examples of action taken by leaders following significant incidents.

The service monitored staff wellbeing and used feedback to inform improvements. Workforce wellbeing was reflected within organisational strategies, and there were processes in place to gather and review staff feedback. Staff were involved, where possible, in the development of wellbeing initiatives, which supported a sense of ownership and engagement. Staff interactions were positive and collaborative, and staff appeared engaged in their work and supportive of one another. This showed a culture that prioritised staff wellbeing and enabled compassionate and effective care.