Chelsea and Westminster Hospital

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• 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 our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

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 evidence showed a good standard. The service made sure 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 people’s needs.

Staff delivered care tailored to individual needs, completing holistic assessments that considered people’s physical, mental, emotional and social circumstances. Electronic patient records reflected these needs and included reasonable adjustments, for example adapting communication methods for people with sensory impairment, cognitive impairment or language barriers, and ensuring timely access to specialist in-reach services such as frailty, mental health or dementia support.

Staff recognised protected characteristics under the Equality Act and adjusted care delivery, accordingly, including providing access to translation services, quieter environments for distressed people and involving carers for those with additional support needs. Staff recognised advance care planning and respected people’s preferences, such as documented RESPECT forms, particularly for people approaching end of life.

Staff were consistently able to adapt care in response to individual preferences and clinical presentations. For example, they prioritised comfort and dignity by ensuring timely pain relief, privacy for sensitive assessments and support for people experiencing distress, including those with mental health needs. People with complex or multiple needs were supported through coordinated care pathways, including multidisciplinary input and clear discharge planning to reflect their personal circumstances. Family members, carers and advocates were involved appropriately, particularly where people lacked capacity, ensuring decisions were made in the person’s best interests and aligned with their known wishes and preferences.

Staff actively involved and empowered people to make informed decisions about their care and treatment. They provided clear, accessible information about diagnoses, treatment options and next steps in a way people understood, using a range of communication methods where required. People were supported to express their views and preferences, and staff engaged in shared decision-making, particularly around investigations, treatment choices and discharge planning. Where people required additional support to make decisions, staff involved family members or advocates and followed the principles of the Mental Capacity Act, ensuring capacity assessments were completed and recorded appropriately.

People were encouraged to take an active role in their care and were supported to maintain independence wherever possible. Staff ensured people understood their treatment plans and discharge advice, and people reported feeling listened to and included in decisions about their care. Staff supported shared decision-making in high-pressure environments through clear communication, visual aids and consistent updates. People were informed of their rights, options and any risks, which enabled them to make informed choices.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff ensured people and those close to them were provided with clear, timely and accessible information about their care, treatment and rights. Information about what to expect during their attendance, treatment plans and next steps was made available in a range of formats, including verbal explanations, written leaflets and electronic resources. Condition-specific information leaflets were available through QR codes (Quick Response code is a digital barcode that acts like a visual hyperlink), which were displayed in the emergency department to support understanding and enable people to make informed decisions. The service took this approach to ensure information was up to date and ensured out of date printed literature was not given to people. The service was able to print information for people who could cannot access QR code.

The service demonstrated a strong focus on accessibility and inclusion in line with the Accessible Information Standard. Staff adapted the format and delivery of information to meet the needs of individual people, including providing easy-read digital leaflets and leaflets in languages commonly spoken by the local population. Translation and communication support were used where required to ensure people understood their care, treatment and rights. This supported people with different communication needs, literacy levels or sensory impairments to engage in their care.

People were provided with clear information about their rights, including how their personal data would be used and their rights under data protection legislation. The service followed established information governance policies, ensuring people received clear information about how their personal data was processed and shared, in line with UK General Data Protection Regulation (GDPR). People were informed of their rights to access, amend or restrict the use of their information and how to raise concerns, including the right to complain to external bodies such as the Information Commissioner.

Information governance systems supported the confidentiality and security of electronic patient records. Access to electronic patient record information was restricted to staff directly involved in care, and audit trails recorded who accessed records, when and where, ensuring accountability. Inspectors raised a concern during the assessment about the use of “service, service” on some electronic patient records instead of the naming staff member who completed the activity. The service provided assurance after the assessment. They confirmed it was an error on the electronic system, that some computers were populating the field with “service, service”. This was raised with the provider of the system and was in the process of being addressed. Also investigated and the individual can be identified but need to go into another screen. We there noted it was not individual staff but an issue with the electronic system on some computers in the ED.

Staff understood their responsibilities in maintaining confidentiality and followed policies to ensure personal information was only shared appropriately and securely.

The service had clear processes to enable people to access wider information, including details about treatments, local services, people’s rights and how to raise concerns or complaints. Information on how to provide feedback or make a complaint was visible and accessible in the department, and staff were able to direct people to appropriate channels such as patient advice services or formal complaints processes. This supported people to raise concerns and be heard.

Staff made appropriate notifications to external bodies where required, including in relation to data protection and people’s rights. Systems were in place to ensure requests about personal data, including subject access requests or objections to information sharing, were recorded, assessed and responded to promptly in line with policy requirements.

The evidence showed a good standard. The 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 actively listened to and involved people in shaping and improving the service. Over the previous 12 months, the emergency medicine directorate had received 54 formal complaints, the majority relating to the main emergency department, with smaller numbers across paediatric and ambulatory emergency care services. Complaints were reviewed through governance processes to identify themes, trends and areas for improvement. This ensured people’s feedback informed service delivery.

Analysis of outcomes showed most complaints were not upheld, with a smaller proportion partially upheld and a limited number fully upheld, which showed concerns were investigated thoroughly and proportionately. No clinical area showed a disproportionate or sustained outlier position for complaints when compared with service activity, although the majority were associated with the main emergency department due to its higher throughput.

The service identified clear themes from complaints, including clinical treatment delays, diagnosis delays, communication issues and access to care. These themes were triangulated with other sources of people’s feedback, including surveys and real-time feedback, to provide a comprehensive understanding of people’s experience. Where concerns were identified, the service took action to address them. For example, feedback relating to delays in time-critical medication administration resulted in a departmental quality improvement project, alongside staff education, system prompts and strengthened governance oversight which improved reliability in practice. Similarly, feedback regarding waiting times, communication and dignity informed the introduction of electronic waiting boards, improved information displays and changes to flow, such as the introduction of a ‘fit to sit’ area and expansion of same day emergency care services.

The provider’s complaints policy supported a culture of openness, transparency and learning. It set out clear processes for the timely acknowledgement, investigation and response to complaints, with most formal complaints responded to within 25 working days. People were informed of their right to escalate concerns to the Parliamentary and Health Service Ombudsman (PHSO) if they remained dissatisfied, and complaints were managed in line with national guidance and duty of candour requirements. The policy also confirmed that staff were expected to resolve concerns at the earliest opportunity, including through informal resolution at department level, and to signpost people to the patient advice and liaison service (PALS) where required.

People were supported to raise concerns and understood how to complain. Information about the complaints process was accessible, and staff encouraged people to provide feedback, including in real time through volunteers and PALS services. People who raised concerns received feedback, including written responses that explained findings, apologised where appropriate and outlined actions taken. Complainants were treated with respect and raising a concern did not adversely affect their care. Staff were also aware that complainants should be protected from discrimination or disadvantage and ensured a compassionate and supportive approach throughout the complaints process.

Senior staff demonstrated a good understanding of how to manage complaints appropriately. Staff were trained in complaints handling processes and were expected to investigate concerns thoroughly, provide clear explanations in plain language and identify learning and actions as part of the investigation process. Staff involved in complaints received feedback on investigation outcomes and were supported to reflect on learning, which was disseminated through governance meetings, handovers and team briefings. Learning from complaints was embedded into practice through structured governance arrangements, quality improvement programmes and regular reporting to divisional and organisation-level forums, ensuring improvements were sustained over time and aligned to people’s need.

The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The service met people’s needs and promoted equitable access to care without disadvantaging protected or vulnerable groups. Staff made reasonable adjustments to meet individual needs. Processes such as the “fit to sit” model ensured that people who did not require a bed but were awaiting investigations or treatment could be cared for safely in an appropriate area, supporting flow while maintaining safety, People had timely access to senior clinical review and medical support at all times. There was adequate junior medical cover day and night, and people could be reviewed promptly in an emergency. People admitted to the Emergency Observation Unit (EOU) were required to be reviewed and authorised by a senior emergency department doctor, ensuring appropriate clinical oversight regardless of the time of day. This supported equitable access to senior decision-making and reduced delays in care.

There were clear systems and process for screening patients for a range of conditions that might need immediate action, these included mental health, sepsis, and critical illness screening at triage. Any patient suspected or confirmed as being septic had care delivered based on evidenced based protocols. Staff we spoke with knew how to access and provided examples when they had used the sepsis protocols to deliver care. We saw evidence that the department audited compliance with the use of sepsis protocols which aimed to improve the diagnosis and treatment of sepsis and septic shock and improve patient outcomes.

The trust had an established learning disability service, led by a learning disability lead nurse and supported by learning disability practitioners who provided specialist advice, advocacy and support across all clinical services including to the ED. To facilitate meeting the needs of patients with learning disabilities 97% of staff had completed their learning disability e-learning, which was above the trust target. Some staff have completed face to face training but to increase the number of staff who have access to this training, recognising there is a national shortage of place and available trainers, the trust has trained internal trainers, is working to identify opportunities for those with lived experience through project search. In the interim they have commissioned an external company to provide training sessions. To mitigate the risk of staff not having the opportunity to complete this face to face training, it has taken a range of actions. These include implementation of an interim internal delivery model and prioritised training for senior clinical leaders, hospital on-call teams, safeguarding staff and mental health practitioners who provide key support and escalation functions for patients with complex needs. All staff during their induction complete learning disability training delivered by the trust LD nurse.

The Trust has also developed and implemented a learning disability dashboard which provided a live report for LD patients in hospital, those that had attended ED in the previous 24 hours and details of upcoming outpatient appointments for people with LD. This information was reviewed daily by the trust Learning Disability team and supported early intervention, implementation of reasonable adjustments and coordination of care throughout the patient journey.

ED matrons and senior clinicians were responsible for overseeing sepsis performance. This was supported by regular review of performance dashboards and escalation of themes to the Divisional Board. Weekly data demonstrated improving sepsis screening completion achieving expected thresholds. We saw evidence of appropriate clinical response to suspected sepsis. The trust had reviewed cases where sepsis screening had not been recorded. This review identified cohorts where antibiotics were administered or de‑escalation documented, indicating appropriate clinical action despite incomplete audit capture. Ongoing work is planned to achieve consistent screening compliance and to align audit measures with clinical pathways to provide full assurance.

The department provided safe care to those patients presenting in mental health crisis. There were established and embedded systems, leadership and escalation processes to ensure this group of patients received timely support and treatment. They were assessed by the psychiatric liaison service, provided by another trust, with most assessed within one hour and cared for in specifically designed rooms that were ligature light, by registered mental health nurses. We observed that any delays in identifying a suitable bed for these patients were escalated and discussed at a range of bed meetings and at the huddle.

The service used structured pathways and operational processes to support timely flow and equitable access to care. For example, the EOU provided a dedicated area for people who required further observation, investigation or social assessment, with a clear expectation that most people would be discharged within 12–24 hours. System-wide approaches such as boarding and escalation processes were designed to maintain flow during periods of high demand while prioritising safety, access to facilities and personalised care. This included access to nutrition, hydration, hygiene facilities and regular clinical reviews for all people, with reasonable adjustments where needed.

The service worked proactively with other departments and wards to minimise delays in discharge and maintain equitable access to inpatient beds. Systems were in place to prioritise medically fit people from wards for discharge, including the use of discharge lounges and daily board rounds to identify and expedite discharge. Discharge was expected to occur without delay once people were clinically ready, and escalation processes ensured delays were actively monitored and addressed through multidisciplinary and system-level actions, including engagement with community partners and social care services. Emergency department staff attended bed management meetings and flow was managed as a whole-hospital priority.

Data demonstrated that the trust regularly exceeded the national 4-hour standard of 78%, achieving compliance typically in the 79–82% range.

Data provided to us demonstrated that most patients consistently had an initial assessment within 15 minutes of arrival and there were systems and processes in place to monitor this. Action was taken if it was identified that the 15-minute initial assessment may not be met. At the time of assessment, data relating to the percentage of people waiting more than 12 hours from decision to admit until being admitted ranged from 3.40% in June 2025 to 1.10% in August 2025, with an average over the preceding 12 months of 2.40%. This was significantly lower than the England and London average of approximately 9% - 10% of all emergency admissions waiting over 12 hours after the doctor decides to admit them. Governance processes ensured delays were monitored through operational meetings and escalation systems, with actions taken to address system pressures and maintain flow.

Overall, the service had effective processes in place to ensure people could access care that met their needs in a timely way, with appropriate adjustments made to support equality of access. These systems supported flow, reduced delays and ensured care remained person-centred, even during periods of high demand.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.