Castle Hill Hospital

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• 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

This meant the effectiveness of people’s care, treatment and support always achieved good outcomes and was consistent.

At our last inspection we rated this key question as requires improvement and this rating improved to good at this assessment. This meant care was effective, evidence based and consistently delivered to a good standard.

Staff within the medical care core service (the service) assessed, monitored, and reviewed patients’ needs reliably, worked collaboratively across disciplines, and used national guidance and recognised clinical tools to support safe and effective decision making. Outcomes were routinely monitored, and patients received care and treatment that promoted recovery, independence, and a good quality of life.

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.

Staff ensured patients received effective care and treatment through assessment and regular review of their health, wellbeing, and communication needs.

Care records and personalised treatment plans were clearly documented following admission and kept up to date to reflect identified needs.

We observed ward rounds where staff reviewed results collaboratively, discussed treatment options, and involved patients in decisions about their care.

Records showed venous thromboembolism (VTE) risk assessments were consistently completed. However, compliance with VTE prophylaxis at 14 and 24 hours was variable and below the 95% target, particularly within the community, frailty and therapies care group. Data quality concerns were addressed through a revised dashboard, and a group‑wide VTE improvement programme launched in February 2025 showed early signs of improvement. As a result, the medical care core service was no longer in breach of this Regulation.

Patient needs were clearly displayed on visual boards, including indicators for falls risk, skin integrity, dementia, and nutrition, supporting safe and individualised care. Staff used recognised symbols, such as the butterfly symbol for dementia.

Staff consistently used risk assessment tools effectively, with clinical risk assessments typically completed within six hours of admission. Daily nursing handovers included discussion of risks, and care plans were adjusted as needs changed and onward referrals completed where required. Managers were able to implement enhanced observations where required to maintain patient safety.

On the frailty ward staff used the wellness questionnaire and structured decision matrix to support early identification of deterioration and appropriate escalation.

Patient records demonstrated that nutritional needs were accurately assessed and monitored using detailed food and fluid charts.

Staff recorded National Early Warning Scores (NEWS) accurately and in a timely way, supporting early recognition and escalation of deterioration. NEWS training compliance exceeded the 85% target across most staff groups, although this role‑specific training was not consistently offered to allied health professionals. However, despite the provision of training, audit findings demonstrated poor compliance with NEWS and sepsis requirements.

Care records reviewed were correctly scored and documented electronically.

Staff planned and delivered care and treatment in line with current legislation, evidence based practice, and national standards ensuring safe, effective, and person centred care.

Staff had access to up to date clinical pathways aligned with national standards and best practice guidance.

There were no outstanding National Institute for Health and Care Excellence (NICE) actions, and all policies reviewed within review dates, providing assurance that care was informed by current evidence. Staff on the infectious disease ward were involved in updating newly revised policies, including the opt out approach to Human Immunodeficiency Virus (HIV) and Hepatitis B testing in the emergency department.

Key clinical guidance, documentation, and risk assessment templates were displayed across wards to support consistent practice and act as visual prompts.

Staff used nationally recognised assessment and screening, including the National Early Warning Score (NEWS2) to identify and respond to patient deterioration, the Malnutrition Universal Screening Tool (MUST), venous thromboembolism (VTE) risk assessments, falls risk assessments, and pain assessment tools to support safe clinical decision‑making.

Care records consistently demonstrated clear documentation of assessment, evaluation and care planning and showed patients were reviewed by a consultant within 24 hours of admission and subsequently reviewed.

Staff assessed and managed pain appropriately in line with national guidance and individual need.

Care records and observations demonstrated good specialty specific practice, including advanced care flow planning in oncology and adherence cardiology protocols and pathways.

Within the cardiovascular care group, a Multidisciplinary Team (MDT) audit tool was used in the cardiac catheter laboratories to national audit collection.

Therapy staff used standardised cognitive assessments to support patient evaluation and care planning.

There was a clear escalation policy for deteriorating patients and managers could deploy enhanced one to one observation in line with risk management policies. Environmental risk assessments were completed. Staff upheld the rights of patients subject to the Mental Health Act and made appropriate referrals to the Mental Health Liaison Team when required.

The endoscopy unit had commenced the process to achieve Joint Advisory Group (JAG) accreditation from the Royal College of Physicians, with a new coordinator appointed to manage the programme and a target date of October 2026. Governance arrangements in place, reviewed standard operating procedures, and external support from an accredited trust to progress the programme.

Staff worked well across teams and services to support patients and shared information effectively when patients moved between services.

We observed strong communication and coordination between staff of all roles and grades. Patient information was shared promptly, supporting continuity of care. Staff spoke positively about the strong culture of teamwork and collaborate working.

Managers held regular multidisciplinary team meetings, promoting shared learning and collaborative decision making. Care group leaders said these were monthly, although some staff reported they occurred every two to three months.

Attendance at handovers, nurse safety huddles and ward rounds varied appropriately by speciality, ensuring relevant staff were present. Multidisciplinary input included medical staff, therapists, advanced clinical practitioners, students, radiographers (for the catheter laboratory), pharmacists, and healthcare assistants. On the frailty ward, therapists also held a weekly ward round with a rehabilitation consultant, supporting coordinated care.

We observed open and positive communication during board rounds, safety huddles, and handovers. This supported timely escalation of issues, effective risk management, and coordination of care. Staff were encouraged to use structured handover tools such as SBAR (Situation, Background, Assessment, Recommendation) to improve clarity and patient engagement.

Staff in endoscopy service under the digestive diseases care group worked on rotation across both sites, attending MDT meetings at alternative locations. Cardiology staff rotated between the cardiac monitoring unit (CMU) and ward 28, despite differing patient needs, and told us they worked effectively as one team.

Staff worked well with other trust teams, including bed management and speciality therapy services to coordinate admissions and transfers. Examples included positive collaborations between infectious diseases ward and dietitians, cardiac catheter lab staff and ICU and effective joint working with ambulance crews during emergencies.

Surgical wards caring for medical outlier patients demonstrated effective multidisciplinary working, including collaboration with physiotherapy, occupational therapy and speech and language therapy.

Within the cardiovascular care group, we observed a cardiology ward round where the consultant actively supported teaching and learning, encouraging questions and discussions. Staff on cardiology ward 28 and CMU received regular in-house training.

Staff supported patients effectively to manage their health and wellbeing promoting healthy lifestyles and providing practical advice to encourage recovery and independence.

The service promoted healthy lifestyles and provided practical advice and support to encourage recovery and independence.

Specialist nurses visited wards regularly, offering condition specific guidance and tailored support. This included education on disease management, safe medication use, and lifestyle changes to promote long term wellbeing.

Oncology patients received coordinated support across multiple services, including outpatients, emergency department, Macmillan staff, paramedics, GPs, and other hospital trusts. Physiotherapy staff focused on preventing deconditioning by promoting mobility, exercise and independence throughout patients’ hospital stays, supporting recovery and improved outcomes.

We observed a wide range of patient information materials, including leaflets, posters, and display boards. These promoted healthy living, discharge planning, and signposted patients to local and national support services and charities.

We observed patient gyms on the complex rehabilitation ward and next to the cardiology ward 26 being used as part of therapy and rehabilitation.

On the complex rehabilitation ward, there was an assessment flat where patients could be evaluated for independent living prior to discharge. Patients were supported with short home leave and staff worked with patients and families to set early goals and complete home assessments. Gyms and kitchen areas were accessible for wheelchair users.

The service routinely monitored patient care and treatment to ensure outcomes were positive, consistent and aligned with clinical standards and patient expectations, despite some variation in audit performance. Staff used audit results, incident data and patient feedback to identify areas for development and drive continuous improvement.

Staff participated in national clinical audits. Cath lab staff contributed to the Myocardial Ischaemia National Audit Project (MINAP), part of the National Cardiac Audit Programme (NCAP).

Performance data demonstrated strong compliance with national standards for investigation, treatment, and follow up of acute coronary syndromes, including timely primary percutaneous coronary intervention (PCI), coronary angiography for Non-ST-elevation myocardial infarction (NSTEMI) patients, echocardiography, and referral for cardiac rehabilitation.

The 2025 Heart Failure Audit (HFA) showed high compliance with evidence‑based medications at discharge. However, referrals to specialist heart failure nurses, cardiology follow‑up, and cardiac rehabilitation were less consistent, indicating opportunities for improvement despite robust overall discharge planning processes.

Care group leaders confirmed this had been reviewed at speciality level but had not yet at care group level. Cardiac rehabilitation was delivered by community‑based teams rather than hospital services, with the service lead linking in with the ward sister regarding any issues. Leaders described a regular multidisciplinary meeting between the heart failure team and community services.

Staff participated in national data monitoring through the UK Rehabilitation Outcomes Collaborative (UKROC) for patients with head injuries and acquired brain injuries, supporting national benchmarking and service improvement for rehabilitation outcomes.

There was effective oversight of pressure ulcer management, regular thematic reviews led by tissue viability teams. These reviews identified trends and led targeted actions, including staff training, mattress standardisation, snapshot audits, and staffing reviews. Learning was shared across teams to strengthen clinical oversight, improve practice, and reduce the incidence and severity of hospital acquired pressure ulcers.

The Commitment to Excellence (ACE) programme was introduced in March 2025 to standardise ward based quality assurance. Only a small number of medical wards had been audited, including oncology wards and the frailty ward which showed high compliance with infection prevention and control (IPC) and environmental standards. Staff spoke positively about the programme about shared learning; however, the programme was paused after six months, providing limited assurance across all wards. To maintain oversight, the trust introduced interim point prevalence audits which demonstrated high compliance with routine assurance processes, alongside monthly resuscitation equipment checks, infection prevention and hand hygiene audits.

Managers and matrons undertook regular clinical and environmental audits, with clear oversight of actions, named leads and progress monitoring.

Staff supported patients to make informed decisions and followed national guidance to gain consent. They demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), acting in patients’ best interests where capacity was lacking, and taking into account the person’s wishes, feelings, culture, and history.

Consent was clearly documented in care records. MCA assessments, DoLS applications, and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were completed accurately and reviewed in line with national guidance.

We observed positive shared decision making with patients usually providing verbal consent before examinations, treatments, or personal care. Staff communicated respectfully, including sitting at eye level, and followed correct consent procedures for cardiology interventions.

Training compliance for MCA was generally high for nursing and medical staff. However, low compliance and gaps in provision were identified for allied health professionals in some care groups, indicating the need for targeted improvement.

Compliance for Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms was generally high across staff groups. However, staff reported that documentation such as ReSPECT forms, DoLS or MCA assessments was not always available for patients transferred from other hospital sites.