• Hospital
  • NHS hospital

King's College Hospital

Overall: Requires improvement read more about inspection ratings

Denmark Hill, London, SE5 9RS (020) 3299 9000

Provided and run by:
King's College Hospital NHS Foundation Trust

All Inspections

26 &27 October 2022

During a routine inspection

King's College Hospital NHS Foundation Trust

King’s College Hospital (KCH) is part of King's College Hospital NHS Foundation Trust. The trust provides local services primarily for over a million people living in the London boroughs of Lambeth, Southwark, Bromley, Bexley and Lewisham.

The trust is one of four major trauma centres, covering south east London and Kent. King’s College Hospital is also a heart attack centre and the regional hyper acute stroke centre. The Hospital offers a range of services, including: a 24-hour emergency department, medicine, surgery, paediatrics, maternity and outpatient clinics. Specialist services are available to patients, which provide nationally and internationally recognised work in liver disease and transplantation, neurosciences, haemato-oncology and fetal medicine.

Medical Care (including older people's care)

The medical care service at Kings College Hospital provides care and treatment for general medical services and specialist services including renal, liver, haematology, cardiology and stroke services, as well as care of the elderly services. They provide these services across 20 medical wards.

Services for Children and Young People

King’s College Hospital NHS Foundation Trust (Denmark Hill) provides a host of secondary and tertiary services for neonates, children and young people. The neonatal intensive care unit (NICU) provides level 3 surgical and medical care for babies born from 22 weeks gestation who often have complex conditions.

Referrals are received both locally and nationally and it is the regional centre for neonatal surgery. In addition to the neonatal intensive care unit, the trust also hosts an eight-bed paediatric intensive care unit (PICU) which is equipped and staffed to provide level 3 intensive care support and is supported by an eight-bed paediatric high dependency unit (HDU).

In addition, there is a children’s general medical ward, a children’s surgical ward, a ward specialising in treating children with liver conditions and a children’s day treatment centre.

Children’s care provided in the emergency department was not reported on during this inspection as this is covered during an inspection of the urgent and emergency service.

01, 02, 11 August 2022

During an inspection looking at part of the service

King’s College Hospital (KCH) is part of King's College Hospital NHS Foundation Trust. The trust provides local services primarily for approximately 1,008,700 people living in the London boroughs of Lambeth, Southwark, Bromley, Bexley and Lewisham.

KCH maternity service is a tertiary unit taking referrals for fetal medicine, women with abnormally invasive placenta, hypertension, liver disease, renal disease and other co-morbidities. The service provides midwifery and consultant led maternity care for women. From August 2021 to July 2022, there were 4,191 births in the maternity service.

The service offers women a choice of three different places of birth; the midwife led unit, the consultant led unit or home birth.

King's College Hospital NHS Foundation Trust employs around 11,723 whole time equivalent staff. The trust is a teaching centre for both medical and midwifery students.

We carried out an unannounced inspection of the KCH 01, 02 & 11 August 2022.

During the inspection our team visited the labour ward; postnatal wards; antenatal ward; birth centre; triage unit; transitional care; maternity day assessment unit; neonatal unit, and community midwife services. We also visited maternity theatres to observe an elective caesarean section with the woman’s verbal consent.

We spoke with 45 members of the maternity team including: maternity assistants; junior doctors; registrars; consultant obstetricians and anaesthetists, and student midwives. We also spoke with band six and seven midwives, specialist midwives, consultant midwives, safeguarding and perinatal mental leads for maternity, matrons and triumvirate. We reviewed five full sets of women maternity records and prescription charts. We received feedback from three women who had used the maternity service. We reviewed a range of policies, procedures and other documents relating to the running of the service. We observed various handovers and multidisciplinary team (MDT) safety huddle meetings.

We last inspected this service in 2019 and rated it as good overall. We rated safe as requires improvement and rated effective, caring, responsive and well-led as good.

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we issued a trust wide letter of intent. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. We found that the service had deteriorated since the last inspection in 2019. The trust took immediate action to address the concerns and we received information to demonstrate this.

2 to 3 March 2022

During an inspection looking at part of the service

We carried out this unannounced focused inspection as part of a pilot project following a direct monitoring call. We had not previously inspected the provider’s acute or community dental services. In accordance with our current oral health team’s revised methodology, we inspected against the safe, effective and well led domains.

We inspected the acute dental services based at the main hospital site at Denmark Hill. We also inspected community-based services at two of the providers satellite locations at the Akerman Road Health Centre and the Waldron Health Centre.

How we carried out the inspection

During the inspection, we spoke with staff at each location, dentists and dental nurses, both trainees and trainers, as well as members of the senior leadership team. In all over 25 members of staff. We also reviewed 13 sets of patient records.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

26 July 2021

During an inspection looking at part of the service

The Emergency Department (ED) at King’s College Hospital is a Major Emergency Centre for the south east. It is a major trauma centre, hyper acute stroke unit, cardiac arrhythmia and cardiac arrest centre. It also fulfils its obligations as a type 1 emergency department for the local population.

The ED is open 24 hours a day, seven days a week and sees patients with serious and life-threatening emergencies. There is a separate paediatric emergency department dealing with all attendances under the age of 18 years. Patients present to the department either by walking into the ED reception area or arrive by ambulance via a dedicated ambulance-only entrance.

It is a busy department with almost 122,000 patients attending in the last 12 months.

We carried out this focused inspection of the Emergency Department (ED) on 26 July 2021, to follow up on concerns and enforcement action we took after our previous inspection. We also followed the ‘Resilience 5 Plus’ process. The ‘Resilience 5 Plus’ process is used to support focused inspections of urgent and emergency care services which may be under pressure due to demands or concerns in relation to patient flow and COVID-19.

Our inspection had a short announcement (around 30 minutes) to enable staff to arrange to meet with us and for us to carry out our work safely and effectively.

At our last inspection in November 2019, we rated the ED as requires improvement overall.

Focused inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of regulation and issued a requirement notice, or taken action under our enforcement powers. In these cases, the ratings will be limited to requires improvement or inadequate. The focused inspection included a review of a previously issued requirement or warning notice that had resulted in the application of a ratings limiter.

We did not rate this service at this inspection. The previous rating of requires improvement remains. We found:

  • The design and use of some parts of the department/premises did not always keep patients and staff safe despite the efforts the department had made during the pandemic. We were concerned with crowding of the patient waiting area in the ED walk-in reception.
  • Several areas of the ED, including resus and majors were untidy and cluttered with opened boxes of equipment and other items left haphazardly.
  • Two internal door handles inside the mental health assessment room in the paediatric ED were potential ligature points.
  • There was no clear signage to indicate which cubicles may have a patient with confirmed or suspected COVID-19 inside.
  • Hand hygiene by medical staff sometimes fell below the required standard.
  • The ambulance triage station was unmanned for 15 minutes and the computer screen unlocked displaying patient details in an area where patients and non-trust staff could access.

However:

  • The service provided mandatory training in key skills, including the highest level of life support training. Although much of the training had moved on-line due to the pandemic.
  • In most aspects the service controlled infection risks well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • The service had enough nursing staff and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix.
  • Patient records were kept updated and the various nationally recognised early warning scores, sepsis reviews and other observations and assessments were properly completed.
  • Although the service was not meeting the pre-pandemic National performance data four-hour wait time 95% standard, it was level with the current National percentage of 71.4% and the trend was upwards.
  • The service made sure only equipment which was in date was available for use within the ED.

How we carried out the inspection

We spoke with approximately 15 staff across a range of disciplines, including nurses, senior nurses, ambulance crew, department consultants trust grade doctors, senior managers and executive leads.

As part of the inspection we observed care and treatment and spoke with 14 patients. We examined 10 patient care records. We analysed information about the service which was provided by the trust.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

27 November 2019

During an inspection looking at part of the service

Whilst we recognised work had been undertaken by the service to correct the concerns raised during the previous inspection, we found that further work was required to demonstrate clear sustainable results.

Mandatory training rates were still variable across the staff groups and during the rolling year of the training schedule. Completion rates provided showed some subjects with completions rates as low as 22% for one subject.

The rotating and stock control of single use consumables still required work as we found a significant number of items which were past their use by date. ED safety checklist completion rates were not in line with trust target and completion was at times sporadic.

The cubicle which was used as a mental health safe assessment room in the paediatric ED still was not fit for purpose. Although we recognised the work the service had done to mitigate risks and the planned building work which was due to commence shortly after the inspection. Despite this, at the time of the inspection the risks remained.

Access and flow within the department remain a concern but we recognise the work undertaken by the service to alleviate this situation where possible.

However:

We saw improvement in the safety checking of resuscitation trolleys, the storage of medicines in fridges which had been fitted with digital locks, correct administration and safe dosage of medicines given to patients. We found there was now a private area within reception for patients to use and plans had been agreed to build a mental health safe room for children in the paediatric ED.

There were new protocols for the use of resus room 10 for administration of intramuscular sedation. This provided assurance of the safe and appropriate use of this room when treating children with mental ill health.

21 and 22 May 2019

During a routine inspection

We carried out this announced inspection of The Havens sexual assault referral service over two days on 21 and 22 May 2019. We conducted this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements of the Health and Social Care Act 2008 and associated regulations. Two CQC inspectors, supported by a specialist professional adviser, carried out this inspection.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions about a service:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

The Havens sexual assault referral service is provided by Kings College NHS Foundation Trust at three sexual assault referral centres (SARC) in London; one site close to Kings College Hospital in Camberwell, one site close to St Mary’s Hospital in Paddington and one site close to the Royal London Hospital in Whitechapel.

Each of the centres has a dedicated entrance with separate pathways for patients who use the forensic service and for those using only the follow-up services. All three centres follow the same common processes and procedures and, although there are local managers in place, each centre is subject of the same central governance and oversight.

Each of the buildings occupied by the centres is configured differently, although each centre has dedicated forensic examination rooms and associated waiting rooms for children and for adults.

NHS England (NHSE) and the Mayor’s Office for Policing and Crime (MOPAC) jointly commission The Havens, which is the only sexual assault referral service in London. The service provides forensic medical examinations and related health services to people living in all of the London Boroughs (the Metropolitan Police area) who have been sexually assaulted. This includes the offer of an independent sexual violence adviser (ISVA) to co-ordinate follow-up care and support for patients. The service also provides a range of additional follow-up psychology services for children and adults although these were not in the scope of our inspection

The Havens is an ‘all-age’ service; that is, adults aged 18 and over, children aged13 and above and children under the age of 13. The service is accessible to male, female and transgender patients.

The service is available 24 hours each day with patients directed to the most appropriate centre where they can be seen quickly. Patients are referred through the police (or child protection processes for patients under 13). Patients aged between 13 and 17 may be brought to the centres by police or a social worker but can also self-refer subject to safeguards in relation to their capacity to consent. Patients aged 18 and over can self-refer without police involvement.

The Havens has an integrated central management structure comprising a service manager and medical and nursing leads. Each centre has a service delivery manager together with doctors who are sexual offence examiners (SOE), forensic nurse examiners (FNE), and nursing staff and duty crisis workers who carry out the role of crisis worker.”. There are specialist paediatric and psychology staff, as well as ISVA workers for both adults and children, nurses who provide crisis support, forensic nurse examiners (FNE) and business support staff who perform a variety of roles. Most staff members work from their base site, although clinical staff may be called to any of the three sites. There are also some medical, paediatric and crisis worker staff who carry out sexual offence examinations on an on-call, sessional basis at any of the sites.

As the service is provided by KCHFT, the trust is responsible for meeting the requirements on the Health and Social Care Act 2008, and the associated regulations about how the service is run.

During our inspection we spoke with the service manager, the service delivery managers for each of the sites, both consultant co-clinical leads, a lead doctor from each of the three Havens sites and a specialty doctor. We also spoke with the interim lead nurse and senior forensic nurse examiner, a senior nursing sister (who is also a crisis worker), a senior crisis worker, an adult ISVA, a young person’s ISVA, the family nurse advocate and the child clinical support worker. We looked at records of eight patients. Two of these were children under 13, two were young adults over 18 and four were older adults. Six were female patients and two were male.

We left comment cards at the location in the two weeks prior to our visit and received 29 responses from people who had used the service in that period. We also spoke directly with three people who had used the service recently.

We looked at the policies and procedures that were used commonly across all three sites and examined performance and quality monitoring information and training data.

Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC.

Our key findings were:

  • Staff knew how to deal with emergencies.
  • Appropriate medicines and life-saving equipment were available.
  • The service had systems to help them manage risk.
  • The staff had effective safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The service was clean and well maintained.
  • The staff had infection control procedures which reflected published guidance.
  • The service had thorough, safe, staff recruitment procedures.
  • The clinical staff provided patients’ care and treatment in line with current guidelines issued by the relevant professional bodies.
  • There were processes for monitoring the standard and quality of care.
  • Staff treated patients with dignity, respect and compassion and took care to protect their privacy and personal information.
  • The single point of access referral system met patients’ needs.
  • The service had effective leadership and a culture of continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The service asked staff and clients for feedback about the services they provided and acted on this.
  • The service dealt efficiently with adverse incidents, complaints and feedback.

There were areas where the provider could make improvements. They should:

  • Complete first stage risk assessments fully for each patient.
  • Account accurately for medicine stocks used.
  • Provide written information about the service and its procedures, and in a suitable format, for younger children, patients with a learning disability and patients whose first language is not English.
  • Provide information to all patients about the gender of the clinician.

30 Jan to 21 Feb 2019

During a routine inspection

Our rating of services stayed the same. We rated it them as requires improvement because:

  • Not all staff had completed the required safety related mandatory training, which was as we found on our previous inspection.
  • The environment in which patients received treatment and care was not always suitable or risk assessed. Privacy was not always achieved in some areas, and equipment had not been checked in a consistent manner.
  • Medicines optimisation was not always achieved, and standards related to infection prevention and control were inconsistent.
  • Patient risk assessments were not always completed and updated.
  • Expected patient outcomes were not always met in some specialties.
  • Access to some services were not meeting some of the expected targets in outpatients and once referred for admission. Waiting times from referral to treatment, arrangements to admit, treat and discharge patients was not always in line with good practice.
  • Communication and engagement with staff by leaders was not always as strong as it could be, and some staff reported low morale.

However:

  • There were enough staff with the right skills and experiences and staff had access to professional development, were competent for their roles, and had opportunities for a review of their performance.
  • Care and treatment was delivered by a multidisciplinary team, in line with evidence based national guidance such as National Institute for Health and Care Excellence (NICE) and professional colleges.
  • The staff recognised the importance of reporting and learning from incidents. Investigations led to the sharing of information learned and improvements.
  • Patients were treated with respect and dignity, were involved in decisions about their care and were provided with information and choices.
  • The co-ordination and delivery of services took account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances.
  • Most clinical areas were led by staff who had the right experience, skills and knowledge. They understood the trusts values and strategic aims and fostered a culture where staff could do their best.

Our rating of services stayed the same. We rated it them as requires improvement because:

  • Not all staff had completed the required safety related mandatory training, which was as we found on our previous inspection.
  • The environment in which patients received treatment and care was not always suitable or risk assessed. Privacy was not always achieved in some areas, and equipment had not been checked in a consistent manner.
  • Medicines optimisation was not always achieved, and standards related to infection prevention and control were inconsistent.
  • Patient risk assessments were not always completed and updated.
  • Expected patient outcomes were not always met in some specialties.
  • Access to some services were not meeting some of the expected targets in outpatients and once referred for admission. Waiting times from referral to treatment, arrangements to admit, treat and discharge patients was not always in line with good practice.
  • Communication and engagement with staff by leaders was not always as strong as it could be, and some staff reported low morale.

However:

  • There were enough staff with the right skills and experiences and staff had access to professional development, were competent for their roles, and had opportunities for a review of their performance.
  • Care and treatment was delivered by a multidisciplinary team, in line with evidence based national guidance such as National Institute for Health and Care Excellence (NICE) and professional colleges.
  • The staff recognised the importance of reporting and learning from incidents. Investigations led to the sharing of information learned and improvements.
  • Patients were treated with respect and dignity, were involved in decisions about their care and were provided with information and choices.
  • The co-ordination and delivery of services took account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances.
  • Most clinical areas were led by staff who had the right experience, skills and knowledge. They understood the trusts values and strategic aims and fostered a culture where staff could do their best.

13 October 2016

During an inspection looking at part of the service

King's College Hospital NHS Foundation Trust is a large provider of acute and specialist services that serves a population of over 1,000,000 in south east London and Kent. The trust operates from three acute sites; King's College Hospital Denmark Hill, Princess Royal University Hospital Bromley and Orpington Hospital.

The trust has over 1300 beds including 1050 acute, 125 maternity and 144 critical care beds. The trust receives over 250,000 emergency attendances, 115,000 inpatient spells and 960,000 outpatient attendances. All core services are provided from King's College Hospital Denmark Hill and Princess Royal University Hospital while inpatient, outpatient and surgical services are provided from Orpington Hospital.

We inspected the King’s College hospital Denmark Hill site and the Princess Royal University hospital on the 13 October 2016. The inspection was a focused inspection, carried out to review the progress made by the trust following our comprehensive inspection in April 2015. We had asked the trust to make improvements in a number of areas and issues requirement notices explaining how the regulations were not being met.

We did not visit the Orpington Hospital site but we spoke with staff and reviewed information provided to us by the trust.

Following this inspection we did not change the rating of the trust. Although there had been many improvements, there were areas still requiring further attention, as indicated below.

Princess Royal University Hospital

  • Continue to work with key stakeholders to improve patient flow throughout the hospital to reduce waiting times in the ED, cancellation of operations and delayed discharges.

  • Review and improve patient record documentation to ensure it is fully completed, and in line with national guidance. This includes the recoding of do not attempt cardio-pulmonary resuscitation (DNACPR) orders.

King’s College Hospital – Denmark Hill

  • Improve safeguarding training completion rates.

  • Ensure the documentation of the use of mechanical restraints mittens in CCU is recorded in patient care records.

Professor Sir Mike Richards

Chief Inspector of Hospitals

13-17 April 2015

During an inspection looking at part of the service

King's College Hospital Denmark Hill Site is part of King's College Hospital NHS Foundation Trust. The trust provides local services primarily for people living in the London boroughs of Lambeth, Southwark, Bromley and Lewisham. King's College Hospital Denmark Hill Site provides acute services to an inner city population of 700,000 in the London boroughs of Southwark and Lambeth, but also serves as a tertiary referral centre in certain specialties to millions of people in southern England.

King's College Hospital NHS Foundation Trust employs around 11,723 whole time equivalent (WTE) members of staff with approximately 8,785 staff working at King's College Hospital Denmark Hill Site.

We carried out an announced inspection of King's College Hospital Denmark Hill Site between 13 and 17 April 2015. We also undertook unannounced visits to the hospital on 25 and 28 April 2015.

Overall, this hospital requires improvement. We found that urgent and emergency care, medical care, services for children and young people and outpatients and diagnostic services were good. However surgery, critical care, maternity and gynaecology services and end of life care required improvement. 

The effectiveness of care, care of patients and the leadership at this hospital were good overall. However, the hospital required improvement in order to provide a safe and responsive service towards patients and their carers.

Our key findings were as follows:

Safe

  • There was an open and transparent approach to the investigation of incidents. Staff were encouraged to report incidents when they occurred.
  • There were largely adequate medical and nursing staff on duty to provide safe care to patients apart from medical care, maternity and neonatal intensive care services.
  • There were effective arrangements in place to minimise risks of infection to patients and staff.
  • Medicines were stored, recorded and administered safely to protect patients.
  • The support provided by the iMobile team for deteriorating patients was excellent.
  • The critical care service did not meet basic safety standards in some areas, particularly on the high dependency units.

Effective

  • Staff followed accepted national and local guidelines for clinical practice.
  • There was a multidisciplinary, collaborative approach to care and treatment that involved a range of health and social care professionals.
  • Some newly qualified midwifery staff had not received appropriate training to enable them to carry out their roles effectively.
  • Patients were given timely pain relief and pain scoring tools were consistently used.
  • The nutritional needs of patients had been assessed and patients were supported to eat and drink according to their needs.
  • Understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards was variable and some groups of staff needed to improve their knowledge in these areas.

Caring

  • Patients were cared for by staff who were kind, caring and compassionate in their approach. Patients were supported, treated with dignity and respect and were involved as partners in their care.
  • Patients felt that they were listened to by health professionals, and were involved in their treatment and care.
  • Staff respected patients’ choices and preferences and were supportive of their cultures, faith and background.

Responsive

  • Services were planned to meet the needs of the local population.
  • The emergency department (ED) was often overcrowded. Patient flow required improvement and waiting times were above the national average, due to capacity constraints and the trust’s arrangements for making decisions to admit patients.
  • Referral-to-treatment times were not being met in a number of surgical and outpatient specialties. Surgical procedures were cancelled and not always rescheduled and undertaken within 28 days.
  • There was a lack of critical care beds, which affected patients’ length of stay and delayed discharges.
  • Outpatient services were not organised in a manner that responded promptly to ensure that patients’ needs were met.

Well-led

  • The leadership, governance and culture of the hospital promoted the delivery of high quality, person-centred care.
  • Robust governance arrangements were in place to monitor, evaluate and report back to staff and upwards to the trust board.
  • Most staff were proud of working for the department and staff worked well together as a team.

We saw several areas of outstanding practice, including:

  • Trauma nurse coordinators tracked pathways and the progress of trauma patients by visiting them daily on the wards. This role also included networking with other trusts and coordinating repatriation in advance.
  • The ED had an established youth worker drop in scheme operated by a London-based organisation, which was effective in supporting vulnerable young people. Staff could refer young people to the service, although engagement was voluntary. The service also supported young people to access specialist services, such as housing support and access to social workers.
  • The iMobile outreach service was innovative and there was evidence that it was producing positive outcomes both for patients and the critical care service as a whole.
  • The pioneering work being done by neurosciences, liver and haematology specialist services.
  • The surgical directorate had set up the first national training for a trauma skills course in the country.
  • There were well-established pathways for pregnant women, which provided appropriate antenatal care, including access to specialist clinics for women with medical needs.
  • The foetal medicine unit provided interventions, such as foetal blood transfusions, fetoscopic insertions of endotracheal balloons and laser separation procedures of placental circulations for complicated monochorionic twin pregnancies.
  • The enhanced scanning programme included combined screening for chromosomal abnormalities at 12 weeks, with women being given the results on the same day.
  • The gynaecology and urogynaecology services offered a one-stop service with diagnostics carried out by a specialist doctor. The hospital was a regional training unit for this service and the unit was recognised as a gold standard unit by The British Society of Urogynaecologists.
  • For children with complex liver conditions and those who required surgery as neonates, staff developed and advocated the use of innovative and pioneering approaches to care.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Review its facilities within critical care so that it meets both patient needs, and complies with building regulations. This includes bed spacing and storage facilities, particularly for IV fluids and blood gas machines.
  • Ensure that the 'Five steps to safer surgery' checklist was always fully completed for each surgical patient.
  • Re-configure the Liver outpatient clinic in order to avoid overcrowding.
  • Ensure patients referral to treatment times do not exceed national targets.
  • Improve patient waiting times in all outpatients’ clinics.
  • Review the capacity of the maternity unit so that women and their babies are receiving appropriate care at the right place at the right time.
  • Implement a permanent solution to the periodic flooding following heavy rain of the renal dialysis unit and endoscopy suite areas.
  • Ensure that current trust policy around syringe drivers affords optimum protection for patients against the risk of adverse incidents.
  • Ensure the cover for the concealment trolley for deceased patients is in good repair and not an infection control risk.

In addition, the trust should:

  • Fully complete controlled drug registers in the ED.
  • Complete safeguarding flowcharts for children attending the ED.
  • Improve the number of senior ED medical staff trained in safeguarding children training at level 3 to meet Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings recommendations.
  • Identify and mitigate risks to patients attending the ED, such as the development of pressure sores, falls and poor nutrition.
  • Improve the uptake of training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards for staff working in the ED, medical care, surgery and services for children and young people.
  • Review staff understanding of the Mental Capacity Act 2005 in critical care and end of life care, to ensure their practice and documentation reflects the legislation.
  • Develop guidelines for admission to the children’s clinical decision unit (CDU).
  • Review the area used for the children’s CDU to ensure the environment fulfils the criteria for a ward area.
  • Review the practice of undertaking adult consultations in the children’s ED.
  • Improve patient flow and waiting times in the ED, including their arrangements for making decisions to admit patients.
  • Take action to improve the percentage of ED patients seen, treated and discharged within four hours.
  • Consider ways of improving the documentation of patient safety checks.
  • Improve attendance at mandatory training.
  • Improve theatre utilisation and a reduction in cancellations.
  • Improve the referral to treatment times.
  • Improve patient flow through the surgical pathway.
  • Consider ways of improving the discharge process by engaging with external agencies.
  • Consider how staff can be made aware of the broader strategy for the surgical division.
  • Review the systems for checking equipment to ensure that they are in date, in working order and stock is effectively rotated.
  • Ensure it continues to review its critical care bed capacity so that it can meet its expected admissions.
  • Review its patient record documentation to ensure it is fully completed and information between wards is seamless.
  • Review its use of the Waterlow assessment to ensure those patients that need pressure-relieving support, receive it.
  • Review the nursing, consultant and junior doctor levels on the neonatal intensive care unit.
  • Review the space between cot spaces on the neonatal intensive care unit as they were sometimes restricted or limited.
  • Provide clear and up-to-date information on outpatient clinic waiting times.
  • Monitor the availability of case notes/medical records for outpatients and act to resolve issues in a timely fashion.
  • Review medical cover for gynaecology and obstetrics.
  • Stop overbooking outpatient clinics including the liver outpatients department clinic.
  • Share outpatients and diagnostic imaging performance data with clinical staff.
  • Make sure the preferred place of care/preferred place of death, or the wishes and preferences of patients and their families is documented.

Professor Sir Mike Richards

Chief Inspector of Hospitals

13 April 2015

During an inspection of this service

29 August 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to be a patient in King's College Hospital. They

described how they were treated by staff and their involvement in making choices

about their care. They also told us about the quality and choice of food and drink

available. This was because this inspection was part of a themed inspection

programme to assess whether older people in hospitals were treated with dignity

and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by two compliance inspectors, a practising professional and an Expert by Experience. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with more than 40 patients as well a number of people who were visiting on the day. Patients felt that the hospital promoted the dignity of older people, and respected their choices. Patients had their treatment explained and were provided with a rough guide of the proposed length of their stay at the hospital.

A typical comment was, 'staff are very knowledgeable about the care I am receiving, the consultants, nurses and junior doctors, discuss with me the treatment I am receiving and the possible outcomes'.

Patients spoke of their confidence in the service and felt safe when under the care of the hospital. They acknowledged that the hospital made appropriate provision for patients, with staffing levels that enabled a good patient experience. Staff interaction and engagement with patients promoted their wellbeing.

A patient told us, "it is my local hospital since I was a young child, I feel lucky, I would not change this for anywhere else, it is special and there are lovely doctors and nurses here".

Another person talked of the benefits of living near the hospital, they said, 'the hospital is top class; I am of the opinion that I could not have been treated any better anywhere else; staff are professional and cheerful at the same time, which makes my disability easier to bear'.

A relative who visited daily told us they felt reassured by what they observed. They observed that staff were approachable and mindful of the needs of elderly people; they saw that patients received good support from staff especially at mealtimes, and had adequate nourishment and drinks.

During an inspection looking at part of the service

We did not talk to people using the service at this review of compliance. We asked the registered provider to provide us with an action plan, and an update on their progress in response to the area of non compliance found by the Care Quality Commission on the inspection visit to the hospital on 21st March 2012.

The evidence we reviewed confirmed that King's College Hospital have acted on what they said, and was compliant.

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

9 February 2012

During a routine inspection

We made an unannounced visit to King's College Hospital on 9th February 2012.

We spoke with people on the following wards, wards in the Health and Ageing Unit, (Marjorie Warren, Donne and Byron ), The Emergency department (ED), Oliver Ward, Christine Brown, Lonsdale, Annie Zunz, Katherine Monk, Mary Ray, Matthew Whiting, Davidson, Philip Isaacs Day Treatment Ward, Princess Elizabeth, Rays of Sunshine.

People receiving care and treatment at King's College Hospital told us that they were well looked after and that staff were generally sensitive and kind.

Elderly people said that nursing staff were gentle when carrying out personal care tasks. We saw that staff talked to patients in a kindly and respectful manner.

We heard from staff of the commitment within the hospital to providing good quality care for people with dementia. To further this there is a team who provide advice and training throughout the hospital. This helps to ensure that the needs of people with dementia are recognised and understood.

One of the wards has been redesigned to provide an environment which addresses the specialist needs of people with dementia. The ward is designed to provide a calming environment with features to help with people's orientation and trigger memory.

Visitors told us that they liked the environment and feel that their relatives benefit from it.

Parents of child patients in the Emergency Department and on children's' wards told us that they were happy with the service. They found that staff were kind and caring, and that they were involved in decision making. One of the parents spoken to described the excellent service experienced in the Emergency Department for an injury sustained by their child.

Another parent said, 'When I arrived at ED I was concerned about my child's condition, we were seen promptly by the doctor, I am pleased that she was treated here in my local hospital, it is such an excellent service to have in our community'.

All of the parents spoken to on the wards were pleased with the way their children were cared for.

One parent said, 'The child's voice is the most important thing they consider in the hospital and they are central to everything that happens'.

Senior medical and nursing staff described the challenges faced when working at the busy emergency department as rewarding.

The following remarks were received from staff, 'We provide an emergency service for people requiring urgent care, good teamwork is most important when responding and treating the people that come through our doors",

" the enthusiasm and inspiration of staff is fuelled by the desire to deliver the quality of care and treatment people need to treat their condition and make them well again.'

9 December 2010

During an inspection in response to concerns

Feedback overall was very positive from people that use the service. We heard of the confidence people have in the services provided at the hospital. People using the stroke unit were pleased with the prompt response of the staff, and the subsequent treatment and care they received. Older people felt they were well cared for on the wards, and that staff listened and responded appropriately to their needs. The maternity service experiences for people were considered good, with suitable numbers of experienced staff personnel available. Mothers found that ante natal services were well coordinated, and that in-patient care and support were consistent and reliable.

People found that communication with staff was generally was good with procedures explained. People find that discharge arrangements are well organised but occasionally difficulties are experienced in keeping other care providers informed of last minute changes. Staff are trained and knowledgeable on policies and procedures that protect vulnerable people. They were enthusiastic and positive about their role and the support that they receive to work well. Staff receive both mandatory and specialist training. Support and guidance is available from senior staff within the ward and from a range of specialists.