King's College Hospital

Updated 22 February 2023

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.

Updated 22 February 2023

Updated 22 February 2023

Updated 31 January 2018

Our rating of this service improved. We rated it as good because:

• The service had improved since our last inspection in 2015. Patient records were now comprehensive, with all appropriate risk assessments completed. Staff were aware of their responsibilities under the MCA and we saw appropriate records were in place in patients’ notes. Management staff had sight of risks on the units and mitigating plans were in place to address those risks.
• There were effective systems to protect patients from harm and a good incident reporting culture was in evidence. Patient records were comprehensive with appropriate risk assessments completed. The iMobile (critical care outreach) team provided rapid response and stabilisation to patients who needed immediate attention and transfer.
• Staff provided evidence based care and treatment in line with national guidelines and local policies. Patient outcomes were better than the national average.
• Patient feedback for the services we inspected was mostly positive. Staff respected confidentiality, dignity and privacy of patients. Patients were engaged through surveys and feedback forms and the response showed high satisfaction with the service.
• Services were developed to meet the needs of patients. Feedback from patients was taken into consideration in designing a new critical care unit. Overnight stay near the hospital was arranged for relatives, and patients had access to a follow up clinic after they were discharged from the units.
• The CCU had implemented a number of innovative services and developed these to meet patients’ needs. The CCU was engaged in research activities and had supported a significant amount of National Institute for Health Research (NIHR) portfolio studies.
• There was good local leadership on the CCU. Staff felt valued, they were supported in their roles and had opportunities for learning and development. Staff were positive about working in the CCU.

However:

• Medical staffing was stretched and did not comply with recommended guidelines. Pharmacy and therapy staffing levels were below the recommended guidelines.
• Although plans were in place to open a new critical care unit, current bed spaces did not comply with the Department of Health’s building note HBN 04-02 which sets out a minimum standard of space for effective infection control.
• The average bed occupancy on the CCU was consistently above 100% and there were delayed discharges from critical care units.

Updated 31 January 2018

We did not rate the service. Our finding are detailed as follows:

• The department had taken a proactive approach following the removal of some of their radiology registrars in April 2017. The potential negative impact on the service was greatly minimised by a robust action plan, reviewing of processes and development of staff.
• Staff knew how to use the incident reporting system, received feedback about incidents and there was evidence of learning from these where relevant.
• Staff were very patient focused and patients and carers spoke positively about the care and compassion shown by the diagnostic imaging staff.
• Managers were visible to their staff and provided opportunity for regular appraisals, support and professional development.
• New equipment had been and was in the process of being installed. Staff could see the progress being made to improve the quality of the service offered.
• We found evidence of strong local leadership and a positive culture of support, teamwork and focus on patient care.

Updated 29 April 2022

Updated 12 June 2019

Our rating of this service improved. We rated it as good because:

• The trust provided mandatory training in key end of life skills to all new staff at induction and at regular updates.
• There were enough staff with the right skills and experiences to ensure the delivery of care. Staff had access to professional development, were competent for their roles, and had opportunities for a review of their performance.
• Risk assessment of equipment and its availability had improved since the last inspection. There was greater oversight of competence for the use of specialised equipment.
• There was good multidisciplinary working. The specialist palliative care team worked closely with the local hospice and there was access to clinical expertise within the hospital.
• Care and treatment was delivered in line with evidence based national guidance such as National Institute for Health and Care Excellence (NICE) guidance.
• Patient outcomes were monitored and improved through participation in the national care of the dying audit and subsequent internal audits relating to the end of life care for the dying patient.
• There were a range of training initiatives available for a variety of staff groups involved in end of life care so that staff had the skills, knowledge and experience to deliver effective end of life care.
• Patients at the end of life and those close to them were treated with kindness, respect and compassion. They were involved in making decisions about their care.
• There was a clear vision and strategy in place with identified priorities and monitoring of action taken by the end of life care team.
• Governance structures around end of life care were in place to ensure continuous improvement.
• There was a strong culture of quality end of life care across the trust, with active engagement, involvement, commitment and representation from a range of staff groups.

Updated 23 December 2022

Updated 12 June 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated outpatients as requires improvement because:

• The service did not take steps to ensure all staff completed the required mandatory training. Compliance rates for required safety related training amongst medical staff was poor.
• The service did not always have suitable premises or equipment and did not always look after them well.
• Patient’s privacy and dignity was not always maintained due to the environments staff were working in, although staff tried their best to maintain standards where possible.
• Outpatient services showed generally poor performance in referral to treatment (RTT) and cancer waiting times. The trust was performing worse than the England average and national standard for both the RTT incomplete pathway, where patients should be seen within 18 weeks, and for urgent cancer referrals, where patients should be seen within two weeks. This meant the service was not always responsive and could not always meet patient urgent clinical needs in a timely manner.
• Services did not always provide the right information to service users prior to their appointments. Incorrect telephone numbers were often printed on appointment letters.
• Morale amongst administrative staff across most services was low.
• Not all risks on the risk register for OPD had not been reviewed recently, and it was not clear if all risks were being addressed.
• There were some additional plans for the long-term future of the OPD, but these were not an immediate priority due to the current challenges faced by the department. Plans did not always have clear timescales, and staff could not give examples of being involved in such plans.

However:

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Services were delivered and co-ordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances.

• The trust used a mostly systematic approach to continually improving the quality of its service, with clear escalation and reporting structures.

Updated 12 June 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service provided mandatory training in key skills to all staff but did not make sure everybody had completed it. Compliance rates for medical staff were poor and we issued the trust with a requirement notice for them to address this matter.
• The service did not always control infection risks well. Staff did not always keep premises and equipment clean. They did not always use control measures to prevent the spread of infection.
• Staff did not always complete an updated risk assessment for each patient. The completion of malnutrition universal screening tool (MUST) scores did still not reach the trust target of 100% and this had not improved since our last inspection.
• Patient outcome targets did not meet the national benchmark and the trust were not performing well in key areas.
• People could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with good practice.
• Most managers at all levels in the surgical division had the right skills and abilities to run a service providing high-quality sustainable care. However, there was a distinct lack of communication and strategic level engagement with clinical staff from the senior executive team.

However:

• The trust had enough nursing and medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff cared for patients with compassion and took account of their individual needs. Feedback from patients confirmed that staff treated them well and with kindness.
• There were systems and processes for effective learning, continuous improvement and innovation.

Updated 18 February 2020