King's College Hospital NHS Foundation Trust rated as Requires Improvement

The Chief Inspector of Hospitals has rated King's College Hospital NHS Foundation Trust as Requires Improvement overall following an inspection by the Care Quality Commission (CQC).

The CQC inspection team, which included specialist advisors and experts by experience, visited the trust over a period of several days during April 2015. Inspectors found that King's College Hospital NHS Foundation Trust was providing services that were caring, but Required Improvement in order to provide services that are safe, effective, responsive and well-led.

Trust core services provided from King's College Hospital (Denmark Hill) and the Princess Royal University Hospital were found to require improvement, whilst outpatient and surgical services provided from Orpington Hospital were found to be good. The trust also provides community services from Dulwich Community Hospital, Queen Mary's Hospital Sidcup, Beckenham Beacon, Camberwell Sexual Health Centre and the Frank Cooksey Rehabilitation Centre.

Full reports on all core services have been published here.

Although care was delivered with compassion and dignity, with specialist areas achieving excellent clinical outcomes, inspectors found that there was congestion throughout both the King’s College Hospital and the Princess Royal University Hospital emergency departments. Action was also required to reduce waiting times, the number of cancelled operations and delayed discharges across both hospital sites.

Trust premises and equipment were not always fit for purpose, properly used or maintained.
Bed spacing and storage facilities, particularly for machines within some critical care departments, did not meet patient needs or comply with building regulations.

A safer surgery checklist was not always fully completed for each surgical patient prior to an operation and the trust did not comply with national guidance recommending access to a dietician for all critical care patients.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Throughout King's College Hospital NHS Foundation Trust, we saw a clear culture of providing compassionate care with dignity which was fully supported by feedback received from patients and carers. Patients and carers told us that they received emotional support from staff and that they were involved in the planning of care.

“Since our previous inspection of the Princess Royal University Hospital in December 2013, a lot of work has been done to improve the reporting and investigating of incidents. Staff told us there was a more open culture and that they were encouraged to report incidents.

“However we were concerned about congestion throughout both the King’s College Hospital and the Princess Royal University Hospital emergency departments. We found that patient waiting times, the number of cancelled operations and delayed discharges within the emergency departments was too high.

“We are also concerned about the safety and suitability of some trust premises, governance processes and the care provided to critical care patients in order to meet their nutritional and hydration needs.

“Although we found several examples of outstanding practice, we have told the trust about a number of areas that require improvement, which I expect the trust to address as a priority. We will continue to monitor the trust's performance and we will return in due course to check on their progress.”

Inspectors saw several areas of outstanding practice, including:

• The King's College Hospital (Denmark Hill) gynaecology and urogynaecology services offering a one-stop service with diagnostics carried out by specialist doctors. The unit was recognised as a gold standard unit by The British Society of Urogynaecologists, and served as a regional training facility.
• The King’s College Hospital (Denmark Hill) emergency department had an established youth worker drop in scheme operated by a London-based organisation, which was effective in supporting vulnerable young people that attended the hospital. Staff could refer young people to the service, and those that engaged with the scheme were able to access specialist services, including housing support and access to social workers.
• The Princess Royal University Hospital stroke service was recently awarded a Level A ranking from the Royal College of Physicians’ Sentinel Stroke National Audit Programme (SSNAP).  Only eight per cent of stroke units in the country had achieved Level A ranking, making the service the most improved in the country, after previously being rated as Level D 18 months ago. The unit joins the stroke unit at King’s College Hospital among the top performers in the country.
• Staff at Princess Royal University Hospital have responded positively to being part of King’s College Hospital and have reported improved staffing and governance arrangements.

The trust has been told that it must make improvements including:

• Work with key stakeholders to reduce waiting times, the number of cancelled operations and delayed discharges within the King’s College Hospital and the Princess Royal University Hospital emergency departments
• Ensure patients referral to treatment times do not exceed national targets.
• Improve patient waiting times in all outpatients’ clinics
• Review King's College Hospital facilities within the critical care department, in order to ensure patient needs are met and compliance with required building regulations.
• Ensure all equipment (including resuscitation trolleys) is cleaned, maintained, checked and secured in line with trust and national policies
• Improve staff awareness and understanding of their role and responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards

The Care Quality Commission has already presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings.

The trust must submit a report to the Care Quality Commission which details the action that will be taken to improve services to meet required services.

Ends

For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. For media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here.

For general enquiries, please call 03000 61 61 61.