The Care Quality Commission (CQC) has rated King’s College Hospital NHS Foundation Trust requires improvement. This follow an inspection of the trust leadership and two core services undertaken between October and December.
CQC inspected the trust’s leadership arrangements, due to the link between the quality of leadership and the care people receive. It found this had improved compared to the previous inspection – consequently the trust’s rating for being well-led improved from requires improvement to good.
CQC inspected services for children and young people at King’s College Hospital, in Denmark Hill, to assess whether learning from an adverse event had led to improvement.
CQC also inspected the hospital’s medical care service, which includes older people’s care, to judge whether information provided by CQC following inspections of medical care at the trust’s other sites had been applied across the organisation.
Following the inspection, the trust, hospital and its medical care were again rated requires improvement overall. These overall ratings are unchanged from those in place prior to the latest inspection.
The hospital’s service for children and young people was rated good. This service was also previously rated good.
Nicola Wise, CQC deputy director of operations in London, said:
“We found some excellent practice in the areas we inspected, and it was evident that the trust’s leaders had worked hard to embed improvements in its leadership arrangements during a time of high pressure.
“However, there are areas where the trust has further improvements to make.
“This includes ensuring it always has staffing levels that support it to provide safe care and treatment to people. While many NHS services and those in the wider care sector face staffing challenges, the trust must find ways to minimise the risk this poses to people in its care.
“The trust must also develop its work with the local healthcare system to enable it to efficiently discharge people who are fit to leave its medical care to other services. This will help reduce pressure it faces, and secure better outcomes for people if they are being cared for by services more suited to their needs.
“The trust’s in a strong position to address the issues it faces because it has better leadership arrangements. Its leadership team now benefits from experienced and knowledgeable professionals who were setting the right priorities to support people to achieve good outcomes.
“We also found staff interacted with people with kindness, compassion and respect. They helped people and their families understand their conditions, and they worked to support people’s individual needs.
“We continue to monitor the trust closely, including through future inspections, to ensure people receive the safe and effective care and treatment they have a right to expect.”
Following the inspection, CQC reported its findings to the trust so its leaders know what they must address.
The inspection found:
- Safe staffing levels were not always achieved. Rotas for junior doctors did not always ensure the safety of people receiving care, and inaccurate information about trainee doctors was occasionally supplied
- Some staff reported not being listened to. They were also frustrated that concerns, including cultural issues, were not responded to as they expected. This was a concern raised following previous inspections
- Board members recognised they had work to do to improve diversity and equality across the trust and at board level
- The Workforce Disability Equality Standards were not being met, and a few Workforce Race Equality Standards needed further work to be achieved
- There was no clinical lead for sepsis
- Learning from incidents was not always captured quickly or shared appropriately.
However:
- The strength, strategic focus and accountability of the leadership team had improved. It had developed good objectives and plans, and it supported staff to carry out their responsibilities effectively
- Clinicians, patients and groups from the local community were involved in shaping the trust’s strategy
- Leaders worked with the wider health and social care system to meet people’s needs
- Staff understood the service’s vision and values, and they were clear about their roles and accountabilities. Most staff felt respected, supported and valued, and they were able to focus on the needs of people in their care
- Services were planned and managed to meet demand using reliable information and improved governance procedures to oversee performance and quality
- There had been significant improvements in risk management
- There were arrangements to ensure staff received appropriate training
- Significant improvements to infection prevention and control had been made, which reduced the risk of hospital-acquired infections
- Consultants specialising in older people’s care attended monthly meetings at local care homes. They were available for contact by care homes and GPs for expert advice
- There was pioneering work on bowel transplants in children, and to close people’s abdomens following surgery.