The trust was rated ‘requires improvement’ for being safe, effective, responsive and well-led. It was rated ‘good’ for being caring, following the inspection in January and February 2019. The trust’s previous overall rating was also ‘requires improvement’.
CQC inspected locations at King’s College Hospital (KCH) in Camberwell and Princess Royal University (PRUH) in Farnborough. CQC inspected the emergency department, surgery, maternity, end of life, and outpatients. The latter included satellite dialysis services. At the PRUH and south sites, CQC inspected the emergency department, surgery, end of life, and outpatients, which also included satellite Dialysis.
There was a lack of effective leadership in the emergency department at PRUH. This had got worse since CQC’s previous inspection. Morale amongst administrative staff across most outpatient services at KCH was low. Staff in some clinical areas did not feel valued or respected.
CQC inspectors found in some of the core services there was a disconnect between what the executive did and how this was perceived by staff. The trust had not ensured that mandatory training was completed to the expected target. Staffing levels in some key areas did not always meet the needs of the services being delivered.
Areas where the trust must now improve include:
• Ensuring the required level of mandatory training trust-wide is completed to the trust’s target.
At KCH the trust must:
• Ensure that patient records are completed in line with trust policy.
• Ensure that there is a suitable environment for assessing children and young people presenting with mental health needs.
• Ensure there are enough nursing and medical staff working in the emergency department to meet patient needs.
• Engage with local communities to help improve services.
• Ensure that cross infection within operating theatres and the recovery area are improved upon.
At PRUH areas where the trust must improve include:
• Ensuring that patients and visitors are treated with kindness and compassion in the emergency department.
• Ensuring that all rooms where patients are seen and treated have call bell facilities.
However, inspectors did find some examples of outstanding care. KCH had led work in south east London to reduce the length of stay for patients with mental health conditions in crisis attending the emergency department. Maternity services advertised and participated in an umbilical cord blood donation scheme. Women were encouraged to donate their umbilical cord blood for use in the treatment of people with blood cancer.
Maternity services and end of life care at KCH have improved from ‘requires improvement’ to ‘good’.
NHS Improvement have rated the trust ‘inadequate’ for use of resources. The combined use of resources and quality rating is ‘requires improvement’.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said: “It is disappointing that there has been no overall improvement in the rating at King’s College Hospital NHS Foundation Trust. In fact, in some areas the trust has gone backwards. For example, there was a lack of effective leadership in the emergency department at Princess Royal University Hospital. This had got worse since CQC’s previous inspection.
“While trust was rated Good overall for caring and there were some examples of outstanding practice, care is not consistently high quality in all services. The trust must take action in response to this report to address this.”