St Thomas' Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

People were treated with kindness, empathy and compassion. Their privacy and dignity was respected. The service listened to and understood people’s needs, views and wishes. They involved people to make decisions about their care. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress. The service had several initiatives to promote the wellbeing of their staff. Staff felt the service supported and enabled them to deliver person-centred care.

At our last inspection we rated this key question Good at this assessment the rating improved to outstanding. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Patients were overwhelmingly positive about their care and treatment in all areas of the ED visited. Patients and their relatives described staff as “excellent”. They said staff “went above the call of duty” and were “so friendly”. Patients told us they have had the “best experience” and are “very impressed” with their care. A patient felt the care and treatment offered was thorough as the doctors “like to rule out everything”. Some of the patients told us it would have been easier for them to go to other hospitals, but they preferred the service because it was “very good”.

We observed staff interact with patients with kindness and compassion. For example, we saw examples of staff being aware of patients individual needs and supported continuity of care where needed.

Ambulance staff we spoke with were positive about the care provided and informed us patients were always happy to be taken to the service.

Staff collaborated with other colleagues to provide support for people with mental ill health and physical conditions. The service had an enhanced care team which provided therapeutic support to patients with mental health needs. Staff from the enhanced care team could access a laptop so patients could listen to music. Several staff we spoke with showed concern and sensitivity for patients’ sexual safety, especially where their mental ill health made them disinhibited and more vulnerable.

There was efficient patient flow through the ED and patients were treated in clinical spaces appropriate for their care. There were no patients being treated on corridors which meant patients could have their privacy and dignity protected. When staff assisted patients with personal hygiene needs and during medical ward rounds, they took care to draw curtains around the bed space for privacy.

However, while there were screens between triage areas, conversations could be overheard. Staff informed us patients could be invited into triage cubicles for sensitive conversations. Signage was displayed in the ED to inform patients that they may request a private conversation, and staff were reminded to offer them the option where appropriate.

The service had a process to send sympathy cards (designed by the department) to relatives of deceased patients.

The trust participated in the NHS urgent and emergency care survey benchmark report for accident and emergency departments (2024). Results of the NHS patient experience survey showed that the trust performed better than the national average for care and dignity. The trust received one of the highest scores for questions regarding patient care and treatment and was rated “much better than expected”. The trust also received one of the highest scores for questions regarding respect and dignity and was rated “better than expected”.

The ED friends and family test survey responses reflected positive feedback for staff professionalism, friendliness and competence, compassion, helpfulness, and emotional and physical support.

The ED ensured peoples cultural and religion needs were met. We observed information about Ramadan displayed in the paediatric ED.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Patients told us they felt listened to and had opportunities to ask questions about their care. They said, “staff are nice, they listen and are very attentive”. They told us staff were “very understanding” and “supportive”.

Patients felt reassured by staff to address any anxiety. One patient told us they suffered from anxiety, however, staff ensured they were not overwhelmed and addressed their needs.

Staff consistently introduced themselves to patients, responded to patients when asked and updated patients regularly. We observed that patient call buzzers were answered promptly.

Our observation of care showed staff were polite, helpful and sensitive. We observed staff interact with children at eye level in the paediatric ED. They explained procedures to children in a way they could understand.

We heard of examples where staff tried to meet people’s individual needs. For example, staff could provide toiletries and access to clean clothes where needed. Patients were offered food and hot drinks and there were regular rounds including hot meals for those in the department longer.

We spoke with patients with mental health needs who told us that they felt safe, cared for and that staff treated them with kindness, compassion and supported their individual needs. For example, one patient told us, staff understood their preferred method of communication, and this helped them to keep calm and manage their emotions. Another patient reported that staff supported them with fresh air breaks. They described staff as being “excellent and friendly”.

Results of the NHS patient experience survey showed that the trust performed better than the national average for staff interaction with patients. These involved questions regarding whether staff listened to patients, discussed their condition and treatment with them, and if staff discussed their anxieties or fears with them. The trust received one of the highest scores for patient interactions with doctors and nurses and was rated “much better than expected”. The trust also performed better than the national average for providing help with patients’ symptoms or conditions while waiting and for controlling patients’ pain.

The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff, and was exceptional at supporting and enabling staff to always deliver person-centred care.

All the staff we spoke to were positive about the quality of care they provided to patients. They felt the service supported and enabled them to deliver person-centred care. Staff were positive about the opportunities for training and personal development. They spoke well about the robust teaching program in the ED including consultant led teaching. There was a focus on mentoring, whereby each staff was mentored by a senior staff.

Staff we spoke with felt satisfied that their role made a difference to the quality of patient care provided. They said they enjoyed working in the service and expressed they were very happy to work in the ED. They confirmed the service supported staff by providing flexibility for staff with parental responsibilities. Staff were happy to recommend the service as a good place to work. They were also happy to recommend the service for care and treatment.

Staff identified good teamwork, hardworking staff, good resources (including information technology resources) and effective streaming as factors that enabled them to deliver person-centred care. Staff informed us they had access to participate in book clubs, running clubs, raffles and other activities for team bonding. They informed us they had access to occupational health and counselling support. Senior staff informed us they conducted wellbeing re-assurance checks, for example, check-ins with staff on long term sick leave.

The service made efforts to promote equality and diversity in daily work and provided opportunities for career development, staff told us they were generally treated fairly and with respect. Leaders acted to continually review and improve the culture of the organisation in the context of Equality, Diversity and Inclusion (EDI).

The service had several training programmes and leadership development opportunities for clinical and operational staff. The service actively supported staff to develop the skills and knowledge to progress their career. Rotations within the trusts urgent and emergency care services enabled staff to maintain skills and confidence in managing a broader range of presentations, and enhanced training such as ENP development, paediatric skills sessions and annual appraisals were consistently undertaken.

Efforts were made to facilitate flexible working arrangements for staff. Where practicable, reasonable adjustments were implemented to support employees in fulfilling their roles effectively.

Staff survey results for the acute and general medicines division (2024) showed that the division performed better than the trust average in people promise themes including morale, staff engagement, and learning and for the statement. However, the result was not broken down for emergency medicine.

The service had several staff wellbeing and recognition programs including monthly employee recognition programme, ED Christmas superstar awards, ED summer party and coffee mornings. The service won the trust care award in December 2024.

Staff had access to health and wellbeing support provided by the trust including dietary support, gym discounts, mental wellbeing resources, physiotherapy services among others.

Staff highlighted increased occasions of violence and aggression which they felt was adequately mitigated by the trust. The service had weekly meetings with site management and security. There were flags on the electronic system to alert staff of potential risk of aggression from patients. Where appropriate, consideration was given to the patient’s exclusion from trust services. All staff were given personal alarms to escalate concerns if required.