St Thomas' Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Staff provided evidence-based care and treatment in line with current legislation, good practice and standards. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care. Staff obtained consent before they delivered care, support, or treatment. The service routinely monitored people’s care and treatment and carried out quality improvement projects to improve care.

At our last inspection we rated this key question Good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Patients received care, treatment, and support that was evidence-based and in line with good practice standards. This included individual risk assessments to support holistic patient care.

Staff followed policies to plan and deliver care according to best practice and national guidance. Guidelines were developed in line with national guidance, such as the National Institute of Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) standards.

Clinical guidelines and policies were available on the trust intranet, and staff knew how to access them. We reviewed a sample of the hospital policies and found they were compliant with current guidance and evidence-based practice.

The service had an audit programme to monitor staff compliance with guidelines. Action plans were implemented following audits to address any areas requiring improvement.

Patients were assessed using evidence-based tools, and the ED had a sepsis pathway which followed national guidelines. We observed good pain management and saw evidence of this in patient notes. Members of the psychiatric liaison team completed full bio-psychosocial assessments for patients with mental health needs, and we saw this in records reviewed.

Where needed the patients with mental health needs had access to a dual diagnosis nurse from the psychiatric liaison team for support with substance misuse issues. People could be referred to separate substance misuse services as needed.

Staff working in the ED described how they received training on mental health. In the adult ED we heard how the psychiatric liaison team offered training on common symptoms, disorders and treatment. Staff were also taught how to support patients using scenarios. In addition, the psychiatric liaison team provided training for medical trainees and junior doctors working in the ED. In the paediatric ED, the Matron who is a mental health lead arranged for the CAMHS team to deliver scenario-based training to the ED staff. There are plans to repeat this training for those who could not attend the last session.

Staff assessed and met people’s nutrition and hydration needs. We observed patients being offered refreshments, food and water. Water dispensers were at various points in the department, including the waiting areas, so patients and visitors had access to water.

The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff worked across teams, health care disciplines and with other agencies when required to care for patients. We saw that information was appropriately shared with GPs, community teams, and other local trusts. The trust worked well with local partners and had a good understanding of system pressures.

Staff had access to information needed to appropriately assess, plan and deliver people’s care, treatment and support. The trust used an electronic record system accessible to all relevant staff. This helped facilitate better communication between healthcare professionals.

Staff within the ED worked well with the psychiatric liaison team to care for patients with mental health needs. Staff and patients informed us about how they valued the support received from the enhanced care team. We also heard and observed how they worked collaboratively with other staff in the ED.

They also worked well with ambulance staff and obtained relevant information to care for patients arriving by ambulance. Ambulance staff we spoke to said they had good working relationships with the ED team. They informed us handover with ED staff was prompt and effective and they didn’t have to stay in the ED for too long.

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When people were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain the continuity of care.

Staff held multidisciplinary meetings to discuss patients and improve their care. The service held daily multidisciplinary team (MDT) huddles and staff handovers. We observed several huddles and saw representation from medical, nursing, allied staff, social workers and administrative staff. Staff discussed ED capacity, patients in the department, their length of stay, care and treatment plan. Flow coordinators and the hospital site managers join in team huddles to review capacity within the ED and wider trust and ensure smooth patient flow.

We observed effective liaison with other teams, speciality units, site managers and flow coordinators to manage capacity and flow within the ED. A team of GPs and Emergency Nurse Practitioners (ENPs) cared for patients at the GP centre and at the urgent treatment centre (UTC). There was a hospital wide approach to managing capacity. For example, there were escalation plans for speciality teams to support ED staff when at full capacity. Staff could dial 3333 to trigger triage escalation or immediate ambulance handover. This prompts senior staff and speciality teams to review bed waits including transfer to a sister location to expediate patient flow. The emergency department and speciality teams worked together effectively. They took a hospital wide approach to supporting patients care.

The paediatric ED had implemented MDT teaching, with a focus on the practical application of emergency medicine algorithms and team integration.

All staff we spoke with were positive about effective team working across teams, external organisations and community teams. There was a positive culture on the unit and staff felt able to provide patients with effective care and treatment.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were mostly positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Managers and staff conducted repeated audits and quality improvement projects to improve patient outcomes.

The service had a quality improvement (QI) lead who worked on all Royal College of Emergency Medicine (RCEM) audits with ongoing quality improvement projects. They had 3 monthly QI meetings and yearly QI poster competitions. The service displayed audit results and shared key messages to staff. QI projects in 2025/26 included Making Every Contact Count (MECC) by helping individuals and communities to significantly reduce their risk of long-term diseases through behavioural change with a focus on addressing lifestyle factors. The department was also working on a major haemorrhage project to ensure protocols were followed appropriately. The ED was working to improve their management of sepsis by reviewing patients monthly and introducing interventions to improve care.

A quality improvement project for streamlining gynaecology referrals in the ED was carried out to eliminate inappropriate referrals to the gynaecology team over a period of 9 months. The QI project reviewed referral outcomes in September 2024 (cycle 1) and May 2025 (cycle 2). Both cycles reviewed 20 referrals each, a fifth of referrals were deemed inappropriate in cycle 1, compared to all referrals deemed appropriate in cycle 2.

The service carried out a quality improvement project to review pain score being completed. This covered a 2 year period from October 2023 (when the new electronic system went live) to October 2025. The result demonstrated an improvement with pain score being completed from 40% compliance in 2022/23 to 60% compliance in 2025. The QIP identified areas for improvement including the requirement to prescribe analgesia within 15 minutes of pain score. The service had submitted a business case to create an ED pain management dashboard on the electronic system by May 2026. The metrics will track and improve performance around time-sensitive analgesia delivery in line with RCEM standards.

The trust had carried out an audit of the RCEM Mental Health (Self-harm) standards of care. The service was above the national average for the percentage of patients undergoing mental health triage, percentage of patients undergoing parallel assessment, time to ED clinician review, evidence of compassionate care and evidence of appropriate physical health assessment. The service also performed better than the national average for the appropriate level of observation for high and medium risk patients, and risk assessment by ED clinician for suicide and further self-harm.

However, the service was below the national average for documented mental health triage within 15 minutes of arrival, capacity documentation for patients who do not wait for assessment, length of time to psychiatry liaison nurse assessment, and length of time spent in the ED. Following the audit, the trust identified areas for improvement carried out extensive work to improve the service. This included the implementation of a mental health risk assessment on the electronic system, teaching sessions for staff and improved documentation of restrictive practices including sedation. The trust consistently collaborated with local system partners to review mental health provision in the community.

There were also bi-annual audits of the use of rapid-tranquilisation and the support given to patients. This had identified the need to improve some of the records. An annual audit took place looking at the care and treatment delivered to patients with mental health needs across the trust.

Results of an audit of time critical medicines (2025) showed improving identification of patients prescribed medication for diabetes from 38% in 2023/24 to 87% in 2025. However, this was taking longer than the recommended 30 minutes. The service had also made improvements in Parkinson medication prescribed and given within 30 minutes of arrival. The department created posters highlighting results from the time critical medicines audit and next steps for improvement.

Result of an RCEM audit of the care of older people showed the service was above the national average for all standards. The audit identified areas of improvement and implemented actions to aid improvement.

The 7 day re-attendance rate is commonly used to reflect the safety and effectiveness of the initial care and discharge from the ED. Between February 2025 and January 2026, the average re-attendance rate within 7 days of the initial ED visit was 3.2% for the paediatric ED and 5.4% for the main ED. This was better than the England average and reflected the safety and effectiveness of care and treatment in the ED.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

People understood their rights around consent to the care and treatment they were offered. People told us staff explained care and treatment options and gained verbal consent for physical assessments. Staff assessed whether a child was mature enough to make decisions about their care and treatment, using the test of 'Gillick competence''. This ensured children could make their own decisions when they had sufficient understanding and intelligence to be capable of making an informed decision. Staff we spoke with fully understood the Mental Capacity Act 2005 as it related to consent to treatment

Staff we spoke to understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (MHA) and Mental Capacity Act (MCA) 2005, and they knew who to contact for advice. Records reviewed showed staff completed mental capacity assessments were relevant. The trust had previously identified the need to tighten processes around the application of the Mental Health Act, including reading people rights. As a result, they had introduced a tracker to ensure patients could access advocacy and rights were being read.

Staff could describe and knew how to access the policy and get accurate advice on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

89% of staff had completed safeguarding vulnerable adults level 2 training which included MCA and DoLS training.