St Thomas' Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding.

We have not awarded this service a score for Responsive.

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

The evidence showed an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients received care that met their individual needs. Patients were positive about the care they received, they said they felt listened to. We saw staff consistently introduced themselves to patients and responded to patients when asked. Patients had access to a range of refreshments including sandwiches, fruit and cakes. Hot meals were ordered for patients who spent longer than 4 hours in the department.

Staff completed individual risk assessments, including delirium screening, falls risk assessments and pressure ulcer assessments. Staff told us they were confident in the care they provided and described a patient centred approach. Staff said they felt confident advocating for patients. One staff member gave an example of challenging colleagues when they felt a safeguarding referral should have been made.

Family members were involved in decision‑making where this was appropriate. Relatives and support people told us they were included in the persons care and felt that the patient’s preferences were respected. Documentation showed that staff recorded when family members had been involved in discussions or decisions.

There were clear pathways for people attending the department. A GP centre, located in the outpatient area but managed by the emergency department team, enabled suitable patients to be streamed directly from the front door. The Multi-Speciality Assessment Unit (MSAU) provided rapid assessment, investigations and short stay care for patients requiring specialist review. The Crisis Assessment Unit (CAU) provided a small unit with a calm environment to provide person centred care for people whose physical health needs had been addressed but they needed ongoing mental health assessment. The CAU had 4 beds in an environment which was designed to be more therapeutic as it was quieter, lights could be dimmed and the patients were supported by staff from the mental health trust. The CAU had close links with other mental health services such as the home treatment teams and inpatient services.

There were in reach services to support person-centred care. Emergency department staff could access support from the psychiatric liaison team, addiction care team, learning disability team and frailty team. The trust had a team to support people who were homeless. This team could be accessed for patients attending the ED. The paediatric emergency department had access to child specific professionals including a health play specialist and we saw them accessing this during the assessment. There was also a liaison health visitor and a youth worker. We observed the health visitor in the department. Staff told us they used a smart page system to request input from specialties, who were usually responsive.

Staff received training to help them meet the needs of diverse patient groups. They told us they had regular teaching and felt confident in their roles. Weekly morning teaching sessions included topics relevant to specific patient needs. Between February 2025 and February 2026, these included marathon patient management, end‑of‑life care, learning disabilities and sickle cell disease. Records showed staff attendance at these sessions. Staff demonstrated good understanding of nursing patients with learning disability and dementia.

We saw a ‘care of the elderly’ board displaying information on frailty, dementia, support aids and pain assessment. A weekly frequent attenders meeting, with multidisciplinary attendance, helped staff plan care for people who presented frequently, for example those experiencing sickle cell crises.

Staff in the emergency department had access to the hospital’s palliative care team for advice and support, either by phone or in person. Staff told us that patients approaching the end of life were fast tracked to the admission ward, where the palliative care team continued their care. In the ED, a swan symbol was used to identify patients nearing the end of life, supporting staff to approach both the room and family interactions with sensitivity. A larger room in resus was used when possible to allow space for families. There was also a viewing room and separate family room available for relatives. Support from the hospital chaplaincy team was offered. The trust used an Amber Care Pathway to help staff recognise when a patient may be entering the end of life phase and to guide early conversations about advance care planning.

The service had systems to ensure neurodivergent patients received suitable care. This included neurodiversity-specific toys and equipment. Compliance for training on autism and learning disabilities was 88% and staff were booked onto the training.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff provided patients, their families, and carers with information that was accessible, and supported their rights and choices. Most patients and relatives said they were provided with relevant information about their condition, follow up care and treatment as required. We observed staff regularly keeping patients and their families informed.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. We saw that patient files could have flags put on their records to quickly alert staff of individual needs such as communication support. For example, if someone had a learning disability this would be on their record so all staff were aware.

Interpreting and translating services were available for people. We saw communication boxes containing tools to support staff in communicating with patients, including Makaton sign cards and picture-based communication aids. There was an on‑demand video conferencing service that connected patients to a remote interpreter. We observed staff offering this service to patients and saw it being used during our visit. However, at the time of the inspection staff told us that only one of the two video conferencing portable devices was functional.

There was information for patients about patients’ rights, how to complain, treatments, and local services displayed throughout the department. Information leaflets were available to patients in a variety of different languages and screens in waiting areas displayed information.

The service had systems to ensure that information about people was managed in a way that supported responsive care, while still maintaining confidentiality and data security.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The trust electronic system allowed information to be shared between teams including community services within Lambeth and Southwark. The trust also communicated information with GPs post discharge. Patients also said they were involved in discussions about their care and knew the next steps.

Patients and their relatives told us they knew how to provide feedback about their care, including how to raise concerns or complaints. We saw accessible information about the complaints process displayed in the service. Patients said they felt comfortable to raise any concerns they had.

The service had an up to date complaints policy that set out clear guidance for staff on managing complaints. Staff we spoke with understood the policy and were able to describe how they would escalate a complaint.

The trust had recently developed a mental health patient feedback form for use in the ED. The form could be accessed online, through feedback equipment in the department and paper feedback forms were also available. The completion of the mental health patient feedback form was variable, and staff were looking at how this could be improved.

In the last 12 months, the service received 179 complaints. Of these, 131 were completed. Twelve complaints were upheld and 53 were partially upheld. The most common subject of the complaints were regarding clinical care.

Managers investigated complaints, identified themes, and shared learning with staff. Complaints data, alongside themes arising from coronial inquests, were discussed at the monthly clinical governance meetings. Staff told us that learning from complaints was shared with them during morning meetings and described how this was used to improve care.

Complaint records showed that action was taken to learn from complaints. For example, following a serious incident investigation, the department introduced post urinary catheter care packs for patients, and updated the electronic patient record to support clinicians documenting all required steps and information given to patients.

Results from the 2024 Urgent and Emergency Care Survey (Type 1 services) showed generally positive performance. Where areas for improvement were identified, the trust acted on feedback and implemented changes to improve the patient experience.

The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

Patients had equal and timely access to care, treatment and support. The service considered the needs of people with different protected characteristics and made reasonable adjustments to ensure patient’s individual needs could be met.

Staff made reasonable adjustments for people with disabilities. For example, a staff member told us that during triage they identified a patient with difficulty hearing. They escalated this to the nurse in charge and expedited the patient’s admission to reduce the risk that they might not hear their name called in the waiting room. Staff also wrote down key information for the patient to support clear communication. Another patient told us they experienced anxiety. They said staff were aware of their needs and communicated with them in a clear and simple way. The patient explained that staff would take them directly to where they needed to go to reduce the risk of them becoming overwhelmed.

There was adequate medical cover during both day and night shifts. Staff told us they could access a doctor in an emergency, and we observed good levels of medical staffing during our assessment. This meant patients had access to medical care at the right time.

Patients were streamed to areas appropriate for their care needs. For example, patients with primary care needs were streamed to the GP centre. This enabled the ED to focus on patients requiring emergency care, thereby enabling timely access to care and treatment.

The service had a coordinated, hospital wide approach to managing patient flow, involving specialty teams, site managers and flow coordinators. Site managers and flow coordinators attended multiple daily huddles to review patient flow and emerging pressures. This supported timely escalation of delays in specialty reviews or discharges, enabling teams to respond quickly and support the flow of patients. The service had access to the discharge lounge until 7pm for patients who were mobile or able to use a wheelchair. The service had escalation protocols for speciality teams to support ED staff when at full capacity. For example, 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.

For example, there were escalation plans for speciality teams to support ED staff when at full capacity.

In the last 12 months, the service met or exceeded the national performance target of 78% of patients being seen and treated within 4 hours in 10 out of the 12 months. Performance did not fall below 76% at any point during the 12 month period reviewed.

The proportion of patients waiting more than 12 hours from a decision to admit until admission remained low at under 0.5% over the past 12 months, with a monthly average of 0.4%. Average ambulance handover times over the past 12 months ranged between 14 and 18 minutes, demonstrating timely transfer of care.

We reviewed length of stay during our assessment and observed that the average length of stay for most patients in the ED was less than 4 hours. Between March 2025 and February 2026, the average length of stay in the ED was 3.27 hours. This meant most patients were seen, treated and discharged in a timely manner in line with national standards.

Patients were triaged in a timely way. Between March 2025 and February 2026, 87% of adult patients were triaged within 15 minutes. The mean time to triage for adults was 13 minutes, while the median time was 3 minutes, showing that many patients were assessed quickly on arrival. For paediatrics, 61% were triaged within 15 minutes, with a mean time to triage of 18 minutes and a median time of 13 minutes.

Although most patients were seen, treated or admitted within 4 hours of ED attendance, we observed long stays for patients with mental health needs. This was due to long waits for transfer to specialist mental health services. The trust monitored this closely and appropriately escalated the people who needed support to move to a more appropriate environment including the crisis assessment unit.

From August 2025 to January 2026, the service saw 102,393 patients. The average number of patients with a mental health condition who waited 12 hours or more from arrival was 133 (0.1%). The average length of stay for adults presenting with mental health needs was 12 hours, and 11 hours for young people.

The department and psychiatric liaison team had access to a live dashboard giving up to date information on who was in the ED. This highlighted patients with mental health needs who were assessed as needing a mental health inpatient bed and how long they had been waiting. There was a clear process to escalate when a person requiring an inpatient mental health admission remained in the department. The most recent audit of the Royal College of Emergency Medicine Mental Health (Self-harm) standards of care showed that the length of time patients with mental health needs spent in the ED was an area for improvement.

The trust closely monitored the patients who waited longest in the ED. For the months of October to November 2025, 6 patients had waited in the ED between 118-178 hours. The trust had looked at the reasons for this and found this mostly related to patients who did not live in the local area (called out of area patients) who were waiting for an inpatient bed.

The trust had arrangements for people with mental health needs who frequently attended the ED. There was a monthly meeting between the trust and the mental health trust to review these patients. Multi-disciplinary reviews took place as needed for each individual and care plans were implemented. The records were tagged for patients who attended regularly so ED staff knew about the care plans and could deliver consistent care and treatment.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.