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St George's Hospital (Tooting) Requires improvement

This service was previously managed by a different provider - see old profile

We are carrying out checks at St George's Hospital (Tooting). We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 19 July 2018

Our rating of services stayed the same. We rated it as requires improvement because:

  • The Department of Health and Social Care standard for 95% of patients in accident and emergency to be admitted, transferred or discharged within four hours, was consistently not met between January 2017 and December 2017.
  • From quarter 3 of 2016/17 to quarter 2 of 2017/18, the trust consistently failed to meet the 93% operational standard for patients to be seen within two weeks of an urgent GP referral for suspected cancer.
  • The environment in theatres remained a significant issue. Theatres were old and in need of significant improvement and maintenance. This presented an increased risk of infection as well as a risk of theatres becoming unusable due to urgent maintenance requirements.
  • The trust was still not reporting Referral to Treatment Time (RTT) data. This meant the trust could not be fully assured that all patients had received their appointments nor could they identify what stage patients were at in their treatment pathway.
  • There was a lack of recording of information about physical restraint and the administration rapid tranquillisation to patients. This meant the trust could not be assured that these practices were being reviewed and monitored or were in line with NICE guidance.
  • Risks were not being dealt with in a timely way. For example, in accident and emergency, some risks entered on to the register in 2014, were still waiting to be resolved.
  • There was low compliance in some mandatory training modules for most staff groups and staff appraisal rates were below the trust target.
  • Medical records were not always held securely and were not completed consistently with gaps in documentation. There were three separate recording systems in place, which meant there could be difficulty in accessing records when patients were moved between wards. We found this was similar at the last inspection.
  • Some staff had limited knowledge of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and some staff did not always complete the required documentation fully or consistently. We found this was similar at the last inspection.
  • Pain score tools were not consistently completed and records demonstrated that timely pain relief was not always administered to patients. We found this was similar at the last inspection.
  • Some complaints were not investigated and closed in line with the trust policy of 85% of complaints being responded to within 25 working days of receipt.
  • The hospital was in the bottom 25% of trusts in terms of the proportion of patients not developing pressure ulcers.
  • The paediatric service was not meeting guidelines for consultants to review patients within 14 hours of admission.
  • In the outpatients department, nasoendoscopes were occasionally decontaminated in a way that was not in line with best practice guidance, as a result of problems with formal sterilisation equipment. This meant there was a risk that a patient could have a procedure carried out with a nasoendoscope that had not been formally sterilised and this was not always reported as an incident.

However:

  • The emergency department (ED) was meeting the Royal College of Emergency Medicine (RCEM) recommendations that consultants should provide 24 hour, 7 days a week cover, as the hospital was a major trauma centre. I

  • There was a good incident reporting culture and learning from incidents were shared across the hospital.
  • There was effective multi-disciplinary team working in all areas.
  • Staff cared for patients with compassion, involved them and those close to them in decisions about their care and took time to ensure patients and their families understood treatment. Feedback from patients we spoke with was overwhelmingly positive about the care they received.
  • Paediatric ED nursing staff were interviewed by a children’s interview panel as well as going through a normal recruitment process. The children were usually service users who had been treated by the ED.
  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs ensuring people could access the service when they needed it. The trust had robust processes in place to manage flow through the hospital.
  • There were effective systems in place to safeguard children and young people from harm. Children were monitored to identify any deterioration in their condition. Children and young people living with mental health challenges were cared for in an anti-ligature bay on Frederick Hewitt Ward.
  • There was strong evidence of a good education and research culture, particularly within the cardiac investigation unit and the therapies department.
  • The trust had introduced an automatic text or phone reminder system which had reduced the ‘Did Not Attend’ rate of appointments by approximately 7%.
  • The hospital had improved the process to ensure there was a complete set of contemporaneous patient notes on site during clinic appointments through a scanning system and had tracked down 1,081 missing files since August 2017.
  • In medical records, some patient notes were equipped with electronic stationery meaning they could be tracked on their journey throughout the hospital.
  • In the therapies department, therapists could use software to send videos of exercises to send to their patients to complete, which staff told us had improved patient outcomes.
Inspection areas

Safe

Requires improvement

Updated 19 July 2018

Effective

Requires improvement

Updated 19 July 2018

Caring

Good

Updated 19 July 2018

Responsive

Requires improvement

Updated 19 July 2018

Well-led

Requires improvement

Updated 19 July 2018

Checks on specific services

Outpatients and diagnostic imaging

Inadequate

Updated 1 November 2016

We rated this service as inadequate because:

  • An external review of Referral To Treatment (RTT) data quality at St George’s University Hospitals NHS Trust was published in June 2016. This found that due to a high number of unknown start times of a patient’s referral journey, patients were prevented from being treated in chronological order. The trust was also inconsistent in achieving their two week targets for patients with suspected cancer.
  • Following the inspection, the trust wrote to NHS Improvement and NHS England , to confirm their intention to temporarily cease national reporting of our RTT data. This was because, they could not guarantee the data they were reporting was robust and accurate.

  • There were several examinations where radiographers gave contrast to patients despite PGDs not being in place.
  • The systems in place for the prevention of healthcare associated infections with specific regard to hand hygiene, were not being consistently followed throughout the outpatient department. Monthly clinic hygiene and cleaning audits were completed by the contracted cleaning provider, however, the results did not reflect the cleanliness of the areas we inspected.

  • The design, maintenance and use of facilities and premises did not keep people safe at all times. Some of the areas were cramped and very busy.

  • Staff were not able to observe the patients waiting in their departments.

  • Staff struggled to maintain patient privacy and confidentiality, mainly due to the lack of space and overcrowding of certain clinics.
  • There was limited audit of patient waiting times for clinics and all the clinics we attended over-ran.
  • Staffing levels had been critically low and the outpatients had been running at approximately 50% vacancy rates. However, the staffing structure had been reviewed and vacancy rates were much improved in outpatient administration areas. Availability of records for outpatient clinics had improved since the last inspection although we found the records were easily accessible by the public during clinic sessions, often left in unsupervised areas.
  • The introduction of the Electronic Data Management System had ongoing issues and extra capacity was needed to ensure further roll-out.
  • Trust level Did Not Attend (DNA) rates (9%), were consistently worse than the England average (7%), between September 2014 - August 2015.

However:

  • Most staff had completed mandatory training.
  • Staff were aware of their responsibilities within adult and children safeguarding practices and good support was available within the hospital.
  • Staff followed consent procedures and had a good understanding of the Mental Capacity Act 2005.
  • Staff were committed to delivering good care, but morale was low and they felt under pressure.

  • Staff were caring and involved patients, their carers and family members in decisions about their care.

Outpatients

Requires improvement

Updated 19 July 2018

  • Referral to Treatment Time (RTT) data was still not being reported. This meant that OPD could not yet be fully assured that all patients had received their appointments or could not identify what stage patients were at in their treatment pathway. Although there was an Elective Care Recovery Programme designed to restart reporting of RTT data, this lack of assurance had a negative impact on our ratings for the responsive and well led domains in the OPD.
  • There was one resuscitation trolley shared by seven clinics in Lanesborough Wing. This meant that in some clinics, the resuscitation trolley was a distance away and would have to be brought to the patient through a busy area.
  • Nasoendoscopes were occasionally decontaminated in a way that was not in line with best practice guidance, as a result of problems with formal sterilisation equipment. This meant there was a risk that a patient could have a procedure carried out with a nasoendoscope that had not been formally sterilised and this was not always reported as an incident.
  • Staff told us it was difficult to meet the demand of overbooked clinics with the baseline staffing levels available.
  • Confidential medical records were not always stored securely, which meant they could be accessible to unauthorised persons.
  • There was a lack of local audits and information on patient outcomes.
  • The cramped environment in the infusion suite had a negative impact on patient privacy and dignity, particularly when full.
  • From quarter 3 of 2016/17 to quarter 2 of 2017/18, the trust consistently failed to meet the 93% operational standard for patients to be seen within two weeks of an urgent GP referral for suspected cancer.
  • The system for blood testing in Lanesborough Wing was unclear which caused confusion amongst patients and long queues at the reception desk.
  • Most clinics overran due to overbooking, and there were too many patients to be seen in too few clinic slots. This meant patients waited longer than they needed to for their appointment.
  • There was not always leadership capacity to deliver high-quality and sustainable care in the OPD, due to heavy workloads for some key staff and a lack of senior staff in some areas.
  • Some staff felt issues were not solved, or their personal development was not funded due to a leadership culture weighted towards achieving financial stability.
  • Not all risks on the risk register had associated actions, a date for review or a date by which actions to be completed.

However:

  • Staff were aware of their responsibilities to report incidents and staff told us of a culture of learning from incidents in outpatients.
  • The trust had introduced daily pre-clinic briefings to discuss clinic lists and staffing which were in the process of being embedded.
  • The OPD used a combination of best practice and national guidance to deliver care and treatment to patients, and staff were competent to provide this care.
  • There was strong evidence of a good education and research culture within the cardiac investigation unit and the therapies department.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff interacted with patients and their families in a kind and compassionate manner, and patients spoke positively about the care they received.
  • There were a range of support teams available including dementia, learning disability and mental health liaison to meet patient’s individual needs.
  • The trust had introduced an automatic text or phone reminder system which had reduced the Did Not Attend rate by approximately 7%.
  • Staff told us there had been an increase in the visibility of leadership from the trust board in the OPD since our last inspection.
  • The hospital had improved the process to ensure there was a complete set of contemporaneous patient notes on site during clinic appointments through a scanning system and had tracked down 1,081 missing files since August 2017.

Maternity and gynaecology

Good

Updated 1 November 2016

Overall we rated maternity and gynaecology services as good although we judged some aspects of the services to be outstanding:

  • Year on year reductions in key indicators for maternal outcomes.
  • The acute gynaecology service offered a highly effective and timely service in acute gynaecology and early pregnancy.
  • There was outstanding performance in relation to supporting women who had pregnancy loss.
  • The service provided safe and effective care in accordance with recommended practices.
  • There were well-developed care pathways in maternity services for women identified as being ‘at risk’ because of medical conditions or vulnerability and the service had staff with expertise in several specific conditions of pregnancy.
  • Staff were confident about reporting incidents and said learning from these was shared with staff.
  • Midwives and doctors worked well together as a team without hierarchy.
  • There were clear pathways for all pregnant women to access the right services for their needs, with excellent access to specialist midwives.
  • Staff demonstrating compassion and patience towards women.
  • Staff were conscious of the need to protect the dignity and privacy of women in all areas of the service.
  • Antenatal clinics were available at many locations in the community thus minimising women’s need to travel.
  • There were many good examples of pioneering work and innovative practices such home monitoring of hypertension in pregnancy, using a mobile phone app.

However:

  • Not all women received continuity of care from midwives.
  • Leadership required improvement as there was no evidence that midwives were being involved in developing the strategy for maternity in line with evolving national developments.
  • Midwives felt concerns they had expressed about the management of the service were not listened to at executive level or board level.

Medical care (including older people’s care)

Requires improvement

Updated 19 July 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • There was low compliance in some mandatory training modules for most staff groups and appraisals and safeguarding training was below the trust target.
  • We reviewed the documentation for Mental Capacity Act assessments and Deprivation of Liberty Safeguards and found most staff did not always complete the required documentation fully or consistently.
  • The trust reported that their Mental Capacity Act (MCA) training which incorporates Deprivation of Liberty Safeguards (DoLS) training was a “non-standard” training provided to all staff group. This meant staff were not applying the concept of MCA and DoLs consistently across the medical directorate.
  • There were no consistency in the use of ‘Forget me not’ stickers on patient records and on whiteboards to indicate that a patient was living with dementia in some wards where dementia patients were been cared for.
  • The planned number of registered nurses and healthcare assistants on the medical wards was not always achieved. The hospital relied heavily on the use of bank and agency staff due to a high number of vacancies.
  • The trusts performance was variable in the national audit of inpatient falls, the national heart failure audit and the national lung cancer audit. In the lung cancer audit, the trust did not meet the audit minimum standard of 90% of patients seen by a Cancer Nurse Specialist.
  • The trust performed poorly in the National Diabetes Inpatient Audit 2016 and National Audit of Inpatient Falls.
  • In the heart failure audit, the trust achieved only 1.1% score for the referral to cardiac rehabilitation against the national score of 12.1%.
  • There were inconsistent pain assessments for patients on some wards we visited during the inspection.

However:

  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs ensuring people could access the service when they needed it.
  • Staff recognised incidents and reported them appropriately. The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors.
  • Staff were attentive and provided compassionate care. Feedback from patients we spoke with was positive; that staff treated them well and with kindness.
  • Staff cared for patients with compassion, involved them and those close to them in decisions about their care and provided emotional support to ease any distress.
  • Staff spoke of good teamwork and we saw examples of multidisciplinary teamwork on all the wards we visited.
  • The trust had robust processes in place to manage patients flow through the hospital.
  • Staff told us that their line managers were visible, approachable and supportive. We saw positive leadership at ward and team level. Staff were aware of the trust’s vision and values, and we saw these displayed on various locations within the hospital.
  • Governance arrangements were robust and heads of nursing attended divisional governance meetings and matrons attend directorate governance meetings.
  • Ward managers were aware of the risks to their service.

Urgent and emergency services (A&E)

Requires improvement

Updated 19 July 2018

  • Our overall rating of this service stayed the same. We rated it as requires improvement because:
  • The Department of Health’s standards for 95% emergency departments to admit, transfer or discharge patients within four hours was consistently not met between January 2017 and December 2017.
  • The Royal College of Emergency Medicine recommends that the time patients should wait from time of arrival to receiving treatment is no more than one hour. The trust consistently failed to meet the standard.
  • From January to November 2017, the monthly median percentage of patients leaving the trust’s urgent and emergency care services before being seen for treatment was worse than the England average in five out of 11 months.
  • The holistic needs of people living with mental health issues were not always met.
  • The lack of recording of information about restraint and rapid tranquillisation meant that the trust could not be assured that this practice was being reviewed and monitored and was in line with NICE guidance.
  • The risk register had eight risks identified including five risks linked to the environment, however, risks were not being dealt with in a timely way with some risk being entered on to the risk register in 2014 and were still waiting to be resolved.
  • The ED had two dedicated cubicles for patients who presented with mental health needs that were not compliant for patients with mental health needs.
  • Mandatory training in key skills was below the trust’s target of 85%.
  • Safeguarding assessments for children and adults were not always completed in records.
  • The management of sharps did not always comply with Health and Safety (sharps instruments in healthcare) regulation 2013.
  • The management of hazardous substances did not always comply with Control of Substances Hazardous to Health (COSHH) regulations 2002.
  • Medical records were not always held securely and were not completed consistently with gaps in documentation. We found this was similar at the last inspection.
  • The ED did not have specific arrangements to identify and meet the needs of patients living with dementia.
  • Appraisals rates for nursing staff were below the trust target of 90%. As of October 2017, 26% of nursing staff had not had an appraisal.
  • Staff had limited knowledge of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). We found this was similar at the last inspection
  • Patients’ consent was not always recorded and where decisions had been taken in a patient’s best interest these were not always recorded in patients notes.
  • Pain score tools were not consistently completed and records demonstrated that timely pain relief was not always administered. We found this was similar at the last inspection.
  • Complaints were not investigated and closed in line with the trust policy of 85% of complaints being responded to within 25 working days of receipt.
  • Not all the issues identified in the last inspection had been addressed for example we had concerns about ED staff’s limited knowledge of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and found no capacity assessment had been documented within records where this should have been appropriate.
  • There was a need for stability in the department due to the high turnover of senior nursing staff over the past six years.

However:

  • The ED was meeting the Royal College of Emergency Medicine (RCEM) recommendations that consultants should provide 24 hour 7 days a week cover as the ED was a major trauma centre. I

  • There was effective multi-disciplinary team working across the ED.
  • The ED participated in Royal College of Emergency Medicine (RCEM) audits. Re -audits of moderate and acute severe asthma, consultant sign off demonstrated an improvement in patient outcomes.
  • Staff provided treatment and care in a kind and compassionate way and treated people with respect.
  • In November 2017, 84% of patients indicated they would recommend the service provided in the emergency department in the Friend and Family Test (FFT).
  • The emergency department had a relative’s room where families could go to discuss issues with medical staff or amongst themselves relating to loved ones care or emotional support.
  • Staff took time to ensure patients and their families understood treatment. We observed doctors speaking respectfully and professionally about next steps for patients.
  • The trust scored “about the same as” other trusts for all three Emergency Department Survey questions relevant to the responsive domain in 2016.
  • From January 2017 to December 2017, only three of the trust’s patients waited more than four hours from the decision to admit until being admitted. The trust’s performance for this metric was much better than the England average.
  • Paediatric ED nursing staff were interviewed by a children’s interview panel as well as going through a normal recruitment process. The children were usually service users who had been through the ED journey.
  • Staff had secure access to the trust intranet which gave then access to trust news, policies and procedures and their training and personal development records.

Surgery

Requires improvement

Updated 19 July 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The environment in theatres remained a significant issue. Theatres were old and in need of significant improvement and maintenance. This presented an increased risk of infection as well as a risk of theatres becoming unusable due to urgent maintenance requirements.
  • The environment throughout the directorate was cluttered, with equipment, both disused and in use, stored in corridors.
  • Patient records were not always fully completed.
  • There were three separate recording systems in place, which meant there could be difficulty in accessing records when patients were moved between wards.
  • Records were not always securely stored and we observed staff leaving computer screens unlocked with patient identifiable data on them.
  • The directorate preformed worse than the national average in respect of the proportion of patients receiving treatment on the day of or day after admission.
  • The hospital performed worse than the national average of Patient Reported Outcomes Measures (PROMS) in respect of groin hernias, varicose veins, hip replacements and knee replacements.
  • The hospital was in the bottom 25% of trusts in terms of the proportion of patients not developing pressure ulcers.

However:

  • There was a good incident reporting culture, and learning from incidents were shared throughout the service.
  • Staff demonstrated genuine care and compassion when speaking about patients.
  • There was a non-hierarchical culture throughout the directorate. The contribution of all staff was recognised and staff at all levels felt able to raise concerns and challenge poor practice and the majority of staff spoke highly of the leadership, both at a local and directorate level. They said that they felt supported and able to escalate their concerns.

Intensive/critical care

Good

Updated 1 November 2016

We rated this service as good because:

  • We saw good evidence of learning from incidents and varied methods of disseminating learning points, including the ‘Big 4’ and work based social media. Learning from serious incidents was shared across the units.

  • The leadership team demonstrated appropriate responses to issues identified, such as gaps in the critical care service specification standards (D16) 2015, a review of the current outreach provision and increased in-house training opportunities for staff.

  • Suitable processes and development opportunities were in place to ensure nursing staff working on the units were competent. We also saw training and learning opportunities for doctors on CTICU and GICU and feedback from these staff members was positive.

  • We saw staff following evidence-based practice via specific clinical guidelines across the ICUs, for example the

  • The ICUs had a comprehensive audit programme in place to ensure audits were completed at appropriate intervals to monitor quality and safety. We also saw evidence of suitable responses to address audit findings, for example with regards to reducing pressure ulcers.

  • There were minimal non-clinical transfers out of the ICUs and few patients were discharged from ICU out of hours. Performance in this area was better than the national average for GICU and CTICU.

  • Patient and relative feedback was very positive about the care provided across the ICUs and staff were frequently described as considerate and respectful. Relatives told us they felt suitably involved in patient care and hospital feedback forms showed most relatives were as involved as they wanted to be in decisions about their loved one’s care.

  • We saw some specific examples where staff anticipated and met specific patient needs, such as nursing a patient in accordance to their religious beliefs on GICU and supporting a patient through a marriage ceremony on CTICU.

  • ICNARC data demonstrated that patient outcomes, including mortality and readmission rates, were as expected. Good outcomes were also achieved for patients who had their chests opened on the unit in emergencies.

However;

  • We were concerned about a potential culture of under reporting incidents. This was due to low incident numbers, staff feedback and minutes from the morbidity and mortality meetings that indicated incident reports were not always completed when they should have been. This had not been identified as an issue by the leadership team.

  • The risk register did not fully document all risks identified across the units and mitigating actions were not always sufficient to address risks.

  • The leadership team did not identify oversight of the satellite areas as an area for concern, despite us identifying some safety concerns in these areas such as poor completion of resuscitation trolley checks on CTICU.

  • Arrangements for doctors’ inductions on NICU were not robust and were not addressed when concerns were raised by staff. Feedback about teaching opportunities for doctors working on NICU was not positive.

  • Processes for managing patient risk on the hospital wards and providing critical care support were not optimised. Patients had to become sufficiently unwell to trigger a National Early Warning Score of six or more before a referral to the critical care team would be triggered.

Services for children & young people

Requires improvement

Updated 19 July 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Many problems that we found during previous inspections still existed; there were insufficient staffing levels on paediatric wards. The percentage of staff qualified in the speciality were still below recommended guidelines for the neonatal unit. Long standing risks to paediatric and neonatal staffing remained on the risk register since our last inspection and there had been little or no improvements in this area.
  • There was no clear strategy for children and young people’s service.
  • Some nurses told us they felt ‘bullied and intimidated’ to admit patients to the inpatient ward even when they felt it was unsafe to do so.
  • The service was not meeting guidelines for consultants to review patients within 14 hours of admission.
  • Spaces between beds on Jungle Ward did not comply with recommended guidelines.
  • There were insufficient controls in place to address the risks to fire safety on some of the inpatient wards.
  • Air conditioning on Frederick Hewitt Ward was unreliable and we noted excess levels of heat on the ward.
  • Curtains used on the anti-ligature bay on Frederick Hewitt Ward were transparent. This compromised patients’ privacy and dignity.
  • Nursing staff did not feel supported by the divisional leadership team.

However:

  • There were effective systems in place to safeguard children and young people from harm. Staff attendance at level three safeguarding training had improved significantly from the last inspection and was meeting the trust’s target of 85%.
  • Children were monitored to identify any deterioration in their condition. Patients with mental health conditions were now cared for in an anti-ligature bay on Frederick Hewitt Ward.
  • The results of investigations into incidents were discussed in departmental and governance meetings and action was taken to follow up on the results of investigations.
  • The service contributed to a wide range of national audits and undertook local audits to monitor and improve patient care.
  • Feedback for the services inspected were mostly positive. Staff respected confidentiality, dignity and privacy of patients.
  • Patients had access to same day and next day clinics and an ambulatory care centre had been set up to ease patient flow from the emergency department.

End of life care

Requires improvement

Updated 1 November 2016

We rated this service as requires improvement because:

  • We found the palliative care team to be highly skilled and knowledgeable; however we found them to be a generalist service not a specialist palliative care service. They reviewed all dying patients, but did not provide specialist palliative care.The palliative care team and ward staff told us that the palliative care team did not provide training to ward staff within the hospital to enable the ward teams to look after non-complex patients without support from the palliative care team.

  • Numbers of patients being referred into the palliative care services had increased year on year and which made the service unsustainable unless they provided a specialist services..

  • Whilst incidents were reported, the staff weren’t always able to locate incidents on the datix system to show us.

  • Patient records were not securely stored.

  • We found no evidence that patient pain assessments scales were used.

  • The palliative care out of hours service provided by Trinity Hospice, did not have a formal service level agreement in place.

  • The end of life care strategy was an action plan not a strategy and there were no clear pathways to achieve the results detailed within the document.

  • The ‘nursing daily evaluation last hour and days of life’ document was a prompt sheet, which was not backed up by either assessment tools or any evaluation tools to show whether the prompt had been addressed.

  • There was lack of strategic direction for the palliative care for the top of the organisation. The lack of multidisciplinary team meetings (MDT) with colleagues from medical and surgical departments and other allied health professionals was an area of concern.

However

  • There was an open and transparent culture within the service. Incidents were mostly reported and learning was shared.

  • Patients were treated with dignity and respect and staff were caring and supportive. The relatives we spoke with were happy with the care that they and their family members were receiving.

  • Anticipatory medicines were prescribed in a timely manner and were available when required by patients.

  • 85% of patients on fast track discharge were able to go to their preferred place of care last year.

  • The Macmillan Cancer Centre offered advice and support to patients with cancer and their relatives.

  • The spiritual centre provided for people of faith or those of no faith, remembrance services were held annually and services of many faiths were held on a regular basis in the centre. The chaplain attended both the end of life programme board and operational groups, which demonstrated the trust recognised the importance of religious and spiritual input to the delivery of the end of life care service.

  • The trust had appointed an end of life non-executive director one moth prior to our inspection.

Other CQC inspections of services

Community & mental health inspection reports for St George's Hospital (Tooting) can be found at St George's University Hospitals NHS Foundation Trust.