St George's Hospital (Tooting)

Updated 28 August 2025

Date of assessment:

• 16 and 17 October 2024 maternity.
• 4 November 2024 to 5 November 2024 urgent and emergency services (ED).
• 28 and 29 January 2025 surgery.

Epsom and St Helier University Hospitals NHS Trust and St George's University Hospitals NHS Foundation Trust formed a hospital group and appointed a Group Chief Executive in August 2021 (following the appointment of a Chairman in Common in 2019) and a single executive team in February 2022.

St Georges University Hospital provides urgent and emergency services, medical care, critical care, end of life care, maternity, outpatient, surgery and medical care services. This assessment looked at maternity services due to a previous inadequate rating. Surgery due to aged ratings and concerns regarding Never Events and at urgent and emergency services due to aged ratings and information of concern. We inspected all quality statements across the five key questions: all services looked at was rated as requires improvement. The rating from maternity, surgery and urgent and emergency services were combined with ratings of medical care, services for children and young people, critical care, end of life care and outpatient from the last inspection. See our previous reports to get a full picture of all other services at St Georges University Hospital. The rating of St Georges University Hospital remains requires improvement.

In our assessment of maternity we found some improvements had been made in specific areas. There was an improvement in the categorisation of incidents and in the provision and facilities for families who experienced bereavement. Staff said the culture and the way multidisciplinary teams reviewed incidents had also improved. However, despite these improvements, there were still some areas of concern that had not been resolved from the previous inspection. Staff did not always complete risk assessment documentation appropriately for each woman or birthing person. Medicines were not always managed safely. The design, maintenance and use of facilities, premises, and equipment did not always follow safety standards. Some equipment safety checks were out of date and daily checks had not always been completed. The service provided mandatory training and appraisals in key skills to all staff but did not always ensure everyone had completed it. The service did not have enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Staff monitored the effectiveness of care and treatment via audits however, appropriate action was not always taken in response to this. There was no stable leadership team within the service. Following the inspection, under Section 29A of the Health and Social Care Act 2008, we issued a warning notice to the provider. We took this action as we believed women, birthing people or babies would or may be exposed to the risk of harm if we had not done so.

In our assessment of surgery services we found the risks to people had not been consistently assessed and mitigated and we were not assured that learning from previous incidents had been embedded fully. Care was not always delivered in line with national clinical guidance, and evidence-based best practice. The service was not always easy to access and at times patients experienced long waits in the hospital for their surgery. The governance systems in place had failed to identify and rectify some of the concerns found at this assessment. However, staff were kind, caring and compassionate. Staff and teams worked together well to deliver good person-centred care. The service was in breach of the legal regulation relating to safe care and treatment. We were not assured that the service appropriately assessed risks to the health and safety of patients receiving care or treatment and did all that was reasonably practicable to mitigate any such risks

In our assessment of urgent and emergency services we found there were a few improvements. However, there were still concerns that had not been resolved from the previous assessment as well as new concerns. Medicines were not always managed safely. Staff did not always complete risk assessments and update them swiftly. Staff did not keep detailed records of patients' care and treatment and records were not always clear and up to date. The environment did not consistently support safe care. Some equipment was out of date and premises were not secure. Patients at risk of deterioration were not always promptly assessed and documentation was inconsistent. Overcrowding was an ongoing issue where privacy and dignity was not always maintained in corridors and triage areas. Following the inspection, under Section 29A of the Health and Social Care Act 2008, we issued a warning notice to the provider. We took this action as we believed the service had not managed patient acuity appropriately during streaming and triage processes and medicine management, including delayed administration of time critical medicines. Breaches were also found around poor standards of documentation and information security.

Updated 13 August 2024

St George’s Hospital is a large teaching hospital in Tooting with 1,300 beds and employs approximately 10,345 staff; serving a population of 1.3 million across Southwest London and surrounding areas. The maternity service provides consultant-led and midwife-led care for both high and low risk women. The hospital's maternity services offer a wide range of specialised care, including a consultant-led labour ward, a birth centre, an outpatient antenatal clinic, a fetal medicine unit (FMU), a maternity day assessment unit, a triage unit, antenatal and postnatal inpatient wards (including transitional care), and bereavement services. From October 2023 to October 2024, there were 4,301 babies born at this hospital.

We inspected the maternity service at St George's Hospital. We last carried out a focused inspection of the maternity service in 2023 as part of our national maternity inspection programme and it was rated inadequate. We carried out an unannounced, comprehensive inspection of the maternity service, looking at all key questions (safe, caring, effective, responsive and well-led). We rated maternity services overall as requires improvement.

Since the last inspection in March 2023, some improvements had been made in specific areas. There was an improvement in the categorisation of incidents and in the provision and facilities for families who experienced bereavement. Staff said the culture and the way multidisciplinary teams reviewed incidents had also improved.

However, despite these improvements, there were still some areas of concern that had not been resolved from the previous inspection:

• Staff did not always complete risk assessment documentation appropriately for each woman or birthing person.
• Medicines were not always managed safely.
• The design, maintenance and use of facilities, premises, and equipment did not always follow safety standards. Some equipment safety checks were out of date and daily checks had not always been completed.
• The service provided mandatory training and appraisals in key skills to all staff but did not always ensure everyone had completed it.
• The service did not have enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment.
• Staff monitored the effectiveness of care and treatment via audits however, appropriate action was not always taken in response to this.
• There was no stable leadership team within the service.

The service was previously in breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008. Although some improvements had been made, they were insufficient, and the service remained in breach of this regulation. Following the inspection, under Section 29A of the Health and Social Care Act 2008, we issued a warning notice to the provider. We took this action as we believed women, birthing people, or babies would or may be exposed to the risk of harm if we had not done so. In response to the warning notice, the trust made a number of changes to ensure women, birthing people, and babies were safe.  

Updated 13 August 2024

Date of assessment: 28 January to 29 January 2025

We carried out an unannounced comprehensive inspection of surgical services on 28 and 29 January 2025 due to aged ratings and concerns regarding Never Events within the service. We inspected all quality statements across the five key questions: safe, effective, caring, responsive and well-led.

During our inspection we visited the following wards: Benjamin Weir, Brodie, Florence Nightingale, Gray, Gunning, Keate, Vernon and Major Trauma Unit. We also visited a selection of theatres and recovery; the Surgical Admissions Lounge, Day Surgery Unit (DSU) and the Nye Bevan unit, which is the Surgical Assessment Unit and includes surgical same day emergency care (SSDEC). We spoke with over 40 members of staff including nursing and medical staff of all grades, pharmacists, healthcare assistants, housekeeping staff, and managers. We spoke with over 30 patients and their relatives.

We rated the service as Requires Improvement. We found 3 breaches of the regulations in relation to safe care and treatment, premises and equipment and good governance. We were not assured that the service appropriately assessed risks to the health and safety of patients receiving care or treatment and did all that was reasonably practicable to mitigate any such risks. Audit data showed the service did not always complete Venous Thromboembolism risk assessments in a timely manner and did not always comply with National Safety Standards for Invasive Procedures. We saw limitations on space and storage of equipment in the corridors on some wards was previously assessed as posing a risk to evacuation in the event of fire. During our inspection we observed that some escape routes remained obstructed by equipment. We were also not assured of effective governance processes. However, staff were kind, caring and compassionate. Staff and teams worked together well to deliver good person-centred care.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 13 August 2024

We carried out an unannounced focused assessment of the St. George's Hospital emergency department (ED) on 4 and 5 November 2024 due to aged ratings and ongoing patient safety concerns from previous assessments relating to IPC, poor documentation and records, incomplete risk assessments, and medicine management. We assessed 30 quality statements across the five key questions: safe, effective, caring, responsive and well-led.

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St. George's Hospital in Tooting is a designated Major Trauma Centre. It serves as the hub for the south west London and Surrey Major Trauma Network, treating patients with severe, life-threatening injuries. This includes patients with injuries from incidents like stabbings, gunshot wounds, and serious road traffic accidents. During our assessment, we visited all areas of the emergency department including majors, the resuscitation area, paediatrics, the urgent treatment centre (UTC), the rapid assessment and treatment (RAT) area and the ambulance handover zone. We spoke with patients, family members and staff including nursing and medical staff across all grades, pharmacists, healthcare assistants, housekeeping staff and managers.

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We last carried out a focused inspection of the ED in March 2024 following incidents in the ED. The service was not re-rated during that assessment and maintained the previous rating of requires improvement from a wider assessment in July 2019. During this assessment, the rating has remained as requires improvement.

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Since the last inspection in 2019 there were a few improvements. However, there were still concerns that had not been resolved from the previous assessment as well as new concerns:

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• Medicines were not always managed safely.
• Staff did not always complete risk assessments and update them swiftly.
• Staff did not keep detailed records of patients' care and treatment and records were not always clear and up to date.
• The environment did not consistently support safe care. Some equipment was out of date and premises were not secure.
• Patients at risk of deterioration were not always promptly assessed and documentation was inconsistent.
• Overcrowding was an ongoing issue where privacy and dignity was not always maintained in corridors and triage areas.

The service was in breach of Regulation 12 (safe care and treatment) and Regulation 17 (good governance). We were not assured the service managed patient acuity appropriately during streaming and triage processes and medicine management, including delayed administration of time critical medicines. Breaches were also found around poor standards of documentation and information security. We have asked the provider for an action plan in response to the concerns found at this assessment.

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Updated 18 December 2019

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

• The service provided mandatory training in key skills to all staff however not all staff had completed it. Medical staff in the division did not meet the trust target for most mandatory training and safeguarding training modules.
• Staff did not always complete and update risk assessments for each patient. Documentation in patient files was inconsistent and not always completed, and consent forms were not always completed in full.
• The service did not always have enough staff, including nurses and doctors, with the right qualifications, skills, training and staff told us this was a potential risk to patient safety.
• Records of patients’ care and treatment were not always stored securely or easily available to all staff providing care. Electronic records were not always accessible in a timely manner and paper records were not always securely stored. We saw paper records that included patient identifiable information and do not resuscitate forms accessible in folders and were not secure or marked as confidential.
• The service did not always coordinate between pharmacy and ward staff use systems and processes to safely store medicines. We found examples of fridge temperature recordings consistently higher than the recommended temperature and ward staff were not clear what action had been taken. Staff could not be sure the medicines was safe to use.
• The catheter laboratory had aging equipment that needed replacing and two beds had been decommissioned as a result. There was a risk of further equipment failure and a temporary mobile catheter laboratory had been commissioned by the trust. The trust is a designated heart attack centre. Following the inspection, the trust advised us that a business case for the provision of equipment was approved by the board in September 2019.
• Patients were at a higher risk of readmission following discharge when compared to the national average. The risk of readmission for both elective and non-elective treatment was higher than the national average in two of the top three specialities by number of admissions.
• The service did not encourage black, Asian and minority ethnic (BAME) to join the staff BAME network where they could seek support. Staff we talked to were not aware of the network and senior staff were not able to direct us to information on the intranet for staff to access.

However:

• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The division had worked hard to reduce the number or patient falls. We saw examples of initiatives such as “bay watch”, where a designated member of staff always remained in a bay to assist patients and patients were provided with socks with grip to prevent slips. All staff we talked to had a good awareness of initiatives and why they were important.
• The trust scored highly in the Sentinel Stroke National Audit Programme (SSNAP). On a scale of A-E, where A is best, the trust achieved grade A in latest audit.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

Updated 18 December 2019

Our rating of this service improved. We rated it as outstanding because:

• The Children’s service had made significant improvements in safeguarding training and supervision, meeting the individual needs of children and young people, reduction of surgical site infections, improved outcomes in the National Diabetes audit, management of risks, maintaining dignity and respect, meeting guidelines for consultants to review patients within 14 hours of admission and the leadership of the service. Many of the issues identified in our previous inspection had been addressed or there were effective plans to address.
• The service had enough staff to care for children and young people to keep them safe. However, some departments were still heavily reliant on bank and agency staff, but a successful recruitment campaign meant this would be addressed. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. Although the staff qualified in speciality on the neonatal unit and paediatric intensive care unit did not meet the national guidelines, it had improved since our last inspection. The service controlled infection risks well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff recognised and respected the totality of the needs of children, young people and their families. They always took their personal, cultural, social and religious needs into account, and found innovative ways to meet them.
• Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from people who used the service, those close to them and stakeholders was always very positive about the way staff treated people.
• Staff found innovative ways to enable children and young people to manage their own health and care when they could and to maintain independence as much as possible.
• There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs.
• The service planned care to meet the needs of local children and young people and took account of their individual needs and made it easy for them to give feedback. Children and young people could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. A Children’s Strategy Priorities was awaiting final ratification, some staff had knowledge of this. Staff understood the service’s values, and how to apply them in their work. Staff felt more respected, supported and valued since our last inspection. Morale was still low in some areas but improving. Staff were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children and young people and the community, to plan and manage services. All staff were committed to improving services continually.

However:

• The neonatal unit was not still meeting British Association of Paediatric Medicine staffing standards for units providing neonatal intensive care. The standards require 70% of nurses to be qualified in the specialty. However, this had improved since our last inspection; 58% were now qualified, compared to 40% at the time of the last inspection. The paediatric intensive care unit was still not meeting national standards requiring 70% of nurses to be qualified in the speciality. However, this had improved since our last inspection and 63% were now qualified, compared to 61% at the time of our last inspection. The service had a tangible plan to ensure this standard was met within the next 12 months.
• The number of nursing staff who had received an annual appraisal was below the trust target in many wards and departments. Across the whole service 72% of nursing staff had received and appraisal which (trust target 95%).
• There were still high level of staffing vacancies on the neonatal unit and paediatric wards, which meant the service had high use of agency and bank staff. Agency staff were not able to carry out all the procedures undertaken by permanent staff. Staffing levels on the inpatient wards had been increased following an establishment review, although the trust still did not have enough staff of the right qualifications, skills, and training. Due to a recent successful recruitment programme the service would be over established with nurses in September 2019.
• Some facilities and premises were not always ideal and in need of modernising or refurbishment, but we didn’t observe this having an adverse effect on the care patients received. For example, some of the departments and wards were excessively hot in the summer months due to lack of air conditioning.

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.

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.

Updated 18 December 2019

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

• The trust returned to reporting on their referral to treatment time (RTT) data for the St George’s Hospital site. However, this reporting was still in its early days. This meant the outpatient department could not yet be fully assured that all patients had received their appointments.
• The trust’s target for completion of mandatory training was not achieved in some areas.
• Staff did not always audit practice regularly to check whether they had made improvements for patients care and treatments.
• Systems to monitor the effectiveness of care and treatment were not embedded in the service.
• There were gaps in management and support arrangements for staff, such as appraisal, supervision and professional development. Appraisal rates for some staff groups working in the outpatient services were below the trust target.
• Most staff and middle grade managers were not aware of what was on their department’s risk register.
• Not all risks on the risk register had associated actions, a date for review or a date by which actions to be completed and the risk owner.
• There was not always a registered nurse available to manage the outpatients’ clinic, some clinics were managed by healthcare assistants as compared to qualified nurses, however all clinics had a registered nurse oversight.
• We uncovered issues with heavy workloads for some key staff and a lack of senior staff support in some areas of the outpatients’ department.

However:

• The service provided mandatory training in key skills and most staff completed the training in line with the trust’s target.
• Staff kept appropriate records of patients’ care and treatment. Records were clear, up to date, and generally available to all staff providing care.
• Medicines in outpatients were managed safely. Medicines and prescription pads were kept locked when not in use.
• Care and treatment were provided based on national guidance. Speciality clinics followed relevant national guidance and participated in national and local audits.
• People were treated with compassion, kindness, dignity and respect, when receiving care. Staff communicated with people in a way that supported them to understand their care and treatment.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.