St George's Hospital (Tooting)

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

We looked for evidence that people were always treated with kindness, empathy, and compassion. We checked that people’s privacy and dignity was respected, that they understood that their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. 

We have not awarded this service a score for Caring.

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

The service treated people with kindness, empathy, and compassion and respected their privacy and dignity. However, women and birthing people’s dignity was not consistently maintained by staff. Not all women had a positive experience or felt listened to.

We found dignity and privacy was not always maintained. For example, we found birth rooms in the birth centre did not have “do not enter” signs on the door when they were in use and staff relied on white boards to know if a room was occupied or not. This could have impacted on the dignity of service users as staff or visitors did not quickly know if a room was in use or not.

Data supplied by the trust highlighted that the main theme in complaints received from women and birthing people was staff were not communicating in a kind or compassionate way. It was unclear how many complaints this related to, and this was not reported by the people we spoke with during the inspection.

Multidisciplinary staff told us some initiatives had been carried out in recent years to improve communication and staff attitude to improve women and birthing people experience in the service.

The 2023 Wandsworth Health Watch report found a significant number of people felt that their ethnicity had negatively influenced the maternity care they received, and experiences included feeling like they weren’t being listened to.

During the inspection, we observed staff taking time to interact with women and birthing people and those close to them in a respectful and considerate way. Women, birthing people, and their families we spoke to felt they were treated with kindness, compassion, and dignity. One person told us staff were helpful, friendly, and caring. Women and birthing people felt that staff listened to them and communicated with them appropriately. A “15 steps” exercise was completed in the birth centre in March 2024 which found that staff seemed “unhurried, well supported and happy” and they were greeted with a smile.

We found there was a culture of kindness and respect between staff, women, and birthing people. Staff treated people with kindness and respect and were discreet when caring for women and birthing people. We observed women and birthing people receiving pain relief soon after requesting it. We saw staff close curtains and doors to protect patients’ privacy and knock on doors before they entered.

We observed the multidisciplinary team treating women, birthing people, and their families as equal partners in the assessment, decision making and delivery of their care. In the Care Quality Commission (CQC) maternity survey published in 2024, service users gave an average score of 9.2 out of 10 (10 being the highest) to whether they were treated with respect and dignity during labour and birth. This was about the same when the score is compared with other trusts.

The service made sure people’s care, support, and treatment met people’s needs and preferences. Staff took account of people’s strengths, abilities, aspirations, culture, and unique backgrounds and protected characteristics.

Staff made sure women and birthing people and those close to them understood their care and treatment. Women and birthing people we spoke with told us that staff treated them as individuals. Staff offered support and health promotion advice to manage long-term conditions, such as diabetes and hypertension. One person we spoke with reported that their cultural background was considered and their request to be treated by female staff was accommodated.

Results of the trust’s friends and family test, give feedback on care survey and CQC 2024 maternity survey were mostly positive. In the CQC maternity survey, the trust scored “about the same” when compared to other trusts in all areas that service users were asked about. Feedback from women and birthing people who had used the specialist service for those who had an abnormally sited placenta between August and October 2024 showed that 100% either agreed or strongly agreed that they received adequate information and were adequately supported and 100% said they would recommend the service to a friend.

Staff we spoke with during the inspection understood the need to assess women and birthing people in a holistic way. Staff assessed individual needs and preferences to help ensure positive outcomes. From our observations and the records reviewed we saw that staff considered the individual, cultural, and communication needs of women and birthing people.

Staff were able to describe the multiple specialist teams and clinics within the service which helped them to tailor care to individual women and birthing people. For example, there was a multiple pregnancy clinic and a maternal medicine service. There was also an opportunity for joint clinics with other specialities such as cardiology and endocrinology to ensure the best care for individual women and birthing people using the service. There was a good level of support provided by the service to bereaved women, birthing people, and families following the loss of a baby.

However, analysis of complaint data showed themes of a lack of information and lack of time to ask questions. Common themes and learning from complaints are discussed at team meetings. Further improvements could be made to the service to ensure that all patients feel they were treated as individuals.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment, and wellbeing.

Women and birthing people said that they had choice and control over their own care. They reported that staff were flexible with appointments and did their best to accommodate their individual needs. We observed staff who supported and involved women and birthing people in assessments and encouraged them to make decisions about their care. The CQC maternity survey published in 2024 found that service users gave an average score of 8.3 out of 10 (10 being the highest) for being involved in decision making.

There were systems and processes in place to ensure that patient choice and control was promoted. Policies, such as the Entonox policy, included details to ensure patients were given adequate information to be able to make an informed choice about treatment options. Audits were completed to look at whether consent for treatment was documented within the patient notes. The November 2024 third stage of labour consent audit result showed 85% compliance which was above the trust’s target. However, further improvement was needed as it was documented in the local care during labour guidelines that the decision for active management should be agreed with the woman or birthing person and must be documented. This audit was now part of the trust’s routine documentation audit.

Staff talked with women and birthing people, families, and carers in a way they could understand, using communication aids where necessary. In the 2024 CQC maternity survey, people who had used the service gave a score of 8.5 out of 10 (10 being the highest) when asked about whether they had confidence and trust in the staff caring for them. This score was about the same as other trusts.

Women, birthing people, and their families could give feedback on the service and their treatment and staff supported them to do this. Staff supported women and birthing people to maintain relationships that were important to them.

The service did not always listen to or understand people’s needs, views, and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

Staff told us they used risk assessment tools to identify when people need urgent help and to facilitate staff to respond to patients’ needs. However, triage processes and phone triage documentation were inconsistent in and out of hours. This could make it difficult to identify repeat callers and could put women, birthing people, and babies at risk of harm and was not in line with national guidance. Gaps in documentation meant that staff did not have an accurate picture of the women and birthing people who were calling the service or the reasons for them calling. This could put them, and their babies, at risk of harm. This was not in line with the Royal College of Obstetricians and Gynaecologists (RCOG) 2023 maternity triage good practice paper. Following the warning notice that was issued as a result of this inspection, the trust made a number of improvements. The service introduced an electronic notes system which ensured contemporaneous notes are completed during working hours and out of hours with mandatory fields which ensure assessments are completed.

Consultants led twice daily ward rounds on all wards, including weekends. This was an improvement since the last inspection. Women and birthing people were reviewed by consultants depending on the care pathway they were on. Staff could call for support from doctors and other disciplines, including mental health services and diagnostic tests, 24 hours a day, seven days a week.

The service did not always care about or promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff wellbeing was not a priority for leaders. There were ineffective resources and facilities for safe working in place, such as regular breaks for staff. Some staff we spoke to reported that they did not always get regular breaks due to high acuity and reduced staffing. Data received from the trust highlighted difficulties with the way the midwifery manager on-call duties rota were arranged and managers worked longer than permitted in the working time regulations (1998). The trust did not have an on-call policy which led to inconsistencies in payments and advice on compensatory rest required after working an on-call shift. This issue had been escalated and was included on the trust’s risk register. Further work could be done by the trust to ensure staff wellbeing is promoted to ensure the best outcome for staff and people who use the service.

Staff felt valued but did not always feel listened to by their leaders. In a maternity safety champion report from May 2024 supplied by the trust following the inspection, it was reported that senior midwives were not consistently listened to and felt excluded from decision-making. The report also highlighted that some staff feared reprisals if they raised concerns. As a result of this an action plan was put in place.

Staff from black and ethnic minority backgrounds told us during the inspection that there were limited development opportunities and career progression. Therefore, further work to improve the culture is required to ensure equity and inclusivity.

The 2023 Staff Survey had a low response rate for maternity, which was 27% and lower than the trust average response rate of 38%. Morale was slightly lower than the trust score (5.5 out of 10, compared to 5.6). As a result of the survey, the trust put an action plan in place to improve the motivation and morale of staff, wellbeing and improving psychological safety.

The majority of staff we spoke with during the inspection felt they were able to give feedback, raise concerns, and suggest ways to improve the service. Staff reported feeling valued by their colleagues and their leaders. They reported a positive culture in the service because of the work done by the trust, with staff, to improve the service culture. Staff felt listened to and reported a culture of inclusivity. The service had programmes in place to assist staff to feel valued, for example long service awards.

The 2024 General Medical Council national trainee survey report showed an improvement in feedback given by trainee doctors regarding their placements in obstetrics and gynaecology at the trust since our last inspection. The majority of the feedback scores were within the normal range when compared to scores given to other services. Workload and induction scores were better than national average. However, the service scored below national average in educational supervision.

The trust had a ‘raising concerns at work’ policy which encouraged staff to raise concerns. It also contained contact details for the Freedom to Speak Up guardian. There were regular team meetings and safety champions who staff could raise concerns to. The trust had a guide to essential workplace adjustments to help managers to support staff to work effectively. There was also a recruitment and selection policy which described the reasonable adjustments that could be made and covered topics to ensure the selection process was equitable and free from discrimination.

There was a counselling service available to all staff and a dedicated wellbeing team. There was also an executive question time initiative which allowed senior leaders to respond to staff feedback.

There were 4 Professional Midwifery Advocates (PMA) in post and, as a team, they tried to ensure that there was one PMA present during day shifts (Monday – Friday) to support midwives.