St George's Hospital (Tooting)

On this page

• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. 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.

We did not rate this key question at our last inspection. This key question has been rated good.

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 service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Women and birthing people’s records and birth plans did not fully reflect their physical, mental, emotional, and social needs, including those with protected characteristics under the Equality Act (2010). We found gaps in the assessments completed and in the documentation of assessments as part of the telephone triage service as staff did not always document the wellbeing, mental, and emotional needs of women and birthing people. The triage audit results for the period of January to September 2024 showed poor compliance in documentation of the time of patient interactions with midwives. Following the inspection, the trust made changes to improve their practice. A new electronic documentation system was introduced following the inspection with mandatory fields to ensure assessments are completed and timings are recorded.

An external maternity report found that the majority of women and birthing people from black and ethnic minorities experienced language barriers and felt judged by members of staff. They also felt that their ethnicity had a negative impact on the care they received. This showed that more could be done to ensure that all service users experienced patient-centred care and ensure there was an equitable service.

Staff we spoke with understood the importance of person-centred care and could describe how they ensured women, birthing people, and their families were involved in planning and making decisions about their care. Staff told us they took the individual needs of their patients into account, especially those with additional needs for example mental health needs or learning disabilities. They did this by completing birth plans and personalised care plans.

Women and birthing people we spoke with felt involved in planning and making decisions about their care which was responsive to their needs. They reported staff worked together and supported them to plan their care and the birth of their baby. Women and birthing people knew how to access their health and care records and were able to decide which personal information was shared with their partners.

The service understood the diverse health and care needs of people and their local communities, to ensure care was joined-up, flexible, and supported choice and continuity.

Managers planned and organised services so they met the needs of the local population. The service delivered and co-ordinated services and care provision which considered the needs and preferences of different people, for example they offered halal, vegetarian, and vegan food options. Information was also available on the trust maternity website in a variety of different languages. Specialist antenatal clinics were also available for women and birthing people with high-risk conditions or with complications during pregnancy.

Women and birthing people we spoke with reported that the care and treatment they received took their diverse health and social needs into account.

The service had systems to help care for women and birthing people in need of additional support or specialist intervention following the birth of their baby. The service worked with staff and leaders to set up a transitional care team within the maternity service to prevent babies who required more intensive medical treatment from being separated from their mothers. The recruitment process was ongoing at the time of our inspection to allow the service to remain open for 24 hours per day.

There was a high dependency unit (HDU) provision within maternity to provide additional medical care for women and birthing people. Staff who worked in this area received appropriate training to work on this unit. However, an audit published in October 2024 showed that there were often instances of short staffing with 13% of night shifts with insufficient staffing which did not meet local guidance. An action plan was put in place with a plan to recruit an additional HDU trained nurse.

Staff supported women and birthing people and babies when they were referred or transferred between services.

Managers worked to keep the number of cancelled appointments and operations to a minimum. However, when women and birthing people had their appointments or operations cancelled at the last minute, managers made sure they were rearranged as soon as possible. Managers ensured that women and birthing people who did not attend appointments were contacted.

The service supplied appropriate, accurate, and up-to-date information about care, conditions, and maternity services in formats that were tailored to individual needs.

Women and birthing people knew how to access their health and care records and decide which personal information could be shared with others, for example their family.

People received information in a timely way that met best practice standards, legal requirements, and was tailored to individual need. Staff gave women and birthing people verbal and written information and advice that was accurate and up to date. They also signposted women and birthing people to the maternity page of the trust website for further information. The information that was on the maternity page of the trust website was accessible and supported patient rights and choice.

During our inspection, staff told us about the digital transformation process to improve electronic records of patient notes which was planned for February 2025. They hoped that this would improve the trust’s IT systems.

There were processes in place to ensure individual information needs were met and reviewed to support care and treatment and in line with the accessible information standard. On the maternity website, the service had included parent education resource videos on the first trimester of pregnancy which was available in English and five other languages including Urdu, Polish, and Arabic. Staff told us they also had other information leaflets that were available in some languages. There was ongoing work to ensure the service continued to meet the communication needs of its growing diverse population by ensuring leaflets were available in the top languages spoken by women and birthing people who accessed the service.

There were processes in place to ensure information about people that was collected and shared was kept safe in line with the data protection legislation requirements. There was a data protection and confidentiality policy which summarised these requirements for staff.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff involved people in decisions about their care and told them what had changed as a result. However, there were delays in the investigations of complaints.

The service clearly displayed information about how to raise a concern and give feedback on care or experience of the service in patient areas. There were also leaflets asking for feedback in patient areas and there was a feedback section on the maternity page of the trust website. Women, birthing people, and their families felt that their complaint or concern would be explored thoroughly, and they would receive a response in good time and in an open and transparent way, with no repercussions. In the 2024 Care Quality Commission (CQC) maternity services survey, service users gave an average score of 8 out of 10 (10 being the highest) to whether concerns were taken seriously once they were raised. This score is about the same when compared with similar trusts.

Staff we spoke with described the processes in place to gather feedback from those who have used the service, for example the friends and family test. Feedback from women, birthing people, and their families was also captured during birth reflection clinic and incidents investigations.

Managers investigated complaints and identified themes. Managers shared feedback from complaints with staff and learning was used to improve the service. Generally, learning from incidents investigations, complaints and concerns was seen as an opportunity for improvement and staff gave examples of how use feedback to improve daily practice. Themes from complaints and investigations were discussed regularly in team meetings to improve practice. Data shared by the trust showed that from February to April 2024, 100% of complaints were acknowledged within 3 working days. This was above the trust target of 95%. However, from July to August 2024, 50% of complaints were resolved within 35 working days which was significantly below the trust target of 85% and meant that opportunities for learning and improving care were delayed.

The service did not always make sure that people could access the care, support, and treatment they needed when they needed it.

There was evidence that further improvements were needed to ensure equity in access for all. A report commissioned by the trust in 2023 found there was limited evidence of interpreter services being made available. Furthermore, the 2023 Health Watch report from the Wandsworth team found a significant number of people felt that their ethnicity had negatively influenced the maternity care they received. Women and birthing people who shared their experiences in the report felt that access to health services was not always equal, reported experiencing language barriers and felt that health professionals could do more to facilitate communication with those where English was their second language. This demonstrated that further work was required to ensure an equitable access for all.

Information provided by the trust following the inspection, identified that not all women and birthing people had an equal experience when accessing the service. The triage audit completed in September 2024 identified that 60.5% of women and birthing people had a medical review within a time frame which was in line with recommendations made by the Royal College of Obstetricians and Gynaecologists (RCOG). Medical review times were not always documented in records, and therefore it is hard to draw firm conclusions about how long people were waiting to see a doctor. However, this data shows that there was variation in access to maternity triage. Since the inspection, the trust has informed us that they have implemented a range of actions aimed at improving triage review times and documentation.

The triage telephone line was diverted during staff breaks during the day and out of hours from 8pm to 8am. This was not in line with guidance from the RCOG. Staff told us that midwifery staff working in areas other than triage were expected to answer triage calls, when the line was diverted, without specific training or completion of required competencies. This raised concerns about their ability to complete appropriate risk assessments and maintain records and we found inconsistency in the telephone triage assessment and documentation used during working hours and out of hours. This meant that women and birthing people who called out of hours did not receive the same level as care as those who called the service during normal working hours. Following the inspection, the trust changed its practice, and a 24-hour maternity triage telephone line was put in place to ensure women and birthing people can get help and advice when they need it, and calls are no longer diverted. There are also standardised assessments with mandatory fields and drop down boxes to improve the standard of documentation.

There have been instances where low staffing led to service suspensions, including 5 home-birth suspensions (July to November 2024) and multiple birth centre closures. These changes impacted the individual birth choice of women or birthing people. There had also been delays for women and birthing people waiting for an induction of labour (IOL). Data showed that between 1 July 2024 and 4 November 2024, 23 women and birthing people had experienced a delay of 2 hours or more between admission and the start of the IOL. These delays could cause harm to the women, birthing people or their babies. However, there was an IOL pathway in place for staff to follow when delays occurred. This was an improvement since the last inspection.

Women and birthing people we spoke with during the inspection felt they had equal access to care, treatment, and support and reported their additional needs were supported by the service.

Staff we spoke with during the inspection were able to discuss ways in which the service ensured equity in access. For example, women and birthing people could access services without physical or digital barriers including out of normal hours and in an emergency. They were able to describe how women and birthing people were given support to overcome barriers to ensure equal access, for example information being available in some languages on the trust website.

The trust complied with legal equality and human rights requirements with appropriate processes and systems in place. The service prioritised, allocated resources, and provided opportunities as needed to tackle inequalities and achieve equity of access for women, birthing people, and babies.

The maternity service strategy included equity and highlighted how the services planned to continue to tackle health inequality including working with the Maternity and Neonatal Voices Partnership (MNVP) to reach out to minority groups and hard to reach women and birthing people.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

Leaders and staff were alerted to discrimination and inequality that could disadvantage different groups of people using their services. There were policies, systems, and processes in place to ensure people’s care promoted equity, removed barriers, and protects their rights including those with protected equality characteristics. Equality impact assessments were considered in their policies and processes.

Multidisciplinary staff we spoke with understood the impact of discrimination and how inequity could disadvantage different groups of people using their service. Staff and leaders reported they proactively sought ways to address inequality barriers to improve experiences of those using the service and acted on feedback and outcomes. Leaders reported they allocated resources and opportunities to achieve equity. For example, the labour ward had a bariatric room that could be used to care for bariatric women and birthing people to ensure the service could respond to the needs of the people and ensure they had a good experience of care.

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 were also opportunities for joint clinics to ensure women and birthing people received the individualised care they required. There was also a fetal medicine unit and a day assessment unit to support women and birthing people with long-term conditions or complications during their pregnancy. The service received tertiary referrals from other areas for women and birthing people who required input from the specialist services available.

The service utilised the together project maternity passport to allow staff, women, birthing people, and their families to work together to plan care and improve people’s experience and outcome. The passport allowed women and birthing people to record how staff could best communicate with them and detailed any additional needs they may have. The service had a maternity strategy in place which focused on tackling health inequality and focused on improving experience and outcomes for all, which showed the service was aware of the diverse population it served.

Women and birthing people we spoke with as part of our inspection reported their care and support were co-ordinated and everyone worked well together. They reported feeling they were in control of planning their care and treatment and the service took their diverse health and social needs into account.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Women and birthing people could get information and advice that was accurate, up to date, and provided in a way they could understand to plan for their birth and future. The service supported women and birthing people to make informed choices about their care. This was achieved through health promotion information, antenatal classes, appointments with midwives, birth plan documents, information leaflets, and resources available on the maternity page of the trust’s website.

Women and birthing people we met reported feeling supported to plan for important changes and reported being given verbal and written information. Women and birthing people reported that they had access to antenatal clinic appointments which never felt rushed, and they always felt they had enough time to discuss all their concerns with midwifery and obstetric staff.

Women and birthing people’s decisions and what matters to them was recorded through personalised care plans that were shared with others who may need to be informed. Women and birthing people attended birth option clinics to discuss their birth options with staff. We were also told that, when changes needed to be made to a birth plan due to clinical reasons, staff communicated and managed this openly and sensitively.  

Policies, processes, and systems were in place to assist staff with supporting women and birthing people to plan for their future care. There were “do not attempt cardiopulmonary resuscitation” (DNACPR), consent, and decision-making forms for different obstetric procedures to allow staff, women, and birthing people to plan for the future. There were also multiple resources on the maternity page of the trust website with information regarding induction of labour, vaccinations, and other screening tests to help women, birthing people, and their families to start planning their future maternity care.