St George's Hospital (Tooting)

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people had the best possible outcomes because their needs were assessed. We checked that people’s care, support, and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a continuous culture of improvement.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people’s outcomes were good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

People were involved in the assessment of their needs. People we spoke with told us their pain had been managed appropriately, and they generally received pain relief in a timely manner. There were appropriate arrangements to ensure patients’ nutrition and hydration needs were met on the wards. The service used evidence-based tools to screen for malnutrition. We saw in patient records a malnutrition universal screening tool (MUST) tool was used for assessing patients’ nutrition.

People’s communication needs were assessed and met. Assessments considered the person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that has the best possible outcomes. People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood.

The trust had implemented the Oliver McGowan mandatory training on learning disability and autism. Staff we spoke with demonstrated a good understanding of how to assess the needs of autistic people, people with a learning disability and dementia. As part of handover before shift changes, nurses were made aware of patient's individual and holistic needs.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, staff did not always follow current evidence-based good practice and standards.

We found some instances where audits such as VTE assessment completion and surgical safety checklist completions identified policies were not being followed. However, the trust’s intranet contained a comprehensive range of policies and standard operating procedures which reflected evidence-based practice and standards practice. We reviewed a random sample of policies during our assessment and observed that polices were up to date and in line with national guidance.

Patients sometimes experienced long waiting times in the surgical admissions lounge. Staff told us that patient arrivals should be staggered but this did not always happen and there have been occasions when patients wait up to 12 hours; this meant that fasting times were not always minimised. In the SAL we observed that patient’s hydration needs were not always met and did not always comply with guidance. On the first day of our inspection, we saw signage telling patients they could drink up to an hour before surgery, but several patients told us they had not had anything to drink since the previous night. On the second day of the inspection patient attendance was staggered in the SAL and there were less than 10 people waiting, we observed that all patients were given a bottle of water on arrival. We reviewed fasting data for the service and found that between January and December 2024 the average fasting time including fluids was approximately 4.5 hours, national guidelines state people may drink clear fluids until 2 hours before their operation. However, this data was combined for both food and fluids. After the inspection the trust told us that data is manually captured for food and fluid separately in the pre-operative checklist. The trust’s data dashboard was being revised to reflect the accurate data for food and fluid separately as per national guidelines. We observed that on surgical wards staff gave patients enough food and drink to meet their needs and improve their health.

We saw there was a formal annual clinical audit programme to evidence performance monitoring, quality measures or patient outcomes relating to surgical services. There was a corporate audit plan, which included national audits, which the trust was submitting data to, for example, the National Emergency Laparotomy Audit (NELA), National Joint Registry (NJR), and the National Lung Cancer Audit (NLCA).

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We saw evidence of good multidisciplinary team (MDT) working. When people were due to move between services, all necessary staff, teams, and services were involved in assessing their needs to maintain continuity of care.

Staff informed us they worked well with other staff. Nursing staff told us medical staff were available for advice and support including overnight and on weekends and there were good working relationships between colleagues. Staff told us that they felt supported by pharmacy staff, and they were accessible out of hours via the pharmacy on call service. The outreach team were described as approachable and quick to attend. Theatre teams were observed to work well together for the safety of the patients. Recovery staff told us about the use of a secure messaging app that was used to improve communication with other teams and escalate problems to matrons and management.

Staff held daily handovers in the morning and evening. We observed the morning handover on the second day of our assessment, staff discussed patient care, concerns, staffing, and capacity. Staff also told us that medical teams worked well together across services to manage patient care, for example staff told us trauma and orthopaedic surgeons and orthopaedic geriatricians routinely performed ward rounds together to discuss care as a team.

We observed multidisciplinary approaches to planning care for patients. Patient records demonstrated input from the full clinical team of doctors, nurses, and allied health professionals. Regular team meetings take place to review updates for the service.

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Staff told us relevant teams, services and organisations were informed when people were discharged from the service. However, data for the service showed that between October and December 2024 only 53% of discharge summaries was sent to GPs within 24 hours. This was included in the service Divisional Quality and Safety Report, and showed leaders were seeking to review the data on discharge summaries sent to GPs within 24 hours data for each specialty to be followed up by care group leads.

The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Health promotion was part of care provided to patients. Staff worked collaboratively to assess all aspects of general health, and to give advice and support to promote healthy lifestyles.

The service delivered preoperative information sessions for patients due to undergo major inpatient surgery, sessions provided dietary, physical, and psychological advice to support health promotion prior to surgery. People’s health was assessed at pre-assessment and staff could make referrals relevant to the patients' needs e.g. smoking cessation at any point in the pathway. On discharge patients were signposted and given advice on where and when to seek help.

The service routinely monitored people’s care and treatment to continuously improve it. However, staff did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We were not assured that sufficient action was taken to improve outcomes in response to audit findings. We found that action to improve outcomes in VTE risk assessment compliance was not taken and audits showed a declining trend in compliance. VTE risk assessment compliance was 67% between April and June 2024, this reduced to 66.1% between July and September 2024 and 65% between October and December 2024. We also found that audits of compliance with surgical safety checklists did not feature action plans or learning points despite demonstrating areas of low compliance.

Metrics for anaesthesia and perioperative medicine as part of the Getting It Right First Time (GIRFT) programme showed that service performance did not comply with the GIRFT standard in most metrics. The service was also an outlier for wrong skin lesion surgery between April 2023 and March 2024; however, we saw evidence of improvements being implemented to address this and prevent future incidents. However, there were effective approaches to monitor people’s care, treatment and their outcomes. Audit schedules were set up for 2024-2025 to assess a wide range of patient care.

Most of the national patient outcome data we reviewed was within national expectations. National patient outcome data showed that the hospital was an outlier in hip revision surgery rates, however management of the service explained that as St George’s is a tertiary centre for specialist hip and knee procedures and as per an established pathway, they complete the most complex cases which means their outcomes are not comparative with other local services.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Written consent was sought from patients. We looked at completed consent forms in the patient records we reviewed; we saw that they were completed correctly and were signed in the correct places with documented risks to surgery.

People told us staff explained care and treatment options in a way they understood and gained verbal consent before carrying out assessments.

People's capacity and ability to consent was considered, and they, or a person lawfully acting on their behalf, were involved in planning, managing, and reviewing their care and treatment. Staff generally showed understanding of when and how to assess whether a patient had the capacity to make decisions about their care, and the Mental Capacity Act (MCA) 2005. Staff received training on the Mental Capacity Act and Deprivation of Liberty Safeguards, division compliance for level 1 of this module was compliant with the trust target but level 2 was 79% and therefore below the trust target of 85%.

Staff followed the trust policy and procedures when a patient could not give consent. We reviewed the consent policy, which was appropriate and next due for a review in December 2026.

People were supported to make their wishes about cardiopulmonary resuscitation known. We saw evidence that decisions around do not attempt cardiopulmonary resuscitation (DNACPR) were captured in patients’ electronic care records.