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.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant people’s needs were not always met through good organisation and delivery.

This service scored 50 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People could receive the most appropriate care and treatment for them, including through the provision of a post anaesthetic care unit (PACU), a dedicated 4 bedded cardiac HDU and a neurosurgery rehabilitation unit.

Staff were focused on delivering patient centred care and respected the individual needs of each patient. Patients were treated as individuals with treatment and care being offered in a flexible way and tailored to meet their individual needs. Staff could explain the additional support available for people with learning disabilities and dementia.

Staff understood how to meet the information and communication needs of patients with a disability. The patient records that we reviewed reflected that individual needs were assessed, and care planning was informed by this.

The service had access to an interpreting service for patients whose first language was not English and sign language interpreters if needed. This was available by telephone and face to face. We observed some posters on walls in the wards that had been translated into other languages.

The hospital chaplaincy service was multi-faith and provided spiritual support 24-hours a day, seven days a week. Patients were given a choice of food and drink to meet their cultural and religious preferences.

The service understood the diverse health and care needs of people and their local communities; however, care was not always joined-up, flexible or supportive of choice and continuity.

Staff told us that there were not enough neurosurgery beds available, and that the neurosurgery rehabilitation unit was difficult to access due to the limited capacity. However, data we reviewed following the inspection showed there was sufficient neurosurgery beds for the demand of the specialty. Leaders told us a lack of capacity in the Intensive Therapy Unit (ITU) negatively impacted their ability to increase capacity and theatre utilisation in the inpatient theatre.

Leaders told us that theatre utilisation for inpatients was approximately 78%. Staff also told us that in some specialties, such as vascular surgery, there was not enough theatre capacity to manage elective cases, as there was only one vascular hybrid theatre. Leaders described ongoing work to monitor and improve theatre utilisation such as addressing issues that affect utilisation through regular specialty level theatre user group meetings and work to obtain new ITU beds in the next year.

Staff told us that patients sometimes stay overnight in recovery and the day surgery unit (DSU). The DSU had provision for 23-hour postoperative care to reduce patient admissions. Following the inspection the trust told us risk assessments were undertaken to keep patients in recovery as an escalation area, we saw that this was in line with the trust’s Full Capacity Protocol.

Managers planned and organised services, so they met the needs of the local population working in collaboration with system partners to analyse what people’s needs were and how they could best meet them. We saw evidence of the service being evaluated with consideration of health inequalities, such as audits and research projects.

People’s care and treatment was delivered in a way that met their assessed needs and was generally coordinated and responsive. The service had an established SSDEC with plans to increase capacity and utilisation improving flow from the emergency department. The service had also introduced patient-initiated follow up, which allows patients and carers who agree to this pathway to initiate their follow up appointments as and when required.

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

Most people’s individual needs to have information in an accessible way were identified, recorded, and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. People could expect information to be tailored to their individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language and for deaf people who use British Sign Language. People who have difficulty with reading, writing, or using digital services were supported with accessible information.

Staff made reasonable adjustments to help patients access services. There was a 24-hour telephone translation service available for patients and carers and in person interpreters or signers could also be requested.

We observed staff providing patients with appropriate information about their care and saw this reflected in patient records. Patients told us that communication with them was generally good, but some people said they would have appreciated more information about their discharge or when they would be called for surgery more often. The service also operated a programme called ‘Get Set 4 Surgery’ providing information to help patients prepare for having an operation and understand what would happen at each stage of their journey.

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.

People we asked knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. The service clearly displayed information about how to raise a concern in patient areas. We saw information on how to raise a complaint displayed around the service and ward areas.

Staff understood how to handle complaints, could provide examples of feedback from complaints and examples of changes made because of complaints. At the time of the inspection the complaints policy was out of date but has since been reviewed and reissued.

We were given examples of action that had been taken following a complaint. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The main theme from the complaints was around delays. Friends and family test responses for the month of December 2024 showed 98% of patients felt the care they received was good. Positive feedback included praise for staff knowledge, care, and helpfulness.

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

The trusts performance in referral to treatment times was mostly in line with the England average, however, both the trust performance and the England average were below national standards. Some specialties including neurosurgery were below the national average, figures for January 2025 showed 46% of patients on a neurosurgical pathway had treatment within 18 weeks versus the England average of 60%. Leaders described ongoing work to improve referral to treatment times. This included work to implement additional operating lists, introducing Saturday cover, and transferring lists to Queen Mary Hospital, Roehampton to increase capacity. Reports to Healthwatch showed people experienced delays to treatment which sometimes caused them significant distress, anxiety and in some instances resulted in people opting for private treatment but reported good care and treatment. One person we spoke to told us their surgery had been cancelled 4 times in 2 years.

Patients often experienced long waits in the SSDEC and SAL. Staff told us waiting times in the SSDEC could be up to 2 hours, which did not meet national targets. National guidance states observations contributing to a NEWS2 score should be obtained within 30 minutes of arrival in SDEC and clinician review within 1 hour. Data submitted by the trust between November and December 2024 showed waiting times for assessment were 64 minutes on average. We observed that the waiting area in the SAL on the first day of the inspection was full, with some patients telling us they were waiting for over 6 hours. Staff told us patient arrivals should be staggered but this did not always happen.

Staff told us medical outliers on surgical wards negatively impacted surgical patient flow. However, staff also told us that systems in place for reviewing medical outlier patients were effective.

Managers worked to keep the number of cancelled appointments and operations to a minimum. Between 1 February 2024 and 31 January 2025, 3% of elective cases were cancelled on the same day as the scheduled procedure. The reasons for these cancellations included the patient not attending or the patient being unwell. The hospitals policy stated that cancelled patients should be rescheduled within 28 days. Data we reviewed following the inspection showed there were breaches of this standard every month between February 2024 and January 2025, although the number of breaches were relatively low.

Managers and staff worked to make sure patients did not stay longer than they needed to. The service offered either day-case or inpatient surgical procedures. Day-case surgery did not require an overnight hospital stay. Staff told us that discharges were often delayed on the wards, and we observed that some patients who were ready for discharge were waiting for discharge summaries and medications. We saw evidence that work was being done to improve flow such as implementing overnight stays in the discharge lounge for patients who are medically fit for discharge.

Managers monitored and took action to minimise missed appointments. For example, implementing a quality improvement proposal for reducing missed appointments in orthopaedic clinics.

Staff and leaders listened to information about people who are most likely to experience inequality in experience or outcomes, however they did not always act on this information. This meant people’s care was not always tailored in response to this.

We saw evidence that health inequalities were being considered throughout the service, however it was not always clear what action was being taken to address recommendations. For example, we saw that an assessment of health inequalities in medical oncology appointments found Black, Asian, younger, male patients and those in deprived areas are less likely to attend appointments. Recommendations had been identified to reduce DNA rates such as transportation assistance and community engagement and outreach; however, we did not see evidence that the recommendations had been implemented or were being actioned. We observed that people’s care, treatment and support promoted equality and protected their rights. There was no indication that people experience any inequalities in experience and outcomes.

We saw evidence that feedback on patient experiences was taken seriously and changes to practice were considered and implemented as a result to remove barriers to care and improve people’s experience.

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

People are supported to make informed choices about their care and plan their future care while they have the capacity to do so. When people want to express their wishes about cardiopulmonary resuscitation, they were supported to do so and can change their mind if they wish. Staff had completed end of life care awareness training to manage such patients as part of mandatory training.