- NHS hospital
St George's Hospital (Tooting)
Assessment report published 28 August 2025
Contents
Ratings - Urgent and emergency services
Our view of the service
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 Some equipment was out of date and premises were not secure.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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People's experience of this service
We spoke with 10 patients and family members about their experience of care in the service. People described staff as friendly, approachable and compassionate. They told us staff took time to explain procedures and answer questions clearly, even when the service was busy. Staff were described as professionals and attentive and patients said the care they received was safe and appropriate. However, some people told us they were confused about the queueing process. We observed privacy and dignity not always being maintained particularly for patients receiving care in corridors and during triage.