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 and communities 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 culture of improvement.

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

We have not awarded this service a score for Effective.

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

The service did not always make sure people's care and treatment were effective because they did not always check and discuss people's health, care, wellbeing and communication needs with them.

We observed a patient that had arrived in an ambulance with shortness of breath with a pacemaker. This patient was placed on corridor care. The patient did not have an Echo Cardiogram (ECG) which is an electrical recording of the heart rhythm and rate. Inspectors reviewed the patient over 4 hours later and saw the patient had not been reviewed by a doctor. We reviewed further patient documentation and found there were three individuals identified as being at risk of falls who were receiving corridor care. Staff had no additional support or assistance to ensure safety with tasks such as administering medication. Patients in the corridor experienced a lack of privacy and dignity, as medical examinations were conducted in full view of passing members of the public. Privacy screens were not utilised, further compromising patient dignity.

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Risk assessments for patients lacked documented mitigation steps or follow-up actions. For example, we observed an incident involving a patient at risk of falls, but the details were not recorded in the patient's notes, and there was no evidence of actions taken to mitigate the risk of further harm. Additionally, National Early Warning Scores (NEWS2) were not consistently recorded, limiting the ability to monitor patients effectively.

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Staff reported that the falls risk assessment process in the service was subjective, with no clear guidance on when to implement specific interventions, such as slip socks, call buzzers, or bed rails. Similarly, the bed rail assessment process lacked clinical guidance, leaving staff uncertain about appropriate usage. This lack of clarity disrupted staff's ability to provide safe and effective care for patients at risk of falls. Post assessment the trust informed us that The Slips, Trips and Falls Policy was applicable to all services including staff in the ED. At the time of inspection staff also had access to a pocket guide for helping to reduce the risk of falls in the ED.

Data submitted by the trust showed a significant increase in the length of time that patients waited to receive antibiotics due to suspected sepsis. Data showed that this was likely due to overcrowding in the ED as there was a direct correlation with the amount of time waiting to see a clinician.

We requested data on the initial assessment of paediatric patients being completed within 15 minutes of arrival, but we were only provided with the standard operating procedure (SOP). This means we were not provided with any assurance that children were being seen within their own SOP guidelines and triaged and escalated effectively.

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Trust level VTE assessments audits showed 63.9% compliance which was below trust target of 95%. In ED this compliance was being affected due to the new electronic patient record system which do not trigger a VTE assessment for patients.

The current triage system presented risks to acutely ill patients. The service recognised this risk and was planning to put mitigations in place. This mitigation was to introduce an E-triage system. Traditional processes were still available for those patients who did not wish to use the technology.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Policies and procedures reviewed during the assessment were up to date and reflected current clinical standards including a policy for patients requiring enhanced care. Clinical staff contributed to the development and review of local policies and treatment protocols including updated guidance for stroke, agitation management, and prescribing in the service. We reviewed medicines optimisation group meeting minutes where standard operating procedures (SOPs) were regularly reviewed and updated with input from pharmacy, ED clinicians and specialist teams, supporting safe and consistent care. New SOPs were developed to guide safe prescribing for patients awaiting discharge and guidelines for nicardipine and thrombectomy care were adapted to reflect national standards.

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The service reviewed Getting It Right First Time (GIRFT) reports, which provided clear actions and best practice recommendations to improve patient outcomes. For example, the service introduced a clinical pathway for assessing patients with back pain that aligns with GIRFT guidance including the use of red flag screening, early bladder scanning and a four-hour MRI target. Multidisciplinary meetings were held regularly, involving psychiatric liaison teams, ambulance services, and social workers, ensuring that complex cases were reviewed, and that learning was shared across the service.

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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.

The service had relevant information promoting healthy lifestyles and support on the ED welcome boards across the department and electronic screens in the waiting area. This included videos and posters of national, regional, local and hospital campaigns. Information displayed covered large demographics and included physical and mental health. Information included cervical screening, smoking cessation, breast cancer screening, weight loss, bowel cancer screening, community pharmacy support, mental health services for LGTQ+ (lesbian, gay, bisexual, transgender, and queer or questioning) people, flu vaccines, stress and mood.

Patient information leaflets were readily available on the trust’s website and available in larger print too.

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

The service had established a comprehensive audit schedule for 2024 and 2025 to assess and enhance patient care across a range of clinical areas. This schedule included audits aligned with the National Institute for Health and Care Excellence (NICE) guidelines, Royal College of Emergency Medicine (RCEM) standards. The schedule including The Trauma Audit and Research Network (TARN). Whilst the trust told us they were doing national audits and provided an audit schedule, we were not provided with the data and actions from these audits. We requested data on participation of national audits, results and improvements made. We looked at a Sickle Cell audit which aimed to evaluate the management of 50 patients presenting with acute pain crisis against NICE guidelines. Results showed that observations on initial assessments of patients had declined over the last 2 years. Only 24% of patients were given analgesia within 30 minutes of presentation, the timeframe set out by the NICE guidelines and only 2% of patients had their pain reassessed within 30 minutes. Although conclusions had been made, we could not review the actions taken because of this audit. We reviewed the audit for compliance with documentation standards in ED delivered regional analgesia. Results showed that documentation was present as per the Local Safety Standards for Invasive Procedures (LocSSIP) for 74.1% of patients, for the actual procedure. However, there were inconsistencies regarding the location of local aesthetic documentation within the electronic patient record for 84.4% of patients. For 15.6% of patients there was no documentation of receiving local aesthetic. Although conclusions had been made, we were not able to review the actions taken because of this audit. A third audit showed that staff were not following guidelines for urine testing and were waiting for urine dip results when there was a clear other source for illness in a child. Although conclusions had been made, we could not review the actions taken as a result of this audit. Although we were assured that patient outcomes were routinely monitored the service lacked evidence for effective improvement.

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For people who frequently used the service, identified as high intensity users (HIU), the service had established a dedicated HIU group with a standard operating procedure (SOP) outlining detailed steps for managing HIUs effectively. This included a multi-disciplinary team (MDT) discussion and referrals.

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The service had a detailed sepsis pathway document, providing clear guidance for managing sepsis. Staff we spoke with demonstrated an understanding of sepsis and were able to explain how they would recognise the symptoms and the actions that would be necessary once identified. This was in contrary to the audit data which showed that improvements needed to be made to keep patients with sepsis safe.

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

Patients told us that staff thoroughly explained care and treatment options and sought their consent before proceeding. This supported a clear understanding of their care and helped foster trust in the service provided.

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The trust had a consent policy in place, which was in date and next due for review in June 2026. This outlined staff responsibilities in supporting patients with reduced capacity and confirmed that capacity assessments were guided by the Mental Capacity Act 2005 (MCA) with a clear framework for determining and documenting capacity. The policy also described strategies to support decision making including the use of accessible information, easy read leaflets and interpreters. The do not attempt cardiopulmonary resuscitation (DNACPR) policy was also in date and scheduled for review in February 2025.

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Staff demonstrated a good understanding of MCA and least restrictive practices, which informed their approach to care. Staff also highlighted the availability of policies and training to support decision-making around consent and capacity.

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Medicine and nursing staff achieved above 91% for level 1 training for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which was above trust target. However, level 2 compliance was below trust compliance target at 81.3% for nursing staff. The trust had processes in place to ensure compliance was monitored, as the practice education team would review this monthly and staff who were not compliant would be flagged to leaders.

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