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 stayed the same. This meant people’s needs were not always met.

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.

We were not assured that patients received person centred care. During our assessment we observed multiple patients experiencing long waits. For example, we observed a palliative patient on end-of-life care who had been left in the ED for 55 hours before being admitted to a ward. After the inspection the trust confirmed that this was due to the lack of capacity and flow within the hospital. We observed a vulnerable elderly patient attempted to get off their trolley 3 times as observed by CQC staff.

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The trust worked with a charity which provided support to young people aged 11—25 affected by violence or exploitation, ensuring they received safeguarding, psychological care, and referrals to specialist services. The service employed the `George the Octopus' initiative to identify children with complex needs, flagging them on the electronic record system to ensure they were prioritised and allocated to appropriate areas. Play specialists and sensory equipment were available to support children and young people during their stay.

The service promoted awareness of non-visible needs using Hidden Disabilities Sunflower Lanyards, which helped staff identify and offer adjustments for people with less visible conditions including scoliosis, autism and anxiety.

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The service employed a `Think Family' approach to support holistic and safe care when working with children. This included recognising and responding to the needs of parents, carers and siblings as part of safeguarding.

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Staff highlighted the service's collaboration with a charity which supported young people aged 11—25 who had experienced violence or exploitation, ensuring their needs were addressed promptly.

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There were significant shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

The trust provided data between April 2024 and October 2024 that showed 4786 patients waited over 12 hours and 18304 patients waited over 4 hours to be seen. Analysis from the Royal College of Emergency Medicine revealed that there were more than 16,600 deaths associated with long ED waits before admission in England in 2024, this was a 20% increase compared to 2023. An estimated 16644 associated deaths were related to stays of 12 hours or longer before being admitted. The Office for National Statistics reported in January 2025 that patients who spent more than 12 hours in ED were more than twice as likely to die within 30 days compared to those who were seen within two hours.

Patients with mental health needs frequently experienced long waits for beds, resulting in extended stays in the service. The longest length of stay reported by the trust over the past 12 months was 270 hours (11 days) for an adult, with two other adults recorded 8 days. Staff identified waiting for mental health beds, placement arrangements, and care packages as the primary causes of these delays. The service regularly managed between 305 and 376 mental health patients each month, contributing to significant challenges in patient flow and care continuity.

However, the service used the Manchester Triage System linked to the electronic patient record, which streamlined patient assessments and referrals. Patients seen by the streaming nurse could be directly referred to alternative services, including the urgent treatment centre (UTC), same day emergency care (SDEC), GPs, or pharmacies, ensuring they received appropriate care outside the ED where possible. Where necessary, analgesics was also provided at the streaming window, ensuring patients received timely symptom management while awaiting further care.

The ED had a dedicated navigator who worked to arrange same-day GP appointments and timely access care in the community. This role enhanced integration with primary care services and supported more efficient use of ED resources.

We reviewed escalation procedures and operational protocols for bed management which set out expectations for specialty response times and actions when delays occur, including escalation to the bronze command team. Staff had access to the patient flow coordinator and were instructed to request a review by senior clinicians when care needs exceeded department scope.

Staff in the waiting room and triage also highlighted the value of having a consultant which facilitated early diagnostics such as X-rays, CT scans, and MRIs. This enabled quicker identification of conditions, including respiratory issues, allowing for timely administration of treatments such as inhalers. Nurses in triage and the waiting room were able to ask the consultant for advice, improving patient outcomes and reducing unnecessary delays.

The NHS England 2 year urgent and emergency care recovery plan published in January 2023 centred around patients being seen more quickly in emergency departments with an ambition to achieve 76% of patients being admitted, transferred or discharged with 4 hours by March 2024, with further improvements in 2024/2025. Between April and October 2024 data provide by the trust showed that over 58% of patients were discharged, 5% of patients were transferred and 17% of patients were admitted within 4 hours of arrival, giving a total 4-hour performance during this period of 80%.

The service did not always supply appropriate, accurate and up-to-date information in all formats that were tailored to individual needs.

Patients had access to a range of information to support their understanding of their health and the services available. In the children's emergency department, health information was made accessible via QR codes, providing digital resources on children's health. Printable leaflets were also available although not in all languages, which limited accessibility for some service users. The trust did however display interpreter service information in different languages and video services to assist with translation whilst in the department.

Complaint information was displayed in the waiting rooms, ensuring patients were aware of how to raise concerns if needed. Complaint information was also displayed on the trust's website; however, we did not see this information offered in any other language. Waiting rooms also displayed real-time updates on waiting times, helping to manage patient expectations. Appropriate signage was displayed for toilets and pay phones were available for patients to use.

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Children with sensory needs were supported in the paediatric ED where there was access to sensory lights, toys, and a play specialist, which enhanced their overall experience. However, the staffing board in the paediatric ED was not updated, which could leave patients and families unclear about who was providing care.

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Staff had access to health promotion materials via QR codes and printable resources, which they could use to educate and inform patients. They reported that this approach allowed them to share up-to-date and relevant information efficiently.

Staff also highlighted the availability of interpreter services, for patients whose first language was not English and those requiring British Sign Language. This service was available in both adult and paediatric EDs and supported effective communication with patients from diverse backgrounds.

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The trust's GDPR policy was in date, with the next review scheduled for November 2026.

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The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care and told them what had changed as a result.

The trust received 87 complaints between October 2023 and October 2024. Complaint numbers varied throughout the year with highest figures recorded in March and September 2024. Monthly totals ranged from 2 to 11. Most complaints related to concerns about care, clinical treatment and staff attitude. Additional themes included communication, wait times and respect for privacy and dignity. We were not assured of how effective the measures in place to address these complaints were; as complaints were repetitive throughout a 12-month period. The complaints policy was in date as of November 2024, with the next review scheduled for December 2024.

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We reviewed verbal resolution letters and found that the service prioritised resolving concerns and complaints by conducting thorough investigations, sharing lessons learned with staff, and providing clear and detailed responses to complainants. When things went wrong, the service apologised, outlined investigation steps, explained what went wrong, and provided assurances about actions taken to address the issues and prevent recurrence. The service listened to feedback and made changes in response to complaints and concerns. Through the service's `you said, we did' plan, actions were taken to improve referral processes, clarify staff roles and address IT system issues. Complaints were acknowledged within 3 working days in line with the trust's policy but only 83% of complaints between October 2023 and October 2024 were closed within the agreed timeframe.

The results of the October 2024 FFT survey showed that 80% of the 1632 respondents would recommend the service, with 59% rating the service as very good and 21% as good. A total of 9% rated the service as very poor. The response rate for the survey in October 2024 was 90.67%. This was slightly above the national average for emergency departments where 77.9% of patients said they would recommend the service and 14.5% gave a negative rating.

Staff reported that feedback was shared through boards around the service and included in monthly updates between managers and staff. The leadership team placed strong emphasis on the importance of the FFT as a tool for understanding patient experiences and improving services. Leadership demonstrated this by involving staff in discussions about how to address patient concerns and implement improvements.

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Patient partners and volunteers were involved in improvement discussions. Notes from governance meetings demonstrated patient partners meeting with ED consultants to discuss explore issues and opportunities for volunteers to support the department during periods of pressure.

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

The ED operated 24/7 year-round, ensuring constant access for patients in need. However, people faced significant delays in accessing care, support, and treatment in the service. This was particularly challenging for those with additional physical and emotional needs, who were sometimes disadvantaged due to the pressures within the service. Staff were not always able to ensure that patients received timely care and support due to delays in access and ongoing capacity pressures. People often waited extended periods in the service due to overcrowding, with a total of 135 patients present during our on-site assessment, 35 of whom were waiting for a ward bed. The longest wait observed for a ward bed was 48 hours. Despite these challenges, patients reported being kept informed about delays, particularly regarding the availability of ward beds, which helped manage their expectations.

Data showed significant numbers of patients experiencing delays exceeding national targets. In August 2024, there were 2,285 waits of over four hours, increasing to 2,716 in September and 2,861 in October. The number of patients waiting over 12 hours also rose, from 643 in August to 669 in September and 798 in October, reflecting growing pressure on capacity and flow. Data showed two patient harms were recorded in the same period. Long waiting periods exceeding 40 hours were considered the norm, with staff reporting that waiting periods exceeding 5 hours is unusual as patients wait for much longer lengths of time.

Although there were over 40 patients waiting for hospital beds in the ED during the assessment, there were no long ambulance queues or prolonged handover delays, reflecting efforts to minimise backlogs at the service's entrance.

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The service had 24/7 access to a psychiatric liaison team. Staff in the ED described the team as responsive to mental health patients in terms of the timeliness of assessments. However, patients waiting for a mental health bed was an issue which often had significant delays of up to 7 days. To support this registered mental health nurses were appointed to provided 1 to 1 care for these patients.

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The service had a pain team which operated from Monday to Friday, 9am to 5pm, where staff could refer patients with chronic pain to. However, we observed a patient with chronic back pain who had not had their pain managed and would have benefited from a referral. Also, we were not assured how patients with chronic pain were referred to the pain team outside of the operational hours, including over the weekend.

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The service did not have a specific frailty team based in the ED. There was however a dedicated ED frailty link nurse. This meant that there was limited capacity to conduct comprehensive assessments or manage complex needs of multiple frail patients in a busy ED environment. This also meant that there was a lack of multidisciplinary input into the care of frail patients.

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.

People’s care, treatment, and support promoted equality and protected their rights. There was no indication that people experienced any inequalities in outcomes or access to care, the trust had systems in place to support patients at risk of experiencing inequitable care including people with learning disabilities, autism or language needs, including a liaison service, use of interpreters and staff training. Discharge summaries and results were shared with patients’ GPs, ensuring continuity of care. The service made reasonable adjustments to support diverse patient needs, including hearing loops and interpreter services for individuals with communication barriers. Patients had access to digital information with QR codes displayed around the service for easy access to advice leaflets. For those unable to access digital resources, leaflets could be printed upon request. Staff actively signposted patients and carers to additional services, including community pharmacies and dentists.

Psychology support services were available for patients treated for major trauma, ensuring that those experiencing emotional distress were not overlooked. Trauma psychologists worked with patients to create personalised care plans, including ongoing therapy and referrals to mental health services.

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.

Advanced Life Support (ALS) training compliance for medical staff was 93.8%. For nursing staff, ALS compliance was at 88.89% with Basic Life Support (BLS) training at 100%. The services aimed to reach 100% compliance in the next 12 months.

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Patients had access to a digital application offered by the service which provided digital tools to monitor recovery, access physiotherapy exercises and included mental health resources and general wellness advice to ensure ongoing support.

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The service secured a grant from the Royal College of Emergency Medicine (RCEM) to trial facial scanning technology for remote vital sign monitoring. The project aimed to explore how digital innovation could enhance patient safety and monitoring capabilities.

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