You are here

King's College Hospital Requires improvement

We are carrying out checks at King's College Hospital using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 31 January 2018

Our overall findings indicated improvements had been made in a number of areas we inspected, although there was work still to be done to bring some of the ratings to a level of good. In particular we noted the significant work already carried out and continuing as a means of developing a well-led service.

We found the medicine services at King’s College Hospital improved the previous rating of requires improvement up to good for safety. All other domains in medicine were rated as previously, which was good.

Surgical services at King’s Collage Hospital were rated as follows: Requires improvement for responsive, which was unchanged from previous ratings. Effective reduced its previous rating from good to requires improvement. Safe, caring and well-led were rated as good, with safe and well led being an improvement from the previous rating.

Critical care services improved its ratings up to good for responsive and well-led and remained as good for effective and caring. Safety was rated as requires improvement, unchanged from the previous inspection.

The diagnostic imaging department at King’s College Hospital was inspected as its own service for the first time but was not rated on this occasion.

Inspection areas

Safe

Good

Updated 31 January 2018

Effective

Good

Updated 31 January 2018

Caring

Requires improvement

Updated 31 January 2018

Responsive

Requires improvement

Updated 31 January 2018

Well-led

Requires improvement

Updated 31 January 2018

Checks on specific services

Medical care (including older people’s care)

Good

Updated 31 January 2018

Our overall rating of this service improved. We rated it as good because:

  • There was a good incident reporting culture and senior leaders had a good oversight of the common incidents within medical services and understood what changes needed to be made to improve. We saw evidence to suggest learning from incidents was communicated to staff.
  • The management of a deteriorating patient had improved. Staff’s understanding of sepsis identification and management and when and how to escalate a deteriorating patient was good.
  • Nursing staffing levels was still one of the main risks all staff identified in medical services. However, staff said nursing staffing was improving and senior leaders provided regular updates regarding recruitment and retention.
  • We saw practice was in line with national recommendations and evidenced based guidance. Use of NICE guidelines was in place across a range of conditions and staff were able to access guidance if required.
  • Staff were well supported and reported good access to training and development.
  • Multidisciplinary (MDT) working across medical services was still good and there was a team approach when discussing patients’ care and treatment. All staff said the MDT working in the trust was excellent.
  • There was an improvement in the number of staff who understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the principles of the Act and how these applied in practice.
  • Patient and relative feedback was mostly positive and we saw patients were cared for in kind and compassionate ways that maintained dignity. We saw numerous thank you cards expressing gratitude to staff for their input and help.
  • We found services had been developed to meet the needs of patients who used it. For example, Marjory Warren Ward had a sensory room and sensory wall for patients with dementia. They had also painted patient bays different colours so patients could identify their bays easier. Oliver Polkey Ward was in the process of getting a roof top garden for longer term neurology patients to access.
  • The trust had recognised the cultural diversity of their local area and ensured staff had access to translators when needed, giving patients the opportunity to make decisions about their care. Food menus were also available in Braille for patients who had sight impairments.
  • There has been a transformation of the leadership of medical services and the new leadership had been in place since March 2017. Feedback from staff was that there were positive changes as a result of the new leadership. Leaders were present and supportive and there was a positive culture across services.
  • Clear governance structures were in place and we saw effective management of risks.

However:

  • We were not assured all medical wards were managing equipment in a way that was in line with hospital protocol and kept people safe. For example, we found two resuscitation trolleys that were not checked on a daily basis. We also found two medicine fridges in which temperatures had exceeded the recommended level on a regular basis.
  • The majority of the time we saw records were stored securely and kept people safe. However, on some occasion we saw staff had left confidential information displayed and computers were logged in and unattended. Agency staff did not have access to the online system and we had some concerns this meant they were unable to access patient information in a timely and accessible way.
  • The trust’s performance in the sentinel stroke audit had got worse and previous performances indicated the unit was capable of much higher performance.
  • Medical services still had a higher than expected risk of readmissions for some of their services, which was above the England average. This included haematology and general medicine services.
  • There were still some challenges with flow through the hospital and patients’ average length of stay for both elective and non-elective care was above the England average. Senior leaders identified patient flow as one of their risks and were taking a number of steps to mitigate this including the opening of a new medical ward in preparation for winter pressures.

Diagnostic imaging

Updated 31 January 2018

We did not rate the service. Our finding are detailed as follows:

  • The department had taken a proactive approach following the removal of some of their radiology registrars in April 2017. The potential negative impact on the service was greatly minimised by a robust action plan, reviewing of processes and development of staff.
  • Staff knew how to use the incident reporting system, received feedback about incidents and there was evidence of learning from these where relevant.
  • Staff were very patient focused and patients and carers spoke positively about the care and compassion shown by the diagnostic imaging staff.
  • Managers were visible to their staff and provided opportunity for regular appraisals, support and professional development.
  • New equipment had been and was in the process of being installed. Staff could see the progress being made to improve the quality of the service offered.
  • We found evidence of strong local leadership and a positive culture of support, teamwork and focus on patient care.

Surgery

Requires improvement

Updated 31 January 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Referral-to-treatment time (RTT) performance remained below the England average.
  • The proportion of patients with a fractured hip who had surgery on the day of or the day after admission did not meet the national standard and was lower than when we last inspected the service in 2015.
  • There was inconsistent completion of the malnutrition universal screening tool.
  • Appraisal rates for nursing and medical staff were below the trust target of 90%.

However:

  • There were improvements in theatre utilisation since the time of the last CQC inspection. Average utilisation in main theatres was 80% and 77% in the Day Surgery Unit.
  • The NHS Friends and Family Test for King’s College Hospital was better than the England average.
  • The new leadership model was seen as a positive change by staff who told us there was a strong sense of commitment to staff engagement.
  • Clinical governance structures were in place across the surgery service lines and staff could tell us of learning from recent serious incidents.

Intensive/critical care

Good

Updated 31 January 2018

Our rating of this service improved. We rated it as good because:

  • The service had improved since our last inspection in 2015. Patient records were now comprehensive, with all appropriate risk assessments completed. Staff were aware of their responsibilities under the MCA and we saw appropriate records were in place in patients’ notes. Management staff had sight of risks on the units and mitigating plans were in place to address those risks.
  • There were effective systems to protect patients from harm and a good incident reporting culture was in evidence. Patient records were comprehensive with appropriate risk assessments completed. The iMobile (critical care outreach) team provided rapid response and stabilisation to patients who needed immediate attention and transfer.
  • Staff provided evidence based care and treatment in line with national guidelines and local policies. Patient outcomes were better than the national average.
  • Patient feedback for the services we inspected was mostly positive. Staff respected confidentiality, dignity and privacy of patients. Patients were engaged through surveys and feedback forms and the response showed high satisfaction with the service.
  • Services were developed to meet the needs of patients. Feedback from patients was taken into consideration in designing a new critical care unit. Overnight stay near the hospital was arranged for relatives, and patients had access to a follow up clinic after they were discharged from the units.
  • The CCU had implemented a number of innovative services and developed these to meet patients’ needs. The CCU was engaged in research activities and had supported a significant amount of National Institute for Health Research (NIHR) portfolio studies.
  • There was good local leadership on the CCU. Staff felt valued, they were supported in their roles and had opportunities for learning and development. Staff were positive about working in the CCU.

However:

  • Medical staffing was stretched and did not comply with recommended guidelines. Pharmacy and therapy staffing levels were below the recommended guidelines.
  • Although plans were in place to open a new critical care unit, current bed spaces did not comply with the Department of Health’s building note HBN 04-02 which sets out a minimum standard of space for effective infection control.
  • The average bed occupancy on the CCU was consistently above 100% and there were delayed discharges from critical care units.