King's College Hospital

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 changed to good. This meant people’s needs were met through good organisation and delivery.

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 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.

The needs and preferences of women, birthing people and abide were taken into account when delivering and coordinating services, including those who were in vulnerable circumstances or had complex needs. Care and treatment was coordinated with other services and providers, to ensure the needs of women and their families were met.

Staff made sure that women and their families were involved in the care planning and decisions around their birth plan and treatment. We observed during the ward rounds that women and their birthing partners were actively involved in decision making. Women we spoke with during the inspection also reported that they were always involved in decision making and staff were responsive when additional support was required from specialist teams.

The service had specialist midwives such as bereavement midwives, consultant midwives and safeguarding midwives who supported women ’s individual needs. Staff knew how to contact these specialist midwives and reported that they were supportive and accessible. Women ’s care plans we reviewed fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act.

The service provided women appointments with the consultant midwife to support informed choice discussions and facilitate the coproduction of personalised care plans that may potentially fall outside clinical recommendations.

Managers made sure staff, women, loved ones and carers could get help from interpreters or signers when needed. The trust had information available on the intranet about the translation services available and how people could access them 24 hours a day. This was through a variety of methods, including telephone and face-to-face interpreting, written translations of women’ information such as letters and British Sign Language (BSL) interpreters.

Managers ensured that women who did not attend (DNA) appointments were contacted. The service monitored the rates of women who DNA appointments over the past 12 months and was exploring a quality improvement (QI) project on how to reduce DNA rates. From the results of an audit carried out for the period January to March 2025, 80% of women were correctly followed up who DNA appointments. The service had an action plan in place to work towards 100% recording of DNA follow-ups and to re-audit compliance in 6 months’ time. The service also carried out an audit for planned appointments in the Maternity Assessment Unit (MAU), which provided assurance that midwives were following the DNA policy within the MAU guidelines and highlighted any areas for improvement. The policy and guidelines were all in date.

Managers worked to keep the number of delayed and cancelled appointments, treatments and operations to a minimum

The maternity services had birthing balls, birthing pools and stool to promote comfort of women in labour.

Women had a choice of meals, which took account of their individual preferences, respecting cultural, nutritional and personal choice.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Managers planned and organised services so they met the needs of the local population. The service had systems in place for women in need of additional support or specialist intervention. The service had community midwives that organised outpatient appointments for women throughout their pregnancies and postnatally at people’s home or community. The service also had a maternity continuity of carer team that provided dedicated care for women who were at risk of poorer outcomes.

The trust had updated the intrapartum care guidelines, which combined all aspects of intrapartum care in a single set of guidelines. These guidelines were approved at the maternity clinical governance committee, and involved the input of senior and consultant midwives and obstetricians. The guidelines covered areas such the need for women in labour to be assessed in line with Birmingham Symptom Specific Obstetric Triage System (BSOTS) guidance, and that all women should receive supportive one to one care when in established labour.

The service also had a personalised place of birth assessment tool, which helped midwifery and obstetric staff identify and reassess any risk factors during the antenatal, intrapartum and postnatal period. This tool ensured that all midwives were supported in identifying changes of risk in a timely manner and act on these findings appropriately, ensuring effective communication with women, their birthing partners and the multidisciplinary team. It was unclear if the service has audited the effectiveness of this tool.

Staff planned women's ’s discharge carefully, particularly for those with complex mental health and social care needs. For example,staff referred women experiencing domestic violence to social services, and contacted the liaison psychiatric team prior to women with known psychiatric illnesses are discharged from the MAU in line with the trust guideline.

Staff in the antenatal clinic told us they did not have enough midwifery clinics on Wednesdays because there were several consultant clinics also taking place. They felt this impacted the antenatal service provision for women. It was unclear, what has been done about this.

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

Women could get information and advice that was accurate, up-to-date and provided in a way that they could understand and which met their communication needs. Information leaflets available electronically in community languages spoken by women, including Arabic, Spanish, French, Portuguese, Romanian and Somali. Staff could provide paper copies of patient information leaflets or copies of information leaflets in other languages if required, so information was tailored to individual needs. The service also promoted resources about supporting the LGBTQIA+ community in the perinatal period, including mental health. All of these resources empowered women with knowledge and supported informed decision-making throughout the maternity experience.

The service embraced a range of innovative approaches to sharing information, ensuring accessibility, inclusivity and real-time engagement. These included the use of interactive digital platforms such as quick response (QR)-coded posters across clinical areas, linking women and staff directly to up-to-date guidance, resources and feedback tools. Social media channels were actively used to disseminate key messages, celebrate good practice and engage with the local community.

The service offered a comprehensive selection of maternity leaflets and resources designed to support expectant and new parents throughout their journey. This information was also highlighted in appointments and was available on the trust’s website. The resources available on the trust’s website covered a range of topics, including aspirin use in pregnancy for pre-eclampsia prevention, postpartum care, dietary guidance during pregnancy and managing specific conditions like immune thrombocytopenia and sickle cell disease during pregnancy. The leaflets and resources on the trust’s website were written in a way that women and their families could easily understand. Women were signposted to external resources where relevant as part of their maternity care.

The service also provided a maternity parent education sessions which women could book onto at their convenience, these were available both online and face-to-face, and were offered in addition to local parent education groups. The sessions covered a range of topics, including workshops on infant feeding, women planning a caesarean birth, and Black and Black mixed heritage antenatal education, support and networking sessions. There were also specific classes available for women identified as having risk factors for pelvic floor issues during pregnancy, including separate classes in other languages spoken in the community that the service offered to women.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Women, birthing people, and their families knew how to make a complaint and felt that their complaint would be acted on. We requested the total number of complaints from the period April 2024 to March 2025 from women, birthing people and their families and carers, in addition to the total number of complaints the service upheld for the same period. The total number of complaints the service received was 86, of which 56% (n48) were upheld. The total number of complaints referred to the Ombudsman for the same period was 3, none of which were upheld. The service had 6 overdue complaints at the time of inspection.

The service had oversight of complaints and women received feedback from managers after their complained had been investigated. Managers understood the policy on complaints and knew how to handle them. The service had a Trust-wide complaints policy, which had recently been updated to include alignment to Parliamentary & Health Service Ombudsman final NHS Complaints Standards & revised Complaints Standard Operating Procedure.

Managers investigated complaints and identified themes. Managers shared feedback from complaints with staff and learning was used to improve the service.

Staff understood the duty of candour. They were open and transparent and gave women and families a full explanation if things went wrong.

The trust’s performance from the most recent CQC maternity survey was largely in line with other trusts. The maternity survey covered a range of areas, including women being involved in the decision to be induced, receiving appropriate advice and support when contacting a midwife or the hospital, the opportunity to ask staff questions about their labour and birth, and a member of staff being available to help if attention was needed during labour and birth.

However, when comparing the survey results with other trusts, the service scored slightly worse than expected for pain management during labour and birth. This meant that staff could improve how they manage pain for women. The survey identified further improvements needed for staff caring for women to be aware of their medical history, which also scored slightly worse than expected.

Women and birthing people could access care, treatment and support when they needed to however, this was not always delivered in a timely way.

Women accessed the maternity services via their GP, local children’s centre or by direct referral. Women could also self-refer to the service by the phone or completing a booking form on-line.

Women were able to access the maternity assessment unit from 8.30am to 6pm, Monday to Friday for clinical intervention and recurrent appointment. Women could also call the maternity helpline 24hrs, 7 days a week. Women could also contact community midwives for non- urgent concerns during working hours.

Women were referred to the day assessment unit and fetal medicine unit (FMU) through self-referral, midwives, GP and ward referrals for on-going surveillance such as blood pressure, cholestasis through scheduled appointment.

Women could access care, treatment and support when they needed to and in a way that worked for them, which promoted equality, removed barriers and protected their rights. However, women experienced delays in the midwives and doctors reviews in triage and MAU.

The service used ‘language line’ for women whose first language was not English. The service had antenatal classes available online for parents who spoke other languages in the community, such as Romanian and Somali.

Women could access services when they needed to, including outside normal hours and in an emergency. The service provided a maternity parent education schedule that women could book onto at their convenience, which had parent education sessions available both online and face-to-face. The sessions covered a range of topics, including workshops on breastfeeding, women considering a planned caesarean birth, and Black mixed heritage antenatal education, support and networking sessions.

The service had recently carried out an audit regarding the delayed induction of labour (IOL) over the period from September 2024 to February 2025. The findings from the audit indicated there were 56 delays in IOL over this period, the maximum number of days delayed was 15 due to maternal choice to await IOL, the second longest delay was 11 days, 1 for maternal choice and 1 due to availability of surgical neonatal intensive care unit (NICU) bed. The most common time of delay was 1 day or less and the most common reason for delay was maternal choice (21 women) or high acuity (15 women).

The service therefore had some minor delays with IOL, but there were no poor outcomes as a result of delays within this area. All delays were reviewed through the MDT and discussion with an obstetric consultant. The service reviewed and triangulated incidents with delays, and this audit demonstrated no adverse outcomes associated with delays in IOL. The service had implemented an action plan and recommendations with the aim of reducing further instances of delays in IOL, including antenatal conversations around offering low-risk IOL from the Princess Royal University Hospital site when capacity dictated. The actions had completion dates set and staff who were assigned to complete each action by the dates agreed.

The service prioritised, allocated resources and opportunities as needed to tackle inequalities and achieve equity of access. There were specific classes available for women identified as having risk factors for pelvic floor issues during pregnancy, including separate classes in other languages spoken in the community that the service offered to women. The service’s maternity parent education schedule was offered to people in addition to local parent education sessions from midwifery teams.

Facilities and equipment were physically accessible to women with disabilities, sensory impairment or additional needs.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service proactively looked for ways to address barriers to improve women ’s experience, acting on information and outcomes and allocate resources and opportunities to achieve equity.

Leaders and staff were mindful of discrimination and inequality that could disadvantage different groups of people using their services. The service worked closely with the MNVP chairs and the local maternity and neonatal system (LMNS) to ensure that the voices of women experiencing discrimination and or inequality was heard to improve service user outcomes and drive improvement to the service.

The service proactively looked at ways to address barriers to improve women’s and babies experience. This was looked at on a service, trust and regional levels at various governance meeting minutes reviewed. There were various initiatives and projects carried out by the service and in collaboration with other services in the region to address barriers and health inequalities. This included targeted health promotion activities available in English and top foreign languages spoken by the local population. We saw evidence of the experience of women from marginalised communities being discussed at quality and safety meetings which was also attended by representatives from the LMNS. The discussion highlighted issues with cultural awareness, communication barriers and lack of clear accessible information. In response to this the service reported that there was a project with the LMNS underway to develop foreign language parent education.

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

Women could get information and advice that was accurate, up to date, and provided in a way they could understand to plan for their birth and future. The service supported women to make informed choices about their care through

• health promotion information,
• antenatal classes,
• appointments with midwives,
• birth plan documents,
• information leaflets,
• and resources available on the maternity page of the trust’s website.

The service had a number of initiatives in place to capture real-time feedback from women. This included dedicated consultant time on the postnatal ward to discuss birth experiences with women to ensure they left with a clear understanding of their care. The service shared feedback through the perinatal quality surveillance report which was shared with both the trust board and integrated care board (ICB).

The service was committed to providing consistent information to women and their families in the right way at the right time, and more seamlessly between departments. This included the creation of post-natal care plans upon admission to the post-natal ward and having posters in the ward welcoming women. The service was also aware about the importance of personalised care, aiming to provide antenatal care by the same midwife ensuring clinicians were aware of the patient’s relevant history and provide antenatal continuity of care.