King's College Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant there were widespread and significant shortfalls in service leadership and culture. Leaders and the culture they created did not assure the delivery of high-quality care. Leaders did not consistently manage risks in a timely way

The service was in breach of legal regulation in relation to the governance of the service. Leaders did not consistently manage risks in a timely way or cultivate a positive and inclusive culture. We found out of date policies and guidelines.

We have not awarded this service a score for Well-led.

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

The service did not have a clear and supportive culture which was based on transparency, equity, equality and human rights, and engagement. However, staff understood the challenges and the needs of people and their communities.

Not all staff groups felt supported, respected, valued and involved in decision making. The midwifery staff did not feel valued and respected by leaders and reported low morale. This has negatively impacted staff morale and the culture within the service. They often felt changes were made by leadership without risk assessing how it will impact staff’s wellbeing and workload. This has further been impacted with the recent cut in bank and agency staff pay. This had resulted in some shifts not been filled and staff reported heavy workload and feeling burnt out. The obstetric and anaesthetic staff reported a good working relationship with the midwifery staff and were empathetic to the on-going challenges faced by their colleagues around pay cut. In response to this, the trust reported that the change in bank rates specifically was a Trust-wide initiative introduced in June 2024 to align with the London sector. They also reported that this was communicated with staff through multiple channels. The trust continues to engage with staff on service changes, prioritise their wellbeing and have implemented a cultural programme for senior leaders in the service.

After the onsite inspection we received whistleblowing concerns from maternity staff that raised concerns about leadership, safety, governance and the overall culture of the unit. We carried out focus groups in response to capture the voices of as many staff as possible. Staff of all levels did not always feel involved in decision making, which was negatively impacting on morale and the culture within the service. Staff felt changes were made without carrying out impact assessments on staff’s wellbeing and workload. This included changes in staffing and service provision in telephone triage, the newborn and infant physical examination process and drop in midwifery staff bank rate. Staff also felt their views, concerns and suggestions around safety and learning were not always listened to and taken into account and this impacted on the service, staff and patient safety. The NHS staff survey 2024 showed that the service scored below the trust average across several categories, including ‘we all have a voice that counts. Following our assessment, the service added that the changes referenced by staff were implemented in line with trust policies and this includes staff engagement and holding question and answer sessions.

Leaders told us they were aware of the culture within the maternity service and how this could affect the quality of people’s care. There was action plan in place to improve the culture and staff experience however, this was not always addressed quickly. The hospital carried out a SCORE survey in March and April 2024 for all maternity staff to better understand the culture within the service. The SCORE survey is an internationally recognised way of measuring and understanding culture. The result highlighted 3 main areas for improvement: staff wellbeing, retention and involvement in decision making. The service had an action plan in place to address areas of improvement, which was monitored at governance meetings and included staff wellbeing, staff forums and training. Six senior leadership team had completed a cultural conversation training and were champions to build and promote a strong safety culture.

The April 2025 maternity staff survey action plan included improvement plans around workload and staffing levels, communication and leadership, training and wellbeing, staff wellbeing, culture and teamworking, leadership development. The workload and staffing levels improvement actions focused on rostering, rota planning to ensure fair shift distribution, recruitment and retention. The communication and leadership improvement actions focused on introduction of monthly staff forum, and ‘you said we did’ initiative.

The service had PMA’s to help maternity staff with restorative clinical supervision, debriefs, wellbeing conversation and providing a safe space to talk and be listened to. It was unclear however, how many PMAs were at the service. Following our assessments, the trust advised that the service had a designated PMA lead and 10 PMA’s as of April 2025. Although the service did not have the recommended 1:20 staff to PMA ratio, all staff were allocated to a PMA for support and safety oversight. The service had secured additional funding to train more PMAs. The service launched a wellbeing room for staff in June 2024, which was well furnished and had a massage chair and mood lights to promote staff wellbeing. Senior staff told us the service also promote staff wellbeing by monitoring staff breaks daily, staff award initiative and extended black history month bake sale. Staff told us this have helped improved their wellbeing.

The trust had a 5-year vision and strategy for what it wanted to achieve and objectives to turn it into action, developed with all relevant stakeholders. The vision and strategy was BOLD which stood for:

• Brilliant People
• Outstanding Care
• Leaders in Research, Innovation and Education
• Diversity, Equality and Inclusion at the heart of everything we do

This vision and strategy was adopted by maternity and an action plan to achieve it was developed specific to the Women’s Health care group. The service values were kind, respectful and team. The service vision was: “We are committed to guide and empower our people to lead and provide a high quality, equitable, compassionate service to every family in our care”. Staff we spoke to were aware of the vision, strategy and values.

The trust had developed a new 3 year single delivery plan, which was being mapped against a draft maternity strategy to align with the NHSE 3 year delivery plan for maternity and neonatal service. Leaders had scheduled maternity and neonatal strategy away days in April 2025 to engage with staff and stakeholders around the draft maternity strategy. The trust also held a care group strategy away day to integrate key initiatives from the SCORE survey, General Medical Council (GMC) survey and the Professional Midwifery Advocate (PMA) launch to help the development of the revised maternity strategy.

The service vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

Staff felt leaders were not always visible, approachable, compassionate, open and managed priorities in the service. This was not an improvement from the last inspection. They did not always embody the culture and values of their workforce and organisation. However, leaders had the skills, knowledge, experience and credibility to lead effectively.

Kings College Hospital NHS Foundation Trust had maternity services at the Kings College Hospital site and the sister site, Princess Royal University Hospital. Maternity services sat within the Women’s Health care group and had a trust level perinatal leadership team also known as the quadrumvirate. The quadrumvirate consisted of the director of midwifery, clinical director of women’s health, clinical lead of neonatology and general manager of women’s health. Each hospital site also had a head of midwifery. The leaders were supported by a deputy clinical director, service managers, matrons, consultant midwives and specialist midwives.

The service had a history of unstable leadership over the past 3 years which staff reported impacted morale. Although the trust now had a fully established senior leadership team, there were some vacancies in the matrons and governance leadership team. At the time of the onsite inspection, the community matron and head of governance posts were vacant and were in the process of being recruited to. A new community matron and head of governance were due to commence at the end of April 2025. The dedicated lead for triage was on short term sick leave at the time of inspection and staff reported that there was a lack of leadership and oversight of triage, which was more pressing and impacting on the service and staff morale.

Leaders had the experience, skills and abilities to run the service. However, staff did not always feel leaders were always compassionate to the needs of women and staff. Staff reported that various changes had been made that had negatively impacted the care they were able to provide. This included but was not limited to reduction in bank pay rates and the removal of band 7 ward managers in some areas across the unit. Leaders did not always understand and manage the priorities and issues the service and staff faced. This was not an improvement from the last inspection. However, following the assessment, the service told us that no Band 7 ward managers had been removed from the ward management rotas.

Staff expressed concern about midwifery leadership, change management, recruitment process, disconnect between staff and senior team and a culture of intimidation.

Leaders were not always visible and approachable in the service for women and staff. Staff told us that the head of midwifery and director of midwifery were not always visible in the service or knew who they were. Some staff felt they were not approachable and would not contact them for support or to escalate concerns. However, staff felt their matrons and ward managers were visible and supportive. Some senior and specialist midwives felt undermined and not valued by their managers. The hospital level senior leadership team and senior midwifery team reported they had direct access to the quadrumvirate, however, they were not always consulted or involved in decision making that affected their clinical areas. Staff felt leaders did not always understand and manage the priorities and issues the service faced and had made decisions which impacted on their clinical areas, patient experience and outcomes. They also expressed concerns around lack of transparency and misrepresentation of staff views and performance to the board and external bodies. Records from governance meetings and site visits confirm that the head of midwifery and director of midwifery regularly attended team meetings, safety sessions, and engagement events. Following the assessments, the service acknowledged that there had been periods of change, which may have left some staff feeling unsettled.

The service was supported by maternity and neonatal board safety champions, executive director and non-executive directors. Majority of staff did not know who the maternity board safety champions were, including their frontline safety champions. This was not an improvement from the last inspection. Safety champion posters were displayed recently in all clinical areas according to staff, identifying the director of midwifery, clinical director, lead clinical neonatologist as frontline safety champions, along with executive director and non‑executive director board level safety champions. We observed that the current perinatal maternity and neonatal safety champion structure did not have frontline safety champions representative and caused confusion for staff. This was not in line with best practice and the national guideline as there was no delegated authority to support board level safety champions and no direct voice from ward-level staff to the board. However, the service provided evidence of regular walk around of safety champions visiting the service.

Not all staff particularly staff from ethnic minority groups felt senior leaders supported staff to develop their skills and take on more senior roles. Following our assessment, the trust advised there was equal opportunity for all staff to apply for advertised roles, with support provided throughout the application process. The trust told us that staff from neurodivergent groups and mixed ethnic backgrounds were supported to apply for secondment opportunities outside the trust. Staff from ethnic minority groups were encouraged and supported to participate in the Capital Midwife Fellowship programme, with five staff participating in 2024 and four enrolled for 2025.The senior midwifery team was diverse, with new staff recruited from a wide range of backgrounds.

Leaders understood how health inequalities affected treatment and outcomes for women and babies from ethnic minority and disadvantaged groups in their local population. They worked closely with various stakeholders such as the maternity and neonatal voices partnership (MNVP), integrated care board (ICB) and the local maternity and neonatal system (LMNS) who attended various meetings and had an extensive programme to improve the equity of experience and address health inequalities.

Senior staff told us they attended regular leadership away and had a motivational speaker coming to speak to the leadership team around resilience.

People did not always feel they could speak up and that their voice would be heard.

Staff told us during the assessment and post assessment the service did not have an open culture that encouraged them to raise concerns without fear. Staff were not confident that their voices would be heard when they raised concerns. Staff that had raised concerns reported being punished and silenced for raising concerns or actions were not always taken which negatively impacted staff morale and desire to raise concerns in the future. Staff expressed concern around a culture of exclusion and leaders silencing those that raised concern. The NHS staff survey 2024 showed that the service scored below the trust average in all the headings including the, ‘we all have a voice that counts’ heading. However, women and their families we spoke with could raise concerns without fear.

The service had a freedom to speak up guardian and champion, and staff knew how to access them. However, not all staff felt they could raise concerns. Staff had raised 13 concerns to the freedom to speak up guardian between April 2024 and April 2025. These concerns were related to bank pay rates, staff access to records, human resources (HR) pay, shift allocation and recruitment process. It was unclear if the service was doing anything in response to these concerns raised.

Following our assessment, the trust informed us that, in response to concerns raised about bank pay rates, staff access to records, HR pay, shift allocation, and the recruitment process, the service has taken specific actions. This includes staff engagement sessions, policy reviews, improvements to access protocols, monitoring of HR KPIs, rota management updates, and streamlining of recruitment processes. Actions were tracked and communicated through ‘You said We did’ updates and governance reports. However, we were not provided with assurance that staff felt safe raising concerns.

Staff of all backgrounds did not always feel valued and respected. However, the service valued diversity in their workforce.

The NHS survey 2024 included trust specific data on Workforce Race Equality Standards (WRES) and Workforce Disability Equality Standards (WDES). This data is representative of the trust as a whole and not specific to maternity services. The finding showed 26% of white staff and 28% of staff from other ethnic groups had experienced harassment, bullying or abuse from staff in the last month. Only 52% of white staff and 44% of staff from other ethnic groups believed that the organisation provided equal opportunities for career progression or promotion. Findings from the hospital workforce disability equality standards question showed 32% of staff with long-term conditions or illnesses and 20% of staff without long-term conditions or illnesses experienced harassment, bullying or abuse from other colleagues in the last 12 months. Only 40% of staff with long-term conditions or illnesses and 49% of staff without long-term conditions or illnesses believed that the organisation provided equal opportunities for career progression or promotion. This highlighted there was room for improvement with workforce equality.

Staff gave examples of how staff with protected characteristics and long-term conditions had been supported by managers. However, not all staff felt there was equal opportunity for career progression. Some staff had experienced or witnessed bullying and harassment in the service.

Leaders made reasonable adjustments to support staff with protected characteristics to carry out their roles well.

Leaders actively ensured staff and leaders were representative of the population of people using the service. Staff and leaders we observed onsite were representative of the population of people using the service.

Leaders ensured there were ways to engage with and involve staff with protected equality characteristics. The trust had equality networks such as staff disability networks, ‘Kings and Queer - LGBTQ network’, women’s network, administration network and interfaith and belief network and people from ethnic minority groups network that staff were actively involved in.

Staff received training on equality, diversity and inclusion as part of their mandatory training.

The trust did not have systems of good governance and risks were not always managed in a timely way.

Leaders did not always operate effective governance processes, throughout the service. We found repeated breach from the last inspection including staffing, policies, risk assessments and patient records. We were concerned around the lack of robust governance process, stable leadership and pace in dealing with the safety, governance and cultural issues in the service.

The governance team was made up of a head of governance, compliance and assurance, a maternity quality improvement transformation lead, a lead midwife for education and workforce, patient safety managers and audit and quality midwives. At the time of the inspection the head of maternity governance, compliance and assurance role had been vacant since January 2025. We were told the post had been recruited to and the appointee was due to start at the end of April 2025. However, while the trust's maternity services operated as an integrated service with a single, cross-site governance process, arrangement, and oversight. We found repeated breaches from the last inspection, including governance, staffing, policies, risk assessments and patient records. Therefore, we were concerned about the lack of a robust governance process, stable leadership, and pace in addressing safety, governance, and cultural issues in the maternity service at this hospital.

Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The service held various governance meetings which fed into the maternity and neonatal quality and safety meeting and were reported to the trust board. This includes the maternity quality governance meeting, weekly patient safety incident response framework (PSIRF) review panel, south east London (SEL) maternity and neonatal system board meeting and SEL LMNS quality surveillance group meeting.

Governance meeting agendas included discussion around all aspects of governance and oversight of the service such as performance data, audits, risk register, safety alerts, incidents, feedback, external reviews, policies and guidelines. Although actions were highlighted and reviewed at governance meetings, the meeting were not always quorate and attended by full multidisciplinary representatives. For example, we reviewed minutes of the quarterly maternity and neonatal quality safety meeting which doubled as the perinatal safety champions meeting and noted the absence of the non-executive board safety champion, neonatal representatives and obstetric consultants at some of the meetings. The lack of a separate safety champions meeting was not in line with best practice.

The trust board minutes reviewed showed that maternity items were part of the monthly meeting papers and included topics such as incidents, staffing, performance reports, national maternity reports recommendations, Clinical Negligence Scheme for Trust safety action compliance (CNST) and NHS staff survey. The trust board had declared they were compliant will all 10 of the safety actions of CNST: maternity incentive scheme (MIS) year 6. The MIS is a financial incentive programme designed to enhance maternity safety within NHS trusts. It rewards trusts that can demonstrate they have implemented a set of core safety actions. However, considering the number of repeated breaches identified as part of this inspection related to lack of audit, coordinator supernumerary status and over 50 multidisciplinary staff concerns around lack of transparency and misrepresentation of staff views, safety concerns and performance to the trust board and external bodies, we were not assured the trust was compliant with all 10 safety actions of CNST MIS year 6. Following our assessment, the service informed us that the trust board had oversight of the MIS year 6, with a monthly panel chaired by the chief nurse and executive director of midwifery, and participation from LMNS. Updates on the 10 safety actions were presented to the quality committee and the trust board, and all supporting documentation was reviewed both internally and externally by the LMNS prior to declaring compliance.

Staff did not always follow up-to-date policies and guidelines to plan and deliver high quality care according to evidence-based practice and national guidance. We found some out of date policies and guidelines such as management of maternal bacterial infection, data protection, information system security, screening, newborn screening and medical gas policy. Following the assessment, the trust informed us that they now had a rolling programme, led by a consultant and an audit midwife, to update the maternity guidelines, which was monitored at the clinical guideline meetings. As a result, as of November 2025, 90% policies and guidelines were now up to date, which was in line with the trust 90% target and 3% improvement from our onsite visit. The newborn screening and maternal sepsis bacterial infection guidelines have been reviewed and were up to date. The management of maternal bacterial infection guidelines have been made obsolete and superseded by the management of maternal sepsis guidelines in June 2025.

The obstetric haemorrhage and intrapartum intermittent auscultation guidelines had professional and national guideline references that were outdated and did not reflect latest guidelines.

The service had a risk register which included risks such as electronic record failsafe reporting issue for antenatal screening, community access to electronic records in areas of network service, midwifery and obstetric staffing, CTG central monitor, staff morale and burnout, transfer of women from midwifery assessment unit (MAU) to triage or labour ward and lack of ligature-light rooms.

The risk register included items such as title, description of risk, risk cause and impact, allocated handler, risk score, review date and the controls currently in place. The risk register included the risks we identified on inspection which provided assurance that leadership and staff were aware of the risks within the service. However, we noted that some of the risks were rated lower than we would expect, had been open on the risk register for extended periods of time with no trajectory and updates were out of date. For example, the transfer of women from MAU had been on the risk register for a long time. This was raised with senior leaders, and they reported that these risks remained on the risk register and had a low score, however they were assured they had control measures in place to ensure women were safe. Following our assessments, the service clarified that the delay in closing the MAU risk was due to the need to ensure the most appropriate location was fully risk-assessed before the MAU could relocate safely by the end of April 2025. They also reported that they regularly reviewed the risk rating and adjusted it depending on how successful the control measures were.

Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. The service participated in relevant national clinical audits.

Outcomes of governance meetings and service dashboards were shared with staff through emails, safety week, posters, handovers and newsletters. The service had an on-going maternity dashboard quality improvement (QI) project in line with their three-year delivery plan and national NHS England Core20PLUS5 approach to reduce health inequalities at a national and system level. The aim was to identify and analyse data relating to ethnic minority and most deprived groups from the maternity dashboard data to help drive improvement.

The service collected reliable data and analysed it. Key performance indicators were displayed for review and managers could see other locations for internal benchmarking and comparison. Data or notifications were consistently submitted to external organisations as required such as MNSI. The information systems were integrated and secure.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff shared information and learning with partners and collaborate for improvement.

Staff and leaders were open and transparent, and they actively collaborate with all relevant external stakeholders and agencies to help improve services for women.

The service exited the NHS England maternity safety support programme (MSSP) in December 2024 and leaders told us they were actively involved in the programme before the exit. The trust maternity services recently received an oversight visit by the regional team and the Southeast London (SEL) Local Maternity and Neonatal System (LMNS). Senior leaders told us no safety recommendations were made, and the trust received positive feedback around their MSSP evidence exit criteria submitted and sustainability plan.

Leaders understood the needs of the local population. Staff and leaders engage with people, communities and partners to share learning with each other that resulted in continuous improvements to the service. For example, the service had engaged with the SEL integrated care system (ICS) to provide foreign language parent education antenatal class and public health workstream that focused on health needs and inequality. The service had also worked collaboratively with the SEL ICS and LMNS to implement some maternal health inequalities initiatives such as providing community outreach projects and lunch time webinars in February and March 2025 for South Asian maternal health, Gypsy And Traveller maternal health, autism in pregnancy and understanding the black maternal experience.

Leaders worked with the local maternity and neonatal voices partnership (MNVP) to contribute to decisions about care in maternity services. Service leaders had built meaningful relationships with the MNVP and encouraged them to attend maternity meetings. The MNVP were active and passionate about their role, had regular engagement activities with leaders and women to make a difference to services provided to women and birthing partners who accessed the service. The MNVP had regular meetings with the trust and had easy access to the senior leadership team to escalate any concerns promptly.

The MNVP held regular online listening events, walk the patch, 15 steps challenge, feedback Fridays on social media and attended the safety champions walks. The MNVP had been involved in the development of the new neonatal intensive care unit (NICU) patient information leaflets, held engagement with women in the diabetes clinic, organised a social media live session on home birth. They also collaborated and supported organisations such as the Parents and communities together (PACT) intervention project to provide support and information for pregnant mothers.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research. Safe innovation was celebrated.

Leaders encouraged innovation, quality improvement and participation in research. The trust had a women’s health research team. The trust had the highest research recruitment in England and the leading site in South London for recruitment of reproductive health and childbirth studies.

The service had 18 research studies for 2024/25 and the fetal medicine department had published 50 research papers in 2024 which included ‘preeclampsia prevention by timed birth at term. The service had also published a research paper in 2024 on RELAX, which focused on reducing levels of anxiety in pregnancy and after birth.

Staff were supported to prioritise time to develop their skills around improvement and innovation. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Examples of QI projects that were completed or in progress included review of community service, induction of labour, CTG data base, opioid use in postpartum caesarean women on discharge, obstetric lead project with Islamic community and Chagas disease screening programme for Latin American population.

The service implemented a British Association of Perinatal Medicine (BAPM) perinatal optimisation clinical and baby passport in July 2024 which helped enhance teamwork, antenatal counselling experience for parents and standardisation of care. An audit showed that 93.4% of staff found incorporating the baby passport into antenatal counselling useful and effective.

The trust also had a quality improvement project aimed at reducing term admissions for hypoglycaemia, which resulted in 67% reduction in number of admissions in the service.

A research maternity staff member had co-created a psychological support leaflet for women who were going through miscarriage.

The service received an award for presenting a perinatal optimisation poster on optimising early maternal breast milk for preterm infants at the September 2024 BAPM conference.

The perinatal specialist midwives were nominated for an RCM award for the in-person birth with confidence class provision for women.

The bereavement midwife received a Mariposa international award for outstanding contribution to bereavement care.

A midwife had launched a maternal journal which had been implemented nationally to address mild to moderate mental health issues during pregnancy and to support Jewish women during pregnancy.

The service was planning to develop an online parent education session for LGBTQ+ parents. A midwife had launched a support meet-up group for LGBTQ+ parents and recently published a guidance tool for clinicians providing LGBTQ+ inclusive reproductive health care.

The service had strong external relationships that supported improvement and innovation. For example, one of the midwives had been seconded to SEL LMNS to develop foreign-language parent education classes. Women could access live, online monthly 3-hour parent education sessions in 6 languages facilitated by native-speaking multi-disciplinary staff. The service had also developed resources in different languages which was made available to any women at the hospital.