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

People could not always access care, support and treatment they needed when they needed it. The service had delayed discharges which affected patient flow on the ward. Several patients had been on the ward for significant lengths of time. The service had significant patients who were placed on other wards (known as medical outliers).

However, patients were provided with relevant information in formats that were tailored to their needs. Patients were involved in planning and making decisions about their care and treatment.

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.

Patients were regularly involved in planning and making decisions about their care and treatment. They understood their condition, care and treatment options (including any associated risks and benefits) and any advice provided.

Patients could receive the most appropriate care and treatment for them as the service made reasonable adjustments where necessary. For example, staff completed individual care plans which addressed specific needs for each patient. The service offered ‘This is Me’ booklets for dementia patients. This contained easy to access information about patients’ preferences.

Staff understood single sex accommodation standards, and there were no breaches.

The service understood the diverse health and care needs of people and their local communities. However, there were delayed discharges due to major constraints within the wider health and social care system.

There were a significant number of patients remaining in hospital for long periods of time when they were medically fit for discharge. During our inspection, we reviewed patient length of stay on the wards and found several cases where patients had been on the ward for significant lengths of time. For example, the longest patient stay on Mary Ray ward was for 223 days due to complex health and social needs. The patient had been awaiting discharge since February 2025. Staff explained that some of the patients were experiencing delays in their discharge processes due to lack of suitable care placement and/or complex social needs. We noted that all wards visited were at full capacity which affected the service’s ability to admit other patients. This impacted the flow of patients through the hospital and from departments such as the emergency department.

We reviewed trust data for patients who were placed on other wards (known as outliers) in acute speciality medicine between November 2024 and April 2025. A medical outlier is a patient who is admitted to a hospital ward that is not their speciality. These patients, often not medically fit for discharge, could face delays in medical reviews as medical teams looking after them were not always in the right place at the right time. The trust data showed significant outliers with 133 in November 2024, 278 in December 2024, 472 in January 2025, 245 in February 2025, 165 in March 2025, and 66 in April 2025. The Trust reported that outlier patients were managed through daily reviews by the Clinical Director and patient flow managers, with efforts to cohort patients on a dedicated ward where possible. During peak periods, additional medical oversight was provided, including a dedicated consultant and resident doctor.

Patients received care and treatment from services that understood the diverse health and social care needs of their local communities. Even in the face of delays (particularly around discharges), patients spoke positively about their experiences due to the patience and kindness of staff.

There was continuity in patients’ care and treatment. Information was appropriately shared with community teams including GPs and specialist teams. Staff could access wider information about patient health records from the regional health service.

Services were delivered and co-ordinated with appropriate consideration of patient’s needs and preferences, including those with protected characteristics under the Equality Act and those at higher risk of a poorer experience of care. The wards were easily accessible by people using wheelchairs or those with reduced mobility.

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

Staff provided patients, their families, and carers with information that was accessible, safe, secure, and supported their rights and choices. Patients were provided with relevant information about their condition, follow up care and treatment as required.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. This included making reasonable adjustments for people with disabilities, interpreting and translating for people who did not speak English as a first language and for Deaf people who used British Sign Language. People who had difficulty with reading, writing, or using digital services were supported with accessible information.

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

Patients and their families knew how to give feedback about their experiences of care including how to raise any concerns or issues and could do so in a range of accessible ways.

The service had a complaints policy, which provided guidance to staff on the processes they should follow in the event of a patient complaint. Staff understood the complaint policy and knew how to escalate concerns. Patient information leaflets included details about the complaints process and leaflets were available on the ward or the trust webpage for patients to access.

Managers investigated complaints and identified themes. Managers shared feedback from complaints with staff and learning was used to improve the service. We reviewed complaint response letters which often highlighted lessons learned. For example, in one case, the trust assured relatives that they would reiterate the importance of detailed documentation with staff following a complaint.

The trust carried out patient satisfaction surveys to obtain feedback about its services. Patient feedback was mostly positive. Between September 2024 and March 2025, the service scored an average of 94.9% for positive feedback.

People could not always access care, support and treatment they needed when they needed it.

The service had significant delayed discharges which affected patient flow on the ward. A delayed discharge is when a patient was not discharged at the earliest time they can go home and meant the bed was not available for other patients.

We reviewed the trust data on 465 patients who were “discharge ready” but still on medical wards at various points between October 2024 and March 2025. The average length of stay for the patients was 26 days, with patients staying on average for 8.8 days after they were “discharge ready”. One patient stayed for 141 days, nine stayed for over 100 days, 44 patients stayed for 50 to 99 days during the period, and 35 patients stayed for 27 to 49 days during the period.

One patient (whose stay was 136 days) was on the ward for 101 days after they were medically ready for discharge. Eleven patients were on the ward between 52 to 85 days, while 121 patients were on the ward between 10 to 49 days after they were medically ready for discharge.

The trust was working with other agencies to improve the position on delayed patient discharges. The trust took several actions to address and mitigate capacity/flow issues on medical wards. This included setting up of a discharge operational delivery group (DODG), a multi-agency discharge event, and use of an integrated patient flow board. The trust worked with another local trust and two local councils within the DODG to improve patient discharge arrangements. The group monitored total discharges across services, length of stay and reasons for delay. Common reasons for delay were identified as patients awaiting new or increased care packages, social work assessment, housing environment and homelessness.

The service held discharge action review meetings (DARMs) twice a week within the local integrated care systems to actively identify and resolve delays in the process, to ensure a safe and effective discharge, and to provide a co-ordinated response to complex discharge planning. The meeting was attended by local authority team managers, community health service representatives, discharge coordinators, and medical, nursing and therapy representatives. The meetings had a standing agenda to review all patients on the complex discharge caseload, provide progress updates and next steps with their estimated date of discharge. A record of all actions on the complex caseload was maintained, and outcomes were shared with all relevant teams.

The site flow performance update showed that as of January 2025, the delayed discharges for patients had steadily reduced (improved) to 23%.

The service had a discharge unit to support capacity and flow by freeing up inpatient beds earlier in the day. The unit was divided into a chair area consisting of 15 chairs and a four-bedded area for patients requiring transfer to another facility with continuing healthcare needs.

Referral to treatment times were generally the same or better than similar trusts. Between March 2024 and March 2025, an average of 75.5% of referrals were seen within the national timeframe (18 weeks). The cancer performance dashboard showed the service met all standards for 28 days (99.1%), 31 days (98.9%) and 62 days (95.3%) pathways Between April 2024 and March 2025.

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.

Patients and those close to them told us they were actively engaged and involved in decision-making. They told us they were treated in a non-discriminatory way.

Staff told us they treated people equally and without discrimination. They were able to give examples of how they respected the individual wishes of people with protected characteristics, such as race, gender and people with communication or language difficulties. Patients were given a wide choice of food to meet their cultural and religious preferences.

The trust’s vision and policies outlined the process for diversity, equality, and inclusion.

This ensured staff did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions.

Information about the outcomes of people’s care and treatment were routinely collected and monitored. The service regularly reviewed the effectiveness of care and treatment through local and national audit.

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.

Patients were supported to make informed choices about their care and treatment. Staff referred patients to specialist services for ongoing care or follow up where necessary. Relevant information about patient’s care and treatment was shared with their GP.

The service used advance care planning to help people plan their future care while they had the capacity to do so. The service had systems to manage patients at the end of their life. They worked closely with the end-of-life team and bereavement team to support such patients and those close to them.