King's College Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service did not always have enough qualified, skilled and experienced staff to cover each shift. Data provided by the trust showed that wards were often short staffed. Compliance with staff mandatory training was lower than the trust target. Although the service generally managed and controlled infection risks well, some of the infection control audits were slightly lower than the trust target.

The service was in breach of legal regulation in relation to Regulation 18 Staffing, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

(The service did not always have enough nursing staff to cover each shift).

However, the service managed patient safety incident well. Lessons were learned from safety incidents, resulting in changes that improved care for others. There was continuity of care when people moved between different specialities and other providers. Most staff had the required levels of training to safeguard people at risk and knew what actions to take to keep people safe from avoidable harm and abuse. The service involved people in their care and managed individual risks effectively. The service had systems to detect and control the risk of infection. Staff kept equipment and premises visibly clean. Staff used systems and processes to safely prescribe, administer, record, and store medicines according to national evidence-based practice.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The trust had a clear process for reporting and learning from incidents. Staff reported incidents on the trust electronic system. They confirmed that they received feedback about incidents from leaders at meetings, during handover, through newsletters and emails. The service followed the duty of candour policy by disclosing incidents to patients and providing feedback on investigation outcomes when necessary. We reviewed three incident investigation reports, and all included clear action plans.

Lessons were learned from safety incidents, resulting in changes that improved care for others. We observed clinical boards in clinical areas which highlighted the top three incidents for the month. The clinical boards also identified learning from incidents. The service highlighted incidents in a multidisciplinary acute medicine governance newsletter which presented individual cases, issues identified, and improvements made. For example, the trust reiterated the need for patients undergoing a procedure to be reviewed by a doctor following a case involving venous thromboembolism (VTE) prophylaxis.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had discharge coordinators to support safe discharge and transition of patients. The service worked with social workers and the local authority to facilitate patient discharge where necessary.

The service held daily bed meetings to identify patients who were ready for discharge and discuss arrangements for their discharge.

The service had an acute emergency care unit (AECU) which acted as a ward for same day emergency care for medical patients. The ward opened from 8am to 8pm with the last referral accepted at 6pm. The ward aided admission avoidance with the aim to treat and discharge patients on the same day.

The service also had an acute assessment unit where patients could stay for up to 12 hours before being discharged or admitted to medical wards.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

The service had a standard operating procedure (SOP) for acute speciality medicine patient flow and discharge. The SOP aimed to ensure that the “SAFER” patient flow bundle was used to reduce delays for patients in adult inpatient wards. The acronym “SAFER” incorporates the following elements:

1. Senior review of all patients before midday.
2. All patients should have an estimated date of discharge and where possible, clinical criteria for discharge set no later than the first consultant ward round.
3. Flow of patients must commence early with 1st ward admission by 10am. To achieve this ward staff should facilitate golden discharge of patients that leave the ward before 10am.
4. Early discharge with 33% of patients being discharged by 12pm.
5. Review ‘stranded’ patients (greater than 14 days length of stay in a formal weekly multidisciplinary meeting.

The service worked with other trusts, local authorities, social services, and community teams to support good patient discharges. However, the service had capacity issues with significant levels of delayed discharges on the ward. This was often due to patients awaiting suitable placements or care home assessments.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Staff received training specific for their role on how to recognise and report abuse. Staff had completed the right level of safeguarding training for both children and adults. The safeguarding training compliance rate exceeded 90% target for most staff. However, medical staff fell slightly short of the compliance rate for safeguarding children level 2 (86%).

Staff we spoke with knew how to identify people at risk of, or suffering, significant harm or abuse and the service worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. The hospital had a safeguarding lead and staff found them approachable and supportive.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff informed us individualised risk assessments and care plans were developed in collaboration with each patient to ensure their specific needs and preferences were reflected in the treatment plan. This personalised approach aimed to optimise patient-centred care and outcomes.

Staff used the National Early Warning Score (NEWS) tool to identify patients at risk of deterioration. NEWS observations were recorded in all patients’ records we reviewed, and we saw information which confirmed monitoring of staff’s completion of these assessments was carried out regularly. The service conducted an audit of how well staff monitored deteriorating patients. Between March 2024 and March 2025 observations were completed in an average of 92% of cases. However, timeliness ranged between 55% to 58% during the same period.

There were clear guidelines for the escalation of deteriorating patients, and we saw this posted around clinical areas.

Most patients had appropriate venous thromboembolism (VTE), risk assessments in place to reduce the risk of blood clots. During the inspection, we reviewed nine sets of notes. We saw risk assessments for VTE, pressure ulcers and falls were regularly completed. VTE audit compliance rate was generally above 95% in the three months from January to March 2025.

The service had a sepsis pathway for the management of patients whose condition met the criteria. This included the administration of antibiotics in line with the trust’s guidelines.

All relevant medical staff had completed the advance life support training on how to manage life-threatening emergencies. However, there were lower completion rates for nursing staff. Seventy-nine percent of nursing staff had completed resuscitation training.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities, and technology supported the delivery of safe care.

The service followed national guidance and had suitable facilities and equipment for patient care. Relevant staff had swipe or keypad access to clinical areas. Staff conducted daily safety checks on specialist equipment. All equipment we reviewed conformed to the relevant safety standards and had been serviced annually. Fire extinguishers were serviced yearly and were in date for servicing. Staff had received training to use equipment.

There were adequate arrangements for handling, storage and disposal of clinical waste, including sharp instruments.

The service did not always have enough qualified, skilled and experienced staff to cover each shift. Staff told us they endeavoured to meet patients’ needs but sometimes felt constrained by capacity issues.

Staff informed us that the number of nursing staff on duty was often lower than the planned number. The nurse in charge often had to directly care for patients which impacted on their role of otherwise focusing on managing the shift for the day. The service used the Safe Nursing Care Tool to manage staffing. Staff said they escalated any staffing issues to senior staff. They said staffing issues could lead to delayed discharges, for example if staff were too busy to take blood from a patient who required a blood test before discharge. They explained that phlebotomists only attended the unit once a day, hence reliance on nursing staff to take blood from patients. Some staff informed us they were not always able to provide the level of care they wanted to provide.

Staffing data provided by the trust showed there were 24.4 nursing vacancies and 19 health care assistant vacancies in January 2025. There were 7.7% vacancies, 8.4% turnover, and 5.2% sickness. Following our inspection, the trust provided further information which showed that the nursing vacancy rate was below the Trust’s target of 10% between October 2024 and April 2025. During the same period turnover was below the trust target of 13%.

The service used a red-amber-green (RAG) rating to review staffing daily. Red areas identified were mitigated by moving staff members within medical care services.

We reviewed staffing data covering the dates of our inspection. For the day shift on 8 April 2025, 4 of 12 wards or clinical areas were rated green or fully staffed, 7 were rated amber and 1 (Christine Brown ward) was rated red. The staffing risk on Christine Brown ward was reduced to amber by adding the ward manager to support staff on the ward. Nine of 11 wards were rated green during the night shift, 1 was rated amber and the other red. A nurse was moved from one of the green wards to Christine Brown ward to make it amber. However, this reduced the total number of green wards to 8.

On 9 April 2025, 5 of 12 wards were rated green, 6 were rated amber and 1 (the ambulatory care unit) was rated red. During the night shift, 7 of 11 wards were rated green, 3 were rated amber and Christine Brown ward was rated red. This was mitigated by moving a nurse from the frailty unit to Christine Brown ward, thereby reducing the total number of green wards to 6.

We reviewed the incident data which showed wards were often short staffed while having to care for patients who needed additional support. This was escalated to senior staff like matrons and ward managers who often had to support staff on the ward.

The service had 174.8 whole time equivalent (WTE) medical staff compared to the 191.4 WTE budget. Nursing staff confirmed the doctors responded well to their requests for review. However, sometimes, it might take a while at night when there were one to two doctors covering several wards. The service reported that any critical gaps were covered by locum staff and that night-time medical staffing arrangements met the Royal College of Physicians (RCP) standards, supported by the Hospital at Night team.

Not all staff were up to date with their regular mandatory training. Staff were positive about the training they received to carry out their roles. This included induction and competency training. Although most staff were positive about the training received to provide care and treatment, we noted there were some areas of low compliance. Overall, 77% of staff were up to date with their mandatory training against the trust target of 90%.

Medical staff had a 76% compliance rate with mandatory training with six of 24 modules above 90% compliance target. The lowest compliance rates were for sepsis in adults (26%), aseptic non touch technique level 2 (50%), blood transfusion (51%), and mental capacity and mental health act (63%). There were varying completion rates for other modules between 70% and 88%.

Nursing staff had 85% compliance rate with mandatory training, with 13 of 23 modules above 90% compliance. The lowest compliance rates were for Oliver McGowan mandatory training (learning disability and autism) at 48%, patient falls (57%) and sepsis in adults (59%).

There was a high compliance rate for allied health staff (91%) and health care scientists (99%). However, administrative and clerical staff had the lowest overall compliance rate for mandatory training (60%).

Staff we spoke with confirmed they had completed an appraisal in the last year. The service had an annual appraisal rate of 94% for staff.

Following our inspection, the trust informed us the service had implemented targeted recruitment and retention initiatives, resulting in significant improvements. As of 1 November 2025, there were 2 registered nurse vacancies.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.However, some of the infection control audits results were slightly lower than the trust target.

We observed that all areas of the service were visibly clean and free from clutter. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly. “I am clean” stickers were placed on equipment to indicate pieces of equipment had been cleaned.

Staff were ‘bare below the elbow’ and adhered to infection control precautions throughout our inspection, such as hand washing and using hand sanitisers when entering and exiting the unit and wearing personal protective equipment when caring for patients.

There were enough hand washing sinks available, in line with the Health Building Note (HBN) 00-09: Infection control in the built environment. Soap and disposable hand towels were available next to sinks and instructions on how to effectively decontaminate hands were displayed above the sinks.

There were infection prevention and control signs on doors to warn people about entry into specific areas or side rooms.

The service carried out monthly environment audits. In March 2025, the total audit scores for all wards were over 90%. However, there were some areas of low compliance with standards, for example, Annie Zunz ward scored 65% for high surfaces and 60% for beds and cots reviewed. The frailty ward scored 67% for toilets, bidets and urinals reviewed.

The service carried out monthly hand hygiene audits. The latest results from January, February and March 2025 showed improvements were needed to be fully compliant. The service achieved an overall compliance rate of 89%, 89.6% and 88% respectively. This was slightly lower than the trust target of 90%. The service implemented an action plan to improve hand hygiene results. This included staff re-education, use of visual reminders and daily hand hygiene champions among others.

The service completed monthly intravenous (IV) line audits to assess compliance with guidelines. Results from January, February, and March 2025 showed overall compliance rate of 88.8%, 89.8%, and 91.4% respectively. This was lower than the trust target of 95%. The audit identified concerns around Visual Infusion Phlebitis (VIP) scoring and poor documentation of IV site conditions. The action plan created to address this included re-education of staff, discussions at daily safety huddles to prompt checks, assigning VIP champions for each ward to support peers and monitor practice, random spot checks of VIP documentation, and IV site condition among others.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. However, on one ward, fridge temperatures were not being safely monitored.

Staff followed systems and processes to prescribe and administer medicines safely. The service had a medicines management policy, which described the handling, storage, prescribing, recording, safe administration, and disposal of medicines.

Staff completed medicines records and kept them up to date. We reviewed patient records which showed prescription charts were completed, signed, and dated. Staff recorded information about patient allergies. Our observation of patient care showed staff checked patient allergies when confirming patient details.

We found medicines were stored securely and appropriately. We reviewed the controlled drugs register which was correctly completed and noted the entries had been signed by designated members of staff as required. Medicines we checked were in date and reconciled with the records.

Medicines requiring cold storage were stored in locked fridges and the temperature was monitored daily. We observed that fridge temperature checks were completed daily on all wards visited except on Matthew Whiting ward. However, during our inspection, patients on Frank Stansil ward were moved to Matthew Whiting ward (for the week of our inspection) pending renovation works on the main ward. We noted that fridge temperature checks were last completed on Matthew Whiting ward around two weeks prior to our inspection and we raised the issue with staff at the time of our inspection.

We observed an elderly patient being provided with their discharge medications. There were a significant number of medications, and the patient informed us they were not confident about how to self-administer the medication. We escalated the incident to the pharmacy team and senior staff took action to address the situation.

We observed an elderly patient being provided with their discharge medications. There were a significant number of medications, and the patient informed us they were not confident about how to self-administer the medication. We escalated the incident to the pharmacy team and senior staff took action to address the situation.