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

Leaders were caring, compassionate and inclusive. They were visible and approachable, and supported staff to develop their skills. The trust had a vision and plans to achieve it. Staff at all levels were clear about their roles and accountabilities. They had opportunities to meet, discuss and learn from the performance of the service. The service collaborated with relevant stakeholders and agencies to improve patient care. The service had an open culture where patients, their families, and staff could raise concerns without fear.

However, risks around nurse staffing and delayed discharges had continued since our last inspection. Actions taken by the trust had not fully addressed these risks.

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 trust had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders ensured there was a shared vision and strategy, and that staff knew, understood and supported the vision, values and strategic goals and how their role helped in achieving them.

The acute speciality medicine (ASM) care group followed the trust vision called “BOLD”. This stood for “Brilliant People”, “Outstanding Care”, “Leaders in Research, Innovation and Education”, and “Diversity, Equality and Inclusion.”

The ASM outlined its’ “BOLD” strategy, based on the key principles above, to improve bed usage and patient flow, build on the success of nursing staff, assess equity in professional development, and promote opportunities for staff from ethnic minorities.

The trust had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The medical wards were led by an acute speciality medicine leadership team which included a senior head of nursing, a senior general manager and clinical director. They were supported in each speciality by lead nurses, matrons, service managers and clinical leads and ward managers.

Leaders had the experience, capacity and capability to ensure that the organisational vision could be delivered. They had a good understanding of the challenges they faced including staff shortages and timely discharge of patients. Leaders regularly reviewed these challenges in collaboration with wider stakeholders. However, these challenges had persisted since our last inspection in 2022.

Staff felt leaders were inclusive and supportive. They felt leaders were approachable and they could raise any concerns with them. One staff gave an example about how they expressed the need to train Health Care Assistants (HCAs) on NEWS scores three years ago and HCA staff received the training.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff said they felt confident to raise concerns to management and receive support, without fear of detriment.

When concerns were raised, leaders investigated sensitively and confidentially, and lessons were shared and acted on. The trust had a freedom to speak up guardian with whom staff could raise concerns about any issues.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Leaders acted to continually review and improve the culture of the organisation in the context of Equality, Diversity and Inclusion (EDI).

The service had a diverse range of staff which was reflective of the local population.

Some of the staff who were internationally qualified informed us they received support when they initially arrived. One of the staff said they had gained experience with documentation and communication over time.

Staff confirmed they had access to flexible working structures. For example, parents could have fixed shifts so that they could plan ahead.

The trust used the Workforce Race Equality Standard (WRES) to monitor and improve the experience of black and ethnic minority staff. The latest WRES 2023/2024 performance summary showed that the trust performed better than the previous year in nine out of 11 metrics reviewed. The performance summary highlighted action taken to improve the standards. For example, the percentage difference between the organisations board voting membership and its overall workforce worsened by 3.7% from the previous year. This was due to the overall workforce ethnic diversity increasing while the board diversity remained the same. The service took action to ensure members of the Trusts’ board participated in a coaching programme to identify strengths, areas for development, and goals for improvement. Each board member had also been allocated the role of an executive sponsor for the trusts’ five staff networks.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. However, the risk register did not reflect critical issues around nurse staffing and delayed discharges.

The service had a clear governance structure with defined roles and responsibilities. Staff were clear about their roles and responsibilities, and they could access relevant information about patients’ care and treatment.

Regular governance meetings were held to discuss information about the service including performance, risks, incidents and complaints.

The trust had business continuity plans for various scenarios. In addition, there were multiple incident response plans including cyber incident plan, adverse weather plan, winter operational plan, emergency preparedness, resilience and response plan among others.

Information was shared with staff through daily handover meetings, newsletters and emails. This kept staff up to date with what was happening in the trust, social events, updates on training and policies.

There were effective arrangements for the availability, integrity and confidentiality of data, records and data management systems. Information was used effectively to monitor and improve the quality of care.

The senior team used a register to manage risks. At the time of our inspection, there were 10 risks on the risk register. These related to various issues regarding facilities and equipment among others. There was a named member of staff responsible for each risk. There were controls to mitigate the risks and the risks were regularly reviewed by senior staff.

Staff informed us they would identify staffing as the main challenge which sometimes affected the quality of care they could provide to patients. However, we noted that the risk register did not reflect critical issues around nurse staffing and delayed discharges identified during our inspection. We noted from the minutes of meetings that staffing and recruitment were routinely discussed during governance meetings. We also saw evidence of daily meetings held to address capacity and staffing issues and actions taken to mitigate those issues. The trust liaised with another local trust, community teams, local authorities and social workers to facilitate discharges from the ward.

Although the service used a red-amber-green (RAG) rating to review staffing daily, actions taken to move staff within medical care services were insufficient to fully address gaps in the daily rotas. Risks around staffing and delayed discharges had persisted since our last inspection in 2022.

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

Staff and leaders were open and transparent, and they collaborated with relevant external stakeholders and agencies.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Staff informed us they had good working relationships with other services. They liaised with GP practices, other acute hospitals and community teams to care for patients.

Staff and leaders engaged with people, communities and partners to share learning with each other that resulted in continuous improvements to the service. They used these networks to identify new or innovative ideas that could lead to better outcomes for people. The service collaborated with another trust, local authorities, social care providers and social workers to facilitate patient discharge into local communities.

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

Staff were committed to learning and improving services. Staff spoke positively about the opportunities for learning and development which enabled them to improve and adapt.

The service had developed bespoke, multidisciplinary training courses to address the complex needs of specific patient groups, including holistic care for individuals with Cystic Fibrosis and enhanced care for older persons. The older persons course had run for two academic years, and the cystic fibrosis course was scheduled to launch in September 2025.

The service had implemented a programme to improve the transition of internationally educated nurses to UK practice. A review of the effectiveness of the programme showed that 80% of nurses that attended the adaptation programme indicated they felt prepared and trained on the ward when they first joined compared with 72% for those who did not attend the adaptation programme.