King's College Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and was not always consistent and did not always achieve good outcomes.

We have not awarded this service a score for Effective.

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

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Children were involved in the assessment of their needs and support was provided where needed to maximise their involvement. We saw care plans were reviewed and updated in conjunction with the child or young person’s family from patient records.

Children and young people's care needs were routinely reviewed. The service used care and treatment plans to improve outcomes for children and young people. Care plans were reviewed and updated regularly in conjunction with the child or young person’s family. Assessments considered children and young people’s health care well-being and communication needs to enable them to receive care that had the best possible outcomes. We saw evidence of appropriate risk assessments such as manual handling and nutrition completed in patient records to ensure their needs were reflected and understood.

Children and young people's communication needs were assessed and met to maximise the effectiveness of their care and treatment. Oliver McGowan training was a part of mandatory training on learning disability and autism; however, compliance was low at 46% on average. Staff we spoke to demonstrated a good understanding of how to assess the needs of autistic people and people with a learning disability. The service had a paediatric learning disability clinical nurse specialist in post to ensure children and young people with learning disabilities and autism had the necessary reasonable adjustments in place. As part of handover before shift changes, the team was made aware of patient individual and holistic needs.

We saw the needs of the families of children and young people were considered, and they were well supported. Some people told us there was not as many meals available for parents as there had been in the past. Staff told us there was cereal, sandwiches and ready meals available for parents to help themselves to in parent rooms located on wards.

People we spoke to were confident their child’s individual needs had been appropriately assessed and fully understood. They also told us their child’s pain had been managed appropriately, and they received pain relief in a timely manner. People told us they were impressed with the handovers between staff and commented that “everyone seems to know everything they should”.

Although the service had policies and procedures available to staff, many were out of date which did not ensure they supported the delivery of evidence-based care. They could demonstrate compliance with legislation and current evidence-based good practice and standards.

Policies were available to all staff on the intranet system and staff demonstrated they knew how to access them. There was a planned approach to monitoring compliance with the NICE guidance. A clinical effectiveness performance report we reviewed from January 2025 showed 95% of policies within the service complied with NICE guidance. The data also showed there were 175 expired guidelines within the service. During our inspection we reviewed a random sample of policies and observed some policies were significantly overdue a review including the Neonatal Abduction Guidelines, Do Not Attempt Cardiopulmonary Resuscitation Policy and Safeguarding Children and Young People Policy. This meant there was a risk that staff are referring policies and guidelines which may not be in accordance with the latest national guidance or best practice. Furthermore, this risk was not identified on the service risk register. However, the service had developed an action plan to improve compliance with guideline reviews with additional resource being provided by the trust to the service to facilitate improvement.

The trust informed us that audits of patient risk assessments as recorded in electronic records were conducted through manual review of the patient records. However, the service was unable to provide evidence that they were effectively auditing compliance with a number of risk assessments and sepsis in line best practice. This was due to the hospital’s electronic patient record system not allowing the service to retrieve the necessary nursing metrics for children and young people, although this was available for adult services. This provided limited assurance that children and young people received the appropriate care at the appropriate time.

Children and young people's nutrition and hydration needs were met in line with current guidance. Staff gave patients enough food and drink to meet their needs and improve their health. We saw in patient records evidence of nutrition assessments being performed. However, the service was unable to effectively audit patient assessments to ensure consistent compliance with local and national guidance.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver peoples care, treatment and support available within patient electronic records.

Information was shared between teams and services to ensure continuity of care. Staff and leaders told us they had good relationships with local partners. There were well established links with local mental health services. Staff worked across health care disciplines and with other agencies when required to care for children, young people and their families. We saw examples of well-coordinated and collaborative multidisciplinary working across regional specialist teams and services, which resulted in positive outcomes for patients.

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. The service had systems to care for children and young people when they transitioned to adult services. We saw they had specific internal planning documents for patients undergoing treatment for cystic fibrosis and blood disorders. Staff told us relevant teams, services and organisations were involved in assessing and delivering people's care and treatment and were informed when people were discharged from the service. However, some families of children and young people told us communication around transfers and coordination of care delivered in conjunction with external services could be improved. One parent we spoke to was waiting for their child to be transferred to a different hospital and commented that there a lack of communication from staff about this.

Staff informed us they generally worked well with other staff. A member of staff told us some junior nurses did not always feel comfortable raising issues with the rotational doctors. However, most nurses told us medical staff were available for advice and support and there were good working relationships between colleagues. Junior doctors told us they had good support from consultant colleagues. The outreach team were described as approachable and quick to attend.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff gave children and young people practical support and advice to lead healthier lives. For example, training for children and young people with diabetes to build their understanding of the condition and its management. Staff also gave support to parents and carers of children and young people and could make referrals to services such as Stop Smoking.

The service did not always routinely monitor people’s care and treatment to continuously improve it. Staff did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was insufficient evidence to show the service routinely monitored people’s care and treatment to continuously improve it, or if it was monitored, it was not being effectively reported. Although, we saw patient outcome indicators for neonates were discussed in a governance meeting, we did not see evidence that showed outcomes throughout the service were positive and consistent, or they met both clinical expectations and the expectations of people themselves. We requested data on how the service reviews patient outcomes, but the evidence did not show that the reviews or audit of clinical outcomes were carried out. Following the inspection the trust provided examples of patient outcome monitoring; however, these did not demonstrate that routine and systematic monitoring was in place.

The service participated in relevant national and local clinical audits to review the effectiveness of care and treatment for children and young people. This enabled the service to benchmark the standard of care provided against local and national standards. This information was used to improve care and treatment. Action plans were developed to address areas of improvement.

National patient outcome data showed the hospital was a negative outlier in the National Paediatric Diabetes Audit regarding continuous glucose monitoring. The trust had been identified as an outlier in this indicator for 3 consecutive years. Prior to the inspection the trust shared with us planned improvement actions to address this, with data indicating a gradual improvement because of the implemented actions. The Paediatric Intensive Care Audit Network (PICANet) data showed only 36.1% of admission records were completed on the PICANet database within 2 months of discharge compared a national average of 77.3%. Completing records as soon as possible and no later than 2 months after discharge is a requirement of the Paediatric Critical Care Society Quality Standards. Staff we spoke to recognised they had previously performed poorly and told us changes had been implemented to improve this such as having a dedicated member of staff per shift to support with completing documentation. The Trust was also working with a neighbouring NHS Trust on setting up a direct link between the new Epic patient care system and PICANet, with a rollout expected at the end 2025. The service participates in national audits for liver transplantation, which showed the service was an outlier for post-transplant outcomes after children and young people underwent super-urgent liver transplantation and for Intestinal and multi-visceral transplant outcomes. We saw an internal review had taken place, changes to practice were made and an improvement plan was in place with set timeframes and action holders identified. However, the audit also showed that the trust’s 5-year survival for elective and super-urgent transplants was high in comparison to other centres. The National Epilepsy12 audit showed compliance within national expectations.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed children and young people received information about their care and treatment in a way they could understand and had appropriate support to make decisions.

Staff supported children, young people and their families to make informed decisions about their care and treatment. We reviewed the trust Strategy & Policy for Consent to Examination or Treatment, which was appropriate and next due for a review in June 2025.

Staff understood the importance of ensuring people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Most staff we spoke with were able to explain the Gillick Competence and the arrangements for seeking consent from children and young people where they had been assessed as being competent to make decisions regarding their care and treatment. They supported children who wished to make decisions about their treatment.

Between February and April 2025, there had been one complaint made by a parent about failure to take appropriate consent. We saw that the service was completing an investigation into this complaint.