King's College Hospital

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• 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. The service was in breach of good governance because it did not operate effective systems and processes to maintain clear oversight of the services and mitigate risks to children and young people. The service management and leadership was inconsistent to support the delivery of high-quality, person-centred care.

Although there has been some improvement since the last assessment particularly around the 2025 NHS staff survey and workforce equality, diversity and inclusion, the service was still in breach of regulation 17 (good governance) for concerns around governance.

At this assessment the rating has remained requires improvement. This meant the service was not always consistently managed and well-led. However, leaders and the culture they created promoted high-quality, person-centred care

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 had a clear and supportive culture for staff based on transparency, equity, equality and human rights, and engagement. The service had a shared vision and strategy that was based on inclusion and engagement, and staff understood the challenges and the needs of people and their communities. However, some staff were unhappy with proposed changes to the service.

The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with relevant stakeholders. The service’s vision was to deliver safe, compassionate and equitable child-centered acute medical care for children in the local area, and expert specialist care for patients from further afield who would benefit from their tertiary services, underpinned by strong clinical expertise, education, and research.

The service’s 5-year BOLD strategy, which stood for ‘Brilliant people, Outstanding Care, Leaders in Research, Innovation and Education and Diversity, Equality and Inclusion’ was nearing its end. At the time of our assessment, leaders had drafted a strategy for 2026 to 2030, following consultation with staff about the care group’s vision, priorities and strategic objectives. Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. For example, leaders had consulted with senior leaders and discussed the draft strategy at a divisional away day. The strategy included care at the right place and right time, environment, delivering highly specialist service’s, support and collaboration for patients.

The service’s immediate priorities for 2026/2027 included the expansion of the neonatal intensive care unit (NICU), refurbishing pediatric outpatients, Princess Elizabeth and Lion wards, and improving how critical care data linked with the electronic patient record (EPR) system. Other priorities included strengthening oversight of children cared for outside child health, extending the primary care in-reach service, developing specialties such as neonatology, and improving performance in key services such as endoscopy and allergy services. The priorities also focused on health equity, using data to reduce inequalities for people in the most deprived areas and those with disabilities, mental health needs and long-term conditions. During our assessment, we found plans were in place to deliver some priorities, including the refurbishment of NICU, paediatric outpatients and some paediatric wards.

The child health goal included delivering consistency, high quality and equitable care, financial sustainability, strengthening collaboration and system partnership. It also focused on population health, workforce, research, innovation and digital excellence.

The service vision and strategy were focused on the sustainability of the service and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress. Staff we spoke to knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff including senior leaders also knew about the service plans and immediate priorities.

The provider’s senior leadership team had successfully communicated the provider’s vision, values, priorities and strategy to the frontline staff in this service. Multi-disciplinary staff could explain how they were working to deliver high quality care.

Staff we spoke to generally described an improvement in the culture of the service since the last assessment. Staff were proud to work in the service, passionate about their role and generally felt supported, respected and valued. However, a small number of medical staff raised concerns about a poor culture. Concerns were around proposed changes being initiated by leadership without adequate notice or risk assessment on how it will impact staff’s wellbeing, workload or the patients and family experience.

However, senior leaders were aware of the medical staff concerns and had commissioned an independent review around the proposed changes. Senior staff acknowledged some elements of the consultation could have been better. Leaders provided evidence to show ongoing engagement and the work being done to address staff concerns and improve the service’s culture and consultation process. This included undertaking listening events and the launch of the Child Health Inter-Team Working Project on 15 May 2026, which will include feedback from staff and staff survey results. The new project aims to enhance staff engagement, improve shared understanding of the teams’ experience, promote psychological safety, identify strong practice and translate it into action. The service also had plans to launch the Child Health Excellence Award on 16 June 2026 to celebrate staff and improve outcomes, compassionate care and culture.

The 2025 NHS Staff Survey showed mixed results. The service scored worse than the trust average for work pressure, flexible working and staff thinking about leaving. However, they performed better than the trust average for staff engagement, learning and retention. Results had improved for staff recommending the organisation as a place to work and as a place for friends or relatives to receive care. Overall, the service showed improvement in the 2025 result compared to the 2024 survey on all questions. Leaders had developed an action plan and taken steps to improve culture, including team building, inclusive events, psychologist-led debriefs and a compassionate team programme. Further actions were planned, including leadership engagement events and a culture deep dive. This showed leaders had identified areas for improvement in the service’s culture however, there was still some work to do.

The trust and service celebrated staff success and contribution through various ways, such as shout-outs in the staff newsletter and the quarterly and annual Kings Stars Award.

Leaders had the skills, knowledge, experience and credibility to lead effectively and understood the context in which they delivered care, treatment and support. However, leaders need to take further actions to strengthen senior leader’s visibility and accessibility.

The service’s leadership team consisted of a clinical director, a general manager and a head of nursing. They were supported by a deputy clinical director, a governance lead, deputy general managers, senior service managers, 7 matrons, governance managers, lead nurses, lead therapists and a lead pharmacist. There was clear line of reporting from the service leadership team to the trust board. The senior leadership team for the service reported good support and access to the trust board.

Leaders were generally described as accessible and visible in the service and approachable for patients and staff. However, some frontline staff told us some of the trust and service leaders were not always visible, approachable, and accessible. Multi-disciplinary staff described feeling supported by their immediate managers and service managers. Most staff felt confident in the service leadership. However, a small number of staff were not assured the leadership team would take fair action to address their concerns. In the 2025 NHS staff survey, the service performed below the trust average on compassionate leadership and line management. This was not an improvement from the last inspection.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the priorities, challenges and services they managed. They could explain clearly how the teams were working to provide high quality care. They were aware of the risks within the service and were able to describe the mitigations and action plans in place to address this. This was an improvement since the last assessment.

Leaders were aware of the culture of the service and how it could impact staff and quality of patient care and were working to address this.

We saw evidence of succession planning and development pathways for multidisciplinary staff of all levels. Leadership development opportunities were available, including opportunities for staff such as the band 6 and 7 leadership programme.

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

The 2025 NHS staff survey showed the service performed better than the trust target and 2024 results on staff feeling they could raise concerns and feeling they have a voice that counts. Leaders had developed an action plan to further improve this, this included scheduling a Freedom to Speak Up walkarounds for staff and a listening session in June 2026.

The hospital had a freedom to speak up guardian, and the service had recently appointed a ‘Raising concerns ambassador’ for the service. The trust had an appropriate and up to date Freedom to Speak Up Policy (which incorporates Whistleblowing) and a Grievance Policy. Between June 2025 and May 2026, 7 concerns were raised to the guardian. This mainly related to changes in staffing, consultant rota arrangements, changes to tongue tie clinic provision and concerns regarding the input of results into systems by non-clinical staff. The key themes also included colleague and workplace relationship issues and the length of competency management processes. Senior leaders advised that these concerns reflected both operational and workforce-related changes during this period.

Patients, parents and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Parents and young people we spoke to knew how to complain or raise concerns. Managers investigated complaints, identified themes and shared feedback with staff. Staff knew how to acknowledge complaints and patients and their families received feedback from managers after the investigation into their complaint. Managers and staff had access to the feedback from patients, parents, carers and staff and used it to make improvements.

Patients, parents and carers were involved in decision-making about changes to the service. They could meet with members of the provider’s senior leadership team and King’s Young Ambassadors to give feedback. The King’s Young Ambassadors programme, and the ambassadors first visit to the paediatric areas took place 19 September 2025. The King’s Young Ambassadors is a trust community and education initiative where a group of patient ambassadors aged 9 – 11 years old from a local primary school regularly visit the hospital to take part in health-related education and wellbeing sessions.

The service received 58 complaints between April 2025 and March 2026 which mostly related to communication, appointments, staff attitude, discharge processes and delays in admission and result. From January to March 2026, the service received 78 contacts from the patient advice and liaison service (PALS), which related to enquiries, concerns and making formal complaints. The top themes were around delays and waiting times, appointments, prescribing and record management.

Majority of the staff we spoke to felt comfortable or confident to speak up. However, not all doctors felt comfortable or confident speaking up or that their concerns would be addressed. A small number of doctors reported pressure from some senior members of staff, to take their names off an ongoing grievance process. Senior leaders told us a number of individuals subsequently withdrew their names from the grievance following independent advice.

The evidence showed some shortfalls. Although the service valued diversity in their workforce however they did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service provided us with trust-wide data on the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) for the period 31 March 2024 to 31 March 2025. The data available at the time of the inspection was representative of the trust as a whole and was not specific to the service.

Following the assessment the trust was able to provide a more detailed breakdown of the workforce equality information specific to Children and Young People services. This information demonstrated a reduction in bullying and harassment across both WRES and WDES measures, a reduction in reported experiences of discrimination among ethnic minority staff, improved experiences for disabled staff, and comparable perceptions of career progression opportunities between white and ethnic minority staff.

Leaders recognised there was still disparities for ethnic minority and disabled staff. However, believed the direction of travel was positive and reflected sustained leadership focus on inclusive culture and psychological safety. Remaining inequalities continued to be addressed through targeted improvement work.

The provider undertakes equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

Leaders considered equality, diversity and inclusion in workforce planning and recruitment. They worked to ensure staff and leaders were representative of the population of people using the service. The 2025 NHS staff survey showed that the service performed better than the trust average and the 2024 scores on inclusion, diversity and equality questions.

Leaders ensured there were effective and proactive ways to engage with and involve staff with protected equality characteristics. The trust supported various staff equality networks and staff we spoke to were aware of the available staff networks. This included:

• Women’s network
• Inter Faith and Belief Network
• Race Ethnicity and Cultural Heritage (REACH) Network
• King’s Able – staff disability network
• King’s and Queers – LGBTQ+ Network

There were also equality and diversity champions within the hospital e.g. LGBTQ+.

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

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. Managers put reasonable adjustments in place for staff members to help them carry out their role.

The evidence showed some shortfalls. Although, the service had clear responsibilities, roles, systems of accountability and good governance, they were still on an improvement journey. Effective governance processes were not fully embedded and leaders were still working on the action plans from the previous assessment.

Although there has been some improvement in governance since the last assessment improvements had not been fully embedded. Leaders were working on the CQC action plan from the last assessment and did not always operate effective governance processes, throughout the service. We found repeated breaches from the last assessment including staffing, incidents, risk assessments and patient records. We found new breach in relation to mandatory training.

At the time of the assessment, the neonatal governance post was vacant but had been recruited to and the appointed staff was due to resume post in July 2026.

Multidisciplinary 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 regular service and cross-site governance meetings, which fed into the children and young people oversite group (CYPOG) and trust board report. This included the cross-site child health quality governance and committee and the child health infection prevention and control meetings. Other governance meetings also included audit and safeguarding meetings, the Patient Safety Incident Response Framework (PSIRF) panels and the safety, harm, incidents and learning discussion (SHILD).

The service also attended various external governance meetings within the integrated care system, partner NHS trusts, local authorities, regional paediatric networks and shared performance with the integrated care board.

The service held regular child death cross site reviews and multidisciplinary perinatal mortality review tool (PMRT) meetings and used the meetings and tools to review care and deaths that occurred within the service to drive improvement.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as risks, performance, guidelines, feedback, learning from incidents and complaints, was shared and discussed. The internal and external governance meetings were well attended by leaders and multidisciplinary staff.

The trust board minutes reviewed showed that children and young people’s health items were part of the governance meeting papers and included topics such as performance on national audits, staffing, research, innovation and priorities.

Staff had implemented recommendations from reviews of deaths, incidents and complaints. This included the update of the vancomycin antibiotics guideline and using the correct cancer alert for suspected malignancy and escalation to the relevant paediatric team. The service has a dedicated service incident newsletter that updates staff on themes from reported incidents. This newsletter also had a dedicated study section of recent incidents and highlights the areas of learning and improvement such as a need for timely feedback of clinical result.

Staff now undertook or participated in local clinical audits. This was an ongoing area of improvement from the last assessment as there are still areas of low compliance and recommendations have not been fully actioned. The audits enabled the leaders to monitor performance, identify areas of improvement and act on the results when needed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients and their families.

The service collated and submitted data to Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) as required. The trust board papers showed that the service neonatal death rates were lower (better) than comparator trusts in the 2024 MBRRACE-UK perinatal mortality report and they ranked the third lowest nationally and lowest in London.

Hospital data showed that the service had a positive outlier status in the National Clinical Audit for Epilepsies in children and young people under the audit measure for epilepsy specialist nurse. However, the service was an outlier in the 2025 National Paediatric Diabetes Audit. The recent trust data for 2025-26 audit year showed improvement in performance and the trust were not anticipating being an outlier in the next audit result.

The trust board papers showed that outcomes for children who had a liver transplant were mixed. One-year survival for paediatric liver transplant patients was better than expected.

This means more children were alive one year after their transplant than would usually be expected when compared with national data. However, the National Hospital-Level Mortality Outcomes audit showed that 5-year term adjusted survival was lower (worse) than expected. This meant that, after taking account of factors such as how seriously ill children were and the complexity of their conditions, fewer children were alive 5 years after their transplant than expected.

The service risk registers included 18 open risks related to the service at the time of the assessment. This included a pseudomonas aeruginosa contamination of the water system in the neonatal intensive care units. The risk register also included risks on mandatory training and violence and aggression on the Paediatric Short Stay Unit. The register included the risk title, description, date opened, risk cause and rating, next review date and controls. The risk register was maintained through an electronic system, which recorded the date on which individual risks were last reviewed. We noted the risk register was also reviewed at various governance meetings. Although the risk included majority of the risks we identified during the assessment, which provided assurance that leaders and staff were aware of the risks and had mitigations in place. Majority of the staff we spoke to could not tell us what the top risks in the service and their ward areas were. Senior staff told is the top risks were staffing, space constraint and infection prevention and control. Not all staff concerns and risks we identified matched those on the risk register. This included high use of locums in NICU. However, following the assessment the trust provided evidence that this was a known risk to the service and had been regularly discussed and monitored through divisional governance arrangements since February 2026. The trust has now added the risk to the formal risk register.

We observed patient identifiable information displayed openly on the ward boards including children’s names within some clinical areas. This did not consistently support the confidentiality and privacy of children and young people. Staff told us the ward boards could be adapted to meet the needs of individual clinical areas. This included the option to use pseudonyms instead of children’s names and to arrange the information displayed on the boards according to each ward’s preference. However, this was not used consistently across the areas we visited.

The service had plans to cope with emergencies and unexpected events and had a business continuity plan, which included major incident plans such as fire and power failure.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.