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

We looked for evidence that the service met people’s needs. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The service did not employ a play specialist in the paediatric ED, for which they were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulation 18 (staffing). The service did not always supply necessary information, such as waiting times, to patients. The service was severely affected by overcrowding and there were limited beds available for patients requiring admission. This resulted in long waits and meant that patients could not always access care in a timely manner.

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 did not always make sure people were at the centre of their care and they did not always work in partnership with people to decide how to respond to people’s needs.

The paediatric Emergency Department (ED) did not employ a play specialist. Staff told us that they sometimes asked play specialists employed by the inpatient paediatrics team to come to the ED and assist, but that this was done rarely. This is contrary to guidelines issued by the Royal College of Paediatrics and Child Health (RCPCH), which states that all EDs must have access to play specialists and that large EDs should directly employ dedicated play specialists. The lack of a play specialist led to a risk that paediatric care within the ED was not person-centred, especially for children with complex needs, and that children would not engage with care.

The service had systems in place to help deliver safe care to patients with learning disabilities. Staff told us that patients with learning disabilities were prioritised for cubicles and that, if they were present in areas without beds (for example, in waiting rooms), they could be given an assessment cubicle if they were showing signs of distress. We did not see any patients with learning disabilities receiving care in the corridor on either visit. However, the trust’s corridor care policy (released after our first visit in May 2026) did not specifically include the presence of a learning disability as an exclusion criterion for receiving care in the corridor (NHS England guidance states that corridor care “must be avoided” for patients with learning disabilities). The service used ‘flags’ on their electronic patient record system to inform staff that patients had a learning disability. Staff were aware of the hospital’s learning disability team and how to contact them. However, completion rates of Oliver McGowan training (a training package regarding the treatment of patients with learning disabilities) were inconsistent across staff groups, with nursing staff having a completion rate of 87%, medical staff 59%, and administrative and clerical staff 42%.

The service used risk assessments, such as falls risk assessments and pressure ulcer risk assessments, to identify issues patients were facing and to personalise their care. However, these risk assessments were not always completed, resulting in a risk that these issues may not be recognised early in a patient’s admission. We reviewed the notes of 10 patients in the majors area, each of whom had either been referred to a specialist team (with the shortest length of stay being 5 hours) or had been present for at least 7 hours. Of these, only 7 had a falls risk assessment completed. However, pressure ulcer risk assessments were completed more consistently, with this being completed for 9 of the 10 patients. Of the 10 patients reviewed, only 3 met the clinical criteria requiring a sepsis risk assessment, and all 3 had a sepsis risk assessment completed in accordance with the Trust's NEWS2 policy. The service provided evidence of internal auditing of some of these assessments, which showed similar results (although sepsis risk assessments were not included).

The service had systems in place to support paediatric patients who attended the ED regularly. Rates of re-attendance within 7 days averaged 11.8% for paediatric patients from May 2025 to April 2026. The service ran a programme named ‘Needs Evaluation & Support Team for Emergency Department Attendances’ (NESTED) in which cases of paediatric reattendance were examined. Outcomes from these meetings included additional support for families in the form of nursing follow-up calls and advisory letters to the patient’s GP.

The paediatric ED had tailored rooms for patients with specific needs. One room for mental health patients had panels which could light the room different colours and a projector for patients to watch films with. There was also a sensory room for patients with autism or learning difficulties.

We did not see any patients being given end-of-life care while we were present. However, the service had robust policies and guidance on how to deliver this care. This included guidance about specific problems encountered in end-of-life care, such as diabetes management. The service’s electronic patient record included order sets (groups of related clinical orders and requests) for end-of-life care prescribing and a referral pathway to the hospital’s palliative care team, about which clinicians were aware.

The service also had access to other in-reach services within the ED. Staff could refer patients to the hospital’s alcohol care team between 8am and 5pm on weekdays. This team provided care and advice to patients struggling with alcohol dependence. Staff could also refer patients suffering from poor mobility due to frailty to the frailty team during the same hours. These services helped staff tailor care to the needs of their patients.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service did not provide waiting time estimates to patients in waiting rooms in any area of the department. This meant that patients did not know how long it would take until they’d be seen.

Signage around the department was not always clear. For example, the ‘blue waiting room’ was a corridor near the ED reception with seats along the walls. Walk-in patients were expected to wait in this area until they had been called into a triage room. However, the only signage for this area was in the form of laminated posters above some patient chairs. These were easy to miss and were often obscured by people sitting in these chairs. This, combined with the presence of another nearby waiting room for triaged patients, led to patient confusion. We saw one patient spend 2 hours in the wrong waiting room, delaying their care. However, the main waiting room contained a comprehensive poster titled “Your Journey Through the ED” which thoroughly explained the different areas of the department and how patients might move through them.

Translation services, including for British Sign Language, were available for all clinical staff in the form of electronic tablets. Staff provided positive feedback about these. However, receptionists told us that they did not have access to these services. If a patient did not speak English when attempting to book in to the ED, reception staff told us that they would use online translation tools on their mobile phones. This led to a risk of mistranslation and of patient misidentification.

The service provided information about patients’ treatment in the ED in the form of discharge summaries. These were sent to the patient’s GP and provided to the patient on request. We reviewed 10 discharge summaries and found they contained clear descriptions of the care that was given, clear descriptions of where the patient was being discharged to, and clear descriptions of any medication changes.

Patients told us that staff kept them informed about their progress and what they were waiting for.

The service did not always make it easy for patients and family members to give feedback and raise complaints. However, the service had systems in place for reviewing patient complaints when these were made.

Patients could make complaints about the service if they desired, but we saw no posters or prompts advising patients how to do this. The service received 92 complaints in the 12 months to May 2026. Service leaders reviewed complaints in a weekly meeting. There was a policy regarding how complaints should be handled. Complaints were graded for complexity as per this policy and had an assigned theme – the most numerous themes were ‘staff values and behaviours’ and ‘communication’. The service met its targets for complaint responses. For example, the service closed 100% of its straightforward complaints within 3 months compared to its target of 95%. When asked for examples of changes made following complaints, the service provided examples of re-education of staff members (for example, further training on the use of infusion pumps following a complaint about an error programming this piece of equipment).

The service participated in the NHS ‘Friends and Family Test’ (FFT), in which patients can give feedback on their care. However, we did not see any posters or prompts for patients to engage with this feedback while we were on site. Relatively low numbers of patients provided feedback via this route (in April 2026 179 patients responded, but in May 2025 this was as low as 2). The overall FFT feedback was 71% positive for April 2026 (below the England average of 80%).

The service performed its own surveys of patient experiences. For example, following the introduction of the ‘digital front door’ (electronic tablets for walk-in patients to book themselves in) the service surveyed 279 patients to gain feedback about the process and identify issues. Other surveys conducted by the service were not always large enough to gain any meaningful data. For example, the service provided evidence of an internal ‘Emergency Department Patient Experience Survey’ which recorded only 2 responses.

Patients were involved in discussions about their care. Patients told us that they were aware of what staff were planning and that their points of view were taken into account.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Patients attending with mental health concerns remained in the Emergency Department (ED) for very long periods due to low availability of beds at a neighbouring mental health NHS trust. Between May 2025 and April 2026, median wait times for all mental health presentations (not just those requiring admission) were 6 hours and 56 minutes for adults and 7 hours and 3 minutes for children. During the same period, the longest wait in ED for a mental health patient within the last 12 months was 5 days and 12 hours. This had a detrimental impact on these patients due to the busy and noisy nature of an ED. This also resulted in overcrowding and higher rates of violence and aggression towards staff. However, the service assessed patients presenting with mental health concerns quickly. In March 2026, the psychiatric liaison team responded to 88% of referrals within 1 hour. Median response times for the psychiatric liaison team in April 2026 were 16 minutes for adults and 54 minutes for children. Psychiatric liaison staff conducted patient assessments alongside ED staff, rather than waiting until a patient was declared medically fit, which resulted in faster treatment for mental health issues.

Patients requiring admission due to physical health concerns remained in the ED for long periods due to low availability of beds on wards. In April 2026, the median waiting times for patients with a ‘decision to admit’ (meaning a specialist team had decided they needed to go to a ward) were 8 hours and 32 minutes for adults, 3 hours and 18 minutes for adolescents (16-17 years), and 4 hours and 50 minutes for children (under 16 years).

In May 2026, 70.7% of patients who attended the ED were seen and discharged or transferred within 4 hours. This was below NHS England’s target of 78%. However, it should be noted that this data does not include patients who attended this ED and were subsequently streamed to the on-site urgent treatment centre (UTC), and that NHS England's target of 78% applies to all patients regardless of how they are streamed. However, the service did meet NHS targets of ensuring the proportion of patients waiting more than 12 hours within the ED is less than 10% (this was 7.8% in April 2026 when including both adults and children).

NHS England guidance states that patients arriving at an ED should have an initial assessment within 15 minutes. This target was met and exceeded for walk-in patients. The median time to triage for these patients for the 12 months prior to our inspection was 8 minutes for adults and 13 minutes for children. Significant improvements had been made within this period for adults (from 22 minutes in May 2025 to 3 minutes in April 2026). This was due to the introduction of the ‘digital front door’ (electronic tablets allowing patients to book themselves in instead of speaking to a receptionist). However, average handover times for patients arriving by ambulance were longer than this 15-minute target, with average times varying between 24 and 26 minutes from April 2025 to March 2026.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.