King's College Hospital

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• 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 people and communities had the best possible outcomes because their needs were assessed. We checked 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 leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of everyday work.

At our last assessment we rated effective as requires improvement due to patient outcome indicators not meeting national benchmarks and staff not always following current guidelines due to the use of out-of-date policies. At this assessment, the rating has changed to good.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s personal and health needs. Staff monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. However, the service did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Audit data showed that pain assessments and re-assessments were not consistently in line with trust protocols and VTE assessments were inconsistent across the care group. A 2024 Getting It Right First Time (GIRFT) programme review of Kings College Hospital in 2024 described the provision of trauma services as a national outlier and we were told by staff there were long waits for trauma patients with ankle and wrist fractures.

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

Staff identified and assessed people’s needs prior to surgery through structured pre‑operative assessment processes. Patients gave consent at each stage of treatment, including pre‑operative assessment and on the day of surgery, and people we spoke with told us they felt well informed about expected outcomes and risks.

We reviewed patient care records from theatres and wards. The records demonstrated that staff had assessed people’s individual health, wellbeing, emotional and social needs. This included a record of medical history, home circumstances and other health information which guided discharge planning and ongoing support requirements.

Staff carried out individual risk assessments and put care plans in place. Records showed that risk assessments and care plans were reviewed as people’s needs changed. We saw that multidisciplinary working between nursing, medical and allied health professionals contributed to the ongoing assessment and care planning processes.

Staff used the NEWS2 system and had received appropriate training in this. They carried out routine monitoring based on people’s individual clinical needs to ensure any changes in medical condition could be promptly identified and addressed.

Leaders monitored compliance with NEWS2 assessment and documentation, which provided assurance that deterioration could be recognised and escalated appropriately. Audits showed that observations were recorded as part of the NEWS2 framework 100% of the time between January and March 2026.

Staff identified and assessed people’s pain using recognised tools and provided pain relief in line with individual need and best practice.

People’s mental health needs were assessed as part of comprehensive assessment processes. We saw examples where patients were referred to mental health services as part of their admission process and we saw that where risk was identified patients were provided with one-to-one specialist mental health nursing support.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service planned and delivered people’s care and treatment in line with current legislation and nationally recognised evidence‑based good practice. Care was delivered consistently and supported good patient outcomes.

Staff told us they could easily access policies through the trust intranet. They followed up-to-date policies and applied recognised best practice guidance in day-to-day treatment and care. For example, staff consistently completed the World Health Organisation (WHO) surgical safety checklist for all patients undergoing surgery. We observed the appropriate use of the checklist during theatre activity. This supported effective communication, shared decision making and patient safety by reducing errors, minimising complications and ensuring effective teamwork during surgery. We saw that other surgical policies and protocols were aligned with guidance from national agencies such as the National Patient Safety Agency (NPSA).

Clinical leaders demonstrated oversight of national guidance and best practice standards. For example, Getting It Right First Time (GIRFT) recommendations formed a basis of service development and improvement planning.

The trust had been awarded the Royal College of Physicians Improving Quality in Liver Services (IQILS) level 1 accreditation in 2023. They had also received Joint Advisory Group (JAG) Gastrointestinal Endoscopy accreditation in April 2024, providing independent assurance that endoscopy services met nationally recognised quality and safety standards.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. We saw there was a formal annual clinical audit programme to evidence performance monitoring, quality measures or patient outcomes relating to surgical services. There was a corporate audit plan, which included national audits, which the trust was submitting data to, for example, the national emergency laparotomy audit (NELA), national joint registry (NJR), and the national liver transplant audit.

Other examples of evidence-based practice included the adoption of sip-till-send protocols where patients are allowed to sip clear fluids right up until they are called to theatre. Baseline audits of fasting and fluid intake prior to surgery were undertaken in 2024 with a repeat audit currently underway to test the adoption of the sip-till-send approach.

People’s nutrition and hydration needs were routinely assessed and staff could access dietetic and speech and language support for patient experiencing nutrition or swallowing difficulties.

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

Surgical teams had effective working relationships. We observed good communication between teams, including wards, theatres, recovery areas, imaging, allied health professionals and administrative teams. We were told that structured handovers, daily huddles and meetings focused on sharing clinical and safety information and were focused on anticipating risks and additional needs in order to ensure smooth and coordinated treatment and care for patients. Regular day to day meetings between clinical, operational and administrative leads supported patient flow, staffing, theatre activity and emerging risks so that timely decision-making and escalation were in place when needed. However, we were also told of longstanding communication and culture issues within the liver service. This included staff expressing concerns about interactions between adult and paediatric liver services. The trust were aware of these issues and had implemented actions including team building exercises to address some of these concerns. However, staff we spoke with told us some of the issues were ongoing despite intervention.

The multidisciplinary team (MDT) included doctors, nurses, theatre staff, physiotherapists, dieticians, occupational therapists and other allied health professionals. There were also clinical nurse specialists in different areas of the surgical specialities who provided support to ward staff around patient care.

Staff reported good internal MDT processes with other departments, including access to diagnostic imaging for x-rays, CT and MRI scans when they needed them. They also had access to critical care services which included a critical care outreach team who supported ward staff when a patient became critically unwell. A multi-speciality same day emergency care (SDEC) provided 7-day access to specialist clinicians for patients requiring same day emergency care.

Other specialist MDT access included access to a psychiatric liaison service where patients could receive urgent mental health assessments. There was also a learning disability support service who were alerted each time a patient with a learning disability was admitted.

We saw theatre staff work together to complete the safer surgery checklist and prepare patients for surgery. Patient records showed routine and coordinated input from nursing and medical staff, as well as allied health professionals.

Staff worked across healthcare disciplines and with other agencies when required to care for patients. Ward staff liaised with other hospitals, general practitioners, community services and social services when coordinating discharge, ensuring care was continued when people moved between services.

Staff held regular and effective multidisciplinary meetings. For example, on Trundle ward we saw that MDT meetings were twice a week and included geriatrician, occupational therapist, physiotherapist, nursing, social work and dietician input. Daily board rounds were also conducted with the duty social worker and discharge coordinator.

Staff we spoke with were positive about MDT working within the service. For example, they told us that MDT members were accessible, they worked together well and were supportive and focused on the needs of patients.

The evidence showed a good standard. 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, reduced their future needs for care and support.

The service had relevant information promoting healthy lifestyles and support within surgical ward areas. We saw there was information available to people about post‑operative care and recovery, including specific information about the surgery and procedures undertaken. In addition, we saw information available around preventing falls, improving wellbeing and support for issues such as stopping smoking and healthy eating advice.

Patients completed a health assessment as part of the pre-operative assessment processes. This included information about alcohol usage, smoking status, dementia screening and falls risk assessments. Staff used this to identify health concerns and tailor care appropriately. Staff gave people relevant health information and materials tailored to their needs.

Following surgery, patients were supported by the multidisciplinary team to support their recovery. Physiotherapists and occupational therapists visited the wards and provided post‑operative advice and exercises to help people regain mobility and confidence and support their recovery.

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

Patients told us staff explained their planned treatment, including risks and benefits during pre‑operative appointments prior to treatment and reiterated this prior to surgery. We viewed records of consent and found these had been completed appropriately and that information had been shared about risks and benefits.

Staff had the appropriate skills and knowledge to seek consent from people. Staff were clear about how they obtained verbal informed consent and written consent before providing care or treatment. Consultants and anaesthetists sought consent during pre-operative assessment and again on the day of surgery.

Staff knew the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, which were included as part of the trust’s mandatory training. Staff described how best interest decision‑making was supported where people were unable to give consent and we saw this was recorded on the consent form and within the patient record.

Staff recorded consent in people’s records. We saw evidence of discussions about ‘do not attempt cardiopulmonary resuscitations recorded in patient records. This included discussions with the patient and / or family as appropriate where patients did not have mental capacity to be involved.