King's College Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm and discrimination.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. The service had processes in place to manage safety incidents and when things went wrong, staff apologised and gave people honest information and support. Staff had the required levels of training to safeguard vulnerable adults and children and took action to keep people safe from avoidable harm and abuse. There was continuity of care when people moved between different services. The design, maintenance and use of facilities, premises, and equipment kept people safe. Infection prevention and control was managed appropriately. However, the service did not always achieve planned staffing levels on wards. Staff worked together effectively to provide safe care that met person’s individual needs, they understood risks but did not always manage them effectively as there were areas of inconsistency in the management of risks such as VTE and falls.

We have not awarded this service a score for Safe.

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

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service managed patient safety incidents well. We found a strong culture of learning from incidents. Staff recognised and reported incidents appropriately and knew how to raise concerns using the hospital’s electronic incident reporting system in line with the hospital’s incident reporting policy. Managers were responsible for investigating incidents and sharing the learning and received appropriate training to enable them to fulfil this role.

There had been 2 never events (a never event is a preventable error that should not happen if proper safety protocols are followed) relating to surgery in the last 12 months. There was evidence that changes had been made and embedded because of learning identified from incidents and this was widely disseminated. For example, we saw that an incident relating to the use of an incorrect implant had led to changes in how stock was managed and labelled, as well as improvements to the checking processes to ensure enhanced procedural checks were aligned with national safety standards.

Staff we spoke with were able to explain the duty of candour (duty of candour is the legal requirement for health care providers and professionals to be open, transparent and honest with patients and families when things go wrong). When things went wrong, staff apologised and gave patients honest information and suitable support, in line with the hospital’s Duty of Candour policy. We saw examples of thorough investigations of incidents being performed where duty of candour had been applied, including the involvement of family members in the investigation and identification of learning and implementation of improvements.

Managers debriefed and supported staff after serious incidents. Staff were also offered appropriate psychological team support following a distressing incident. In addition, staff were involved in investigations and the identification of learning and improvements to reduce the risk of repeat incidents and improve patient safety.

We saw evidence that the service learnt from risks and concerns. Risks were identified through different sources such as audits, incidents, patient and staff feedback, and risk assessments. Staff were also involved in mortality / morbidity reviews to identify learning and improvements. There were appropriate arrangements for identifying, recording and managing risks, issues and mitigating actions.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff told us there was good multidisciplinary team working within the service. We observed a collaborative approach with staff working well to manage safety. There was good continuity of care when patients moved between services.

Pre-operative assessments were undertaken in a dedicated pre-operative assessment clinic. Fitness for surgery was assessed using a self-completed health questionnaire and a combination of telephone and face to face appointments depending on individual factors. Pre-operative screening processes supported appropriate case selection and escalation where additional complexity was identified, including decision making about the appropriateness of surgery as a day case or as an inpatient. There was clear exclusion criterion for day surgery, where patients considered to be at greater risk were more likely to be considered for inpatient treatment and care.

There were daily bed meetings attended by bed managers and matrons, where patients who were outlier numbers were also reviewed and tracked. There were handovers, safety huddles and consultant ward rounds that included input from members of the multidisciplinary team. There was 24/7 access to surgical consultant and critical care input.

Temporary escalation spaces (where patients were held in temporary locations because there was no appropriate inpatient bed available) were used on Twining, Lister, Coptcoat and Trundle wards. On Trundle ward we saw there was a boarding trolley at the end of 2 other beds with limited space for movement. Staff told us a risk assessment had been undertaken, and that only fully mobile patients should be boarded in this space, however, they cited an occasion in the weeks before our visit where a patient requiring hoisting in and out of bed had been admitted to the space.

We saw that discharges from hospital were considered as part of admission and planning processes, with estimated discharge dates. Discharge letters were sent to the patient’s GP on discharge, informing them of procedures undertaken and any follow up arrangements, or postoperative testing or care required.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff had access to the trust’s up to date safeguarding policies on the hospital intranet. The policy detailed individual responsibilities, processes for reporting and escalation of concerns and who to contact. Staff we spoke with knew how to access the policy.

All clinical staff were trained to level 2 safeguarding adults and level 2 safeguarding children, with some additional nursing and midwifery staff trained to level 3 children’s safeguarding. The service’s compliance rates in safeguarding training met or exceeded the trust’s target of 90% for most clinical staff groups. However, achievement of level 3 adults safeguarding was below target at 75% for nursing staff.

Staff we spoke with could demonstrate a good understanding of safeguarding vulnerable adults and children and were able to articulate different forms and examples of abuse. Staff knew how to escalate concerns to their manager and safeguarding lead.

Staff were trained in safeguarding, knew how to raise a safeguarding concern, and did that when appropriate. Safeguarding concerns were raised to a dedicated safeguarding team using the electronic patient record system. Safeguarding staff provided expert advice, input and liaison with other services, as appropriate, to ensure patients were safeguarded and staff supported. There were staff dedicated to supporting safeguarding of children and vulnerable adults, including adults with a learning disability.

The evidence showed some shortfalls. Staff worked together well to provide safe care that met people’s individual needs and made sure staff received effective support, supervision and development. However, the service did not always make sure there were enough qualified, skilled and experienced staff.

Managers planned and reviewed staffing levels. Staff told us that staffing was variable with most ward staff reporting unfilled shifts and the use of bank staff. The wards we visited had regular shifts covered by bank and most wards we visited had at least 1 registered nurse shift unfilled on the days of our assessment. For example, both Cotton and Trundle wards had unfilled day registered nurse shifts when we visited. Staff told us that bank were regularly used to cover shifts and occasionally agency staff would be used but this was generally for one-to-one patient care.

There was a vacancy rate of 7.64% across surgery. This included a rate of 16.12% for additional clinical services, 7.17% for medical staff and 5.98% for nursing. Sickness rates for surgery were 5.17%. Theatres and anaesthetics had a vacancy rate of 0.4% and a sickness rate of 5.27%. Staff in main theatres told us they did not experience many staff shortages, however, staff in the day surgery unit did have some shifts unfilled. They told us they managed by moving staff and regular staff covering with additional shifts where needed.

We reviewed rotas and saw that planned staffing was not always achieved and there were regular unfilled shifts on days, covered with the additional use of bank staff and movement of staff. There was minimal use of agency staff. Some shifts were unfilled and staff told us a review of risk was undertaken to ensure ward areas were safe. There were processes in place to escalate staffing concerns, and staff were supported by matrons and senior staff to ensure levels were safe. This included moving staff from one ward area to another. We were also told that ward managers would undertake regular clinical shifts to provide cover.

There were sufficient medical staff to keep people safe and meet their individual needs. Staff reported that anaesthetists were accessible within theatres and there were clear rotas and on-call rotas in place for anaesthetists and surgeons. As a minimum there was a speciality trainee or doctor with equivalent ability available to see and treat acutely unwell patients at all times within 30 minutes and they were able to escalate concerns to a consultant. The service ensured an anaesthetist was always available postoperatively if required.

New staff undertook competency-based training and assessment. There were practice educators providing support. There were competency frameworks for staff in relation to different roles including scrub practitioners, recovery practitioners and leadership roles as well as specific competencies for staff working on the wards. There were clear induction programmes for new staff, including corporate and service specific areas.

Staff received training appropriate to their role. Mandatory training rates were generally close to the trust’s 90% target, although slightly below. The surgical division achievement rate was 87%. Mandatory training included safeguarding, infection control, resuscitation, moving and handling and information governance. At our last inspection we identified a breach of regulation due to poor medical staff mandatory training compliance. At this assessment we found that overall mandatory training compliance for medical staff was 83%. Most modules had an achievement rate of more than 75%, with over half of modules meeting the mandatory target. Only one module, conflict management, was well below the achievement target at 50%.

Staff told us they had opportunities to develop their skills and complete training outside of mandatory training requirements. Staff we spoke with told us they had received an appraisal in the last year. Achievement rates for appraisals across the surgery division were 94%. For non-medical staff achievement was over 94% but for medical staff achievement was at 83% which was below the trust target of 90%.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All the areas within the service we inspected were clean and had suitable furnishings, which were generally well-maintained. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly. Theatre areas were visibly clean.

Infection prevention and control audits were carried out monthly. Surgical IPC audit compliance was below the trust target of 90%, between 79% and 85% from January to March 2026. However, there was evidence of improvement on a monthly basis, with an infection control improvement plan in place. Examples of improvements included changes to the way ward areas were cleaned, with local cleaning audits introduced to areas where problems had been identified.

We reviewed the infection control policy which was in date and accessible on the hospital intranet. The policy was comprehensive, and staff could easily access it. Staff had support from the site IPC team and medical microbiology to manage concerns.

The service completed monthly infection control audits and monitored numbers of healthcare associated infections and surgical site infections (SSI). This included information on MRSA, clostridium difficile, pseudomonas, Escherichia coli (E. coli) and methicillin-susceptible Staphylococcus aureus (MSSA). We viewed SSI data for hip and knee replacements for the year to December 2025 and saw there had been no knee infections and 1 hip. This included all surgical wards. Katherine Monk ward was part of the trust clostridium difficile quality improvement project where a different cleaning product was used. Following this there was a reduction in cases from 4 the previous year, to 1 in the 2025/26.

There were actions in place to improve surgical site infection rates and hospital acquired infections. For example, we viewed a surgical wound screening compliance report and saw the trust had implemented an MRSA campaign that was launched in October 2025. We viewed February 2026 data that showed elective MRSA screening was 98% within division C of the hospital and 99% in division B. Emergency MRSA screening was 71% for division B and 84% for division C.

There was easy access to personal protective equipment (PPE) such as gloves and aprons. Staff followed IPC principles and were bare below the elbow. We observed theatre and ward staff wearing appropriate PPE.

Waste management was handled in line with national standards, with different colour coding for general waste and clinical waste. All clinical bins were seen to be operated with lids and were not overfilled. Most sharps bins were found to be correctly labelled and not filled above the maximum fill line, although temporary closure devices were not always used.

There was access to hand sanitisers throughout the hospital and hand hygiene was visibly promoted. Audits of staff hand hygiene consistently showed achievement was below the trust target of 90%. For example, between January and March 2026, compliance ranged between 79% and 85% with consultant/doctor hand hygiene compliance consistently the lowest between 60% and 70%. However, over the 3-month period there were improvements in registered nurse hand hygiene compliance.