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. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. 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 evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. We saw these displayed. The leadership of the division had worked with the strategy team and each care group to draft a strategy, with clear priorities until 2031. These included improving referral to treatment times, patient flow, length of stay and workplace morale. Success outcomes had also been identified.

The senior leadership team had successfully communicated the trust’s vision and values to the frontline staff in this service. The process for developing the strategy included involvement of a range of staff within the care group and wider organisation. This included input from the Kings leadership forum and there were plans for a divisional away day to further develop and embed the strategy.

Staff could explain how they were working to deliver high quality care. They were able to articulate priorities, including efforts to improve patient flow and experience. However, there were ongoing cultural issues in liver transplant between the adult and paediatric team. This was a long-standing issue and was impacting morale.

The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Friends and family test responses for the quarter from January to March 2026 showed an average of 94% of patients cared for on surgical wards felt the care they received was good.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. For example, we saw evidence of changes to cleaning schedules as a result of patient feedback.

Staff and leaders promoted staff empowerment to drive improvement. Staff were encouraged to raise concerns. The trust had a Freedom to Speak Up (FTSU) Guardian with whom staff could raise concerns about any issues. There had been 5 disclosures relating to surgery between March 2025 and April 2026. We saw 3 of the 5 related to leadership concerns, including line managers and senior leaders.

Staff told us there was a culture of speaking up where staff actively raised concerns. We saw evidence of Freedom to speak up information and posters on walls in clinical areas. Staff told us they knew how to raise concerns and where to go to with this. However, some staff reported they did not feel confident that they would be protected in the event of making a Freedom to speak up disclosure. This included staff who shared concerns around the liver care group specifically, citing cultural and historical concerns of bullying and a poor morale as a result. We heard from staff who told us they did not have faith in raising concerns and they did not feel enough would be done about them. We saw staff survey data that showed 58% of staff surveyed felt safe to speak up.

We spoke with managers and divisional leads about actions to address concerns around culture. We saw that action had been taken in the form of external reviews and improvement recommendations. We also so that work on culture and team building had been undertaken and prioritised.

The trust had an appropriate and up to date Freedom to Speak Up and whistleblowing policy.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate and service leaders engaged with external stakeholders. We saw examples of this throughout our assessment. For example, leads shared with us examples of collaboration, such as the Significant Polyp and Early Colorectal Cancer (SPECC) team held a service improvement away day supported by the Southeast London Cancer Alliance (SELCA). Breast and Colorectal nursing teams also participated in SELCA pathway groups.

The Trust's Stoma Care team leads the Southeast London (SEL) Stoma Care Nurse Group, a collaborative involving King's and other South East NHS trusts with a primary aim to improve patient pathways across the region. A mapping workshop was recently held to establish the current provision and patient offer across the region with plans to include patient involvement in the process.

We were also given examples of collaborative working with other NHS services to improve waiting times and manage surgical lists, with a shared aim of sharing learning and improvements where possible. The service worked closely with the integrated care board (ICB) and NHS England to ensure that services met the needs of the local community and improvements were made as needed.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Staff we spoke with told us they were supported by their managers to access development opportunities and develop their leadership skills. The service was actively involved in research.

Staff were involved in various quality improvement projects. The service was active in trying to improve and respond to individual patient care needs. Quality improvement examples included the use of Endoscopic Electroporation, where electrical pulses are used to destroy tumour tissue in patients with colorectal cancer who are not suitable for surgery. A pilot demonstrated positive outcomes for patients where treatment saw a reduction in admissions and blood transfusions. Examples of ward-based quality improvement included improving assessment and monitoring of patients as part of a deteriorating patient dashboard.

Improvements in waiting times and theatre utilisations were a focus of quality improvement activity. These included the development of a straight to day surgery unit (DSU) where patients were identified as being eligible for a streamlined pre-operative assessment process to reduce face to face appointments and positively impact waiting times. Other initiatives included having standby patients for late cancellations and short notice bulk texting to eligible patients who may be able to attend for surgery at short notice.

Learning from incidents and complaints was shared across directorates to drive change and improvements. There were systems in place to share learning, and we saw evidence of this during our assessment.

Quality improvement initiatives included the development of a young person’s service within neurosurgery as a result of patient and family feedback.