King's College Hospital NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

King’s College Hospital NHS Foundation Trust is a large and complex NHS foundation trust that employs over 14,000 staff, providing both secondary and tertiary acute services across Southeast London and parts of Kent. The trust operates from five hospital sites: King’s College Hospital, Princess Royal University Hospital, Orpington Hospital, Queen Mary’s Hospital and Beckenham Beacon. It serves a diverse and densely populated area, providing care and treatment for a core population of over 1 million people across the London boroughs of Lambeth, Southwark, Lewisham, and Bromley, with specialist services extending regionally and nationally.

The trust is a major provider of tertiary services, including liver disease and transplantation, neurosciences, haematology, foetal medicine, diabetes, and hyper-acute stroke care. It is the designated major trauma centre for Southeast London, Kent, and parts of Surrey and Sussex, and also operates a London-wide cardiac centre. The trust has an established academic and research role and works in partnership with universities and other providers to support research, education and innovation. It contributes to wider system working through collaborative arrangements and participation in regional service planning. The trust plays a part in the wider health and social care system, delivering complex care, driving research and innovation, and contributing to regional service transformation. The trust is part of the Southeast London Integrated Care System (SEL ICS), which covers six boroughs: Bexley, Bromley, Greenwich, Lambeth, Lewisham, and Southwark. The trust is also part of the Southeast London Acute Provider Collaborative, where it collaborates closely with neighbouring trusts to focus on acute care, elective recovery, and diagnostic services.

The trust is a large acute provider with an annual income of approximately £1.9 billion. In 2023–2024, it reported a £78.7 million deficit and was subject to enhanced NHS England (NHSE) oversight. During 2024–2025, the trust reported a reduced deficit of £33.7 million, reflecting improvement alongside continued financial challenge. Governance is led through a unitary board structure.

In January 2024, the trust re‑established a dedicated chair role, following the end of its shared chairmanship arrangement, to strengthen board leadership during a period of financial recovery and regulatory oversight.

At the time of this trust‑level assessment, the trust was in the NHSE Regulatory Support Programme, and as such was subject to enhanced oversight. By March 2026, it was judged to have met the majority of the agreed transition criteria and exited from the programme. It remains subject to enhanced oversight by NHSE London Region, as required by the NHSE National Oversight Framework.

We previously inspected the trust in October, November, and December 2022. At that time, we inspected the medical care (including older people’s care), and the services for children and young people assessment service groups and if the organisation was well led. We rated the trust overall as requires improvement and the well led key question as good. Since the last inspection, there have been significant changes to the board leadership, both executive and non-executive, and we wanted to assess the impact of these changes.

We conducted a trust level (well-led) assessment, which included an onsite visit on the 16, 17 and 18 September 2025. We also held 24 focus groups with 572 members of staff participating and observed board and committee meetings between May 2025 and October 2025.

We assessed all 8 quality statements under the well led key question, using our current framework methodology. We reviewed evidence for all quality statements under our Single Assessment Framework.

The trust-level assessment followed inspections of some of the trust’s front-line services. We inspected 3 assessment service groups: maternity, medical care (including older people’s care) and services for children and young people. We undertook these inspections to ensure we understood a range of services the trust provides before the trust-level assessment.

Summary of assessment findings

We carried out an announced assessment of King’s College Hospital NHS Foundation Trust on the 16, 17 and 18 September 2025. We carried out this assessment in line with our assessment priorities. As well as the trust-level assessment, we inspected the following assessment service groups:

• Maternity
• Medical care (including older people’s care)
• Services for children and young people

Overall, the trust was rated as requires improvement for the well led key question.

We assessed quality statements within the well led key question. Each quality statement assessed is awarded a score. Details on how we score can be found on our website: https://www.cqc.org.uk/about-us/how-we-do-our-job/ratings

You can find further information about how we carried out our assessments at: https://www.cqc.org.uk/about-us/how-we-do-our-job/what-we-do-inspection

Well led

Rating Requires improvement

At our last assessment we rated the trust as requires improvement and the well led key question as good. At this assessment, the well led rating has changed to requires improvement.

We identified areas for improvement across seven of the eight well led quality statements. These areas were as follows:

• Although the trust had an articulated strategy and clear leadership intent, these were not yet translated consistently into improved staff experience, organisational culture or trust‑wide impact. Staff confidence, psychological safety and inclusive leadership were not yet reliably experienced across the organisation, and the trust had more to do to ensure its values, behaviours and strategic ambitions were consistently delivered in practice.
• The trust’s vision and values were well publicised and generally understood by staff, with kindness, respect and collaboration evident in many local teams. However, staff reported that these values were not consistently modelled at senior leadership levels, with variability across sites and staff groups in how stated behaviours were lived in practice.
• Staff described significant cultural concerns. This was reflected in the staff survey results, which showed that while the latest figures showed an improvement for the trust, these were below national averages across engagement, morale, leadership confidence, and psychological safety. Many staff reported a culture characterised by low visibility of senior leaders, poor communication, fear of speaking up, and limited confidence that concerns would be addressed. Staff reported bullying, harassment, discrimination, and inequitable career progression, indicating a disconnect between the trust’s stated values and the lived experiences of staff.
• Leadership demonstrated integrity, respect and commitment, and positive behaviours were observed in board and committee settings. However, compassionate and inclusive leadership was not consistently experienced across the organisation. Staff told us senior leaders were not always accessible or responsive to frontline concerns, and operational pressures sometimes resulted in top‑down decision‑making with reduced opportunities for learning and collaboration. The board did not yet reflect the diversity of the workforce or the communities served.
• The trust had appropriate Freedom to Speak Up functions, with two full‑time Guardians, executive and non-executive director oversight, and a network of King’s Ambassadors. Accessibility had improved, but the high volume of cases, well above national averages, indicated ongoing cultural concerns. Staff survey results showed low confidence in psychological safety. Staff described trusting the Guardians but not the wider organisational response, citing poor feedback loops, inconsistent follow‑through, and limited evidence that speaking up leads to change. Bullying‑related concerns were common, and many staff felt reluctant to raise issues. Although leaders had set clear priorities to improve culture and accountability, the trust had not yet embedded a psychologically safe speak‑up culture, and staff confidence remained low.
• Whilst the board voiced a commitment to equality for all staff, staff felt they did not always experience fairness across the organisation. Despite positive initiatives such as the cultural intelligence programme and targeted development delivered by the staff networks, progress remained limited, and inclusion was not experienced consistently. Staff told us the restructuring of the director of equality diversity and inclusion role in 2025, removing its direct reporting line to the chief executive officer and attendance at the board, was perceived as a downgrading of the agenda and contributed to a loss of senior‑level advocacy. Staff survey results also showed a mixed and often static picture, with ongoing disparities for Black, ethnic minority and disabled staff. This reinforced concerns that the trust’s stated ambitions for equality were not yet being realised in practice.
• Governance and assurance systems were not yet operating consistently across the organisation. Information flow from ward to board, risk articulation, ownership and assurance required strengthening, and some long‑standing risks had not been mitigated or reduced at pace. Although structures were in place, there were weaknesses in the oversight and assurance of safeguarding arrangements, including inconsistent documentation, follow‑up and recording of safeguarding decisions, and variation in Mental Capacity Act and Deprivation of Liberty Safeguards practice. The trust demonstrated an awareness of population health priorities and health inequalities, with examples of community engagement and partnership activity aligned to system objectives; however, population health intelligence and health inequalities work were not consistently embedded within core governance and assurance arrangements. In addition, incident backlogs, variable staff feedback, uneven embedding of learning and limited evaluation of impact reduced assurance that risks were being identified, addressed and mitigated effectively. Actions taken since the previous inspection had not yet translated into sustained improvement in staff experience or organisational culture.

Our positive findings from the well led review included:

• The trust had a clear and current 2021–2026 strategy, refreshed in 2025 to focus on financial recovery, digital transformation, inclusive leadership and reducing inequalities. The strategy was developed through extensive engagement with staff, patients, governors, partners and public contributors, and aligned with the demographic needs of the Southeast London population.
• System partners confirmed the trust had a clear strategic direction and leadership intent. The trust had taken some action since the previous inspection to address concerns relating to culture, leadership visibility, workforce processes and equality, diversity and inclusion, with improvement programmes underway.
• Staff across frontline services were committed, compassionate and professional, with many examples of kind, respectful and person‑centred care observed in local teams, supported by inclusive and approachable service‑level leadership.
• The trust demonstrated a strong commitment to learning, innovation and research, with notable strengths in specialist services and maternity. There were established systems for learning from incidents, deaths, audits, research, and external reviews aligned to Patient Safety Incident Response Framework principles, and evidence of system‑focused learning leading to meaningful improvement in some areas.
• Research performance, accreditation, external partnerships and innovation activity were significant, with national recognition and strong participation in clinical research, supported by committed leaders and engaged teams.
• The trust demonstrated an exceptional standard of environmental sustainability, with clear leadership, strategic oversight, strong governance and an embedded, organisation‑wide and mature commitment to reducing environmental impact. Leaders demonstrated a well‑developed understanding of climate risk, robust and systematic oversight of a nationally aligned Green Plan, and delivered innovative and high‑impact initiatives with measurable outcomes across estates, clinical practice, transport, procurement and waste. While staff carbon literacy and consistency of embedded programmes require further development, the scale of progress, demonstrable impact, external funding success and active system leadership showed a sustained, forward‑looking and organisation‑wide commitment to environmental sustainability.

People's experience of this service

People using the trust told us:

The trust gathered patient feedback through national surveys, the Friends and Family Tests (FFT), local surveys, and Healthwatch engagement.

The 2024 Adult Inpatient Survey (published in September 2025) showed that overall patient experience at King’s College Hospital NHS Foundation Trust was broadly in line with other trusts. Patients reported generally positive interactions with staff and rated aspects of the ward environment, such as lighting, temperature and noise from staff, as similar to other trusts. However, several areas for improvement were identified. These included delays in accessing beds and the time spent waiting to be admitted, as well as significant concerns about noise at night from other patients, which continues to negatively affect rest and recovery. Overall sleep quality scored particularly poorly.

The 2025 Maternity Survey (published in December 2025) showed signs of improvement from the previous year, with respondents reporting clearer communication, stronger teamwork among staff, and greater involvement in decisions during labour and birth. Overall patient experience scores improved, moving the trust from performing somewhat worse than expected in 2024 to performing about the same as other trusts in 2025. However, recurring concerns remained around the quality of information provided about induction options, the consistency of advice given during early labour, and occasions where women felt left alone at worrying moments. While confidence and trust in staff strengthened compared with 2024, the survey indicated that further improvement was needed to ensure women consistently receive comprehensive information and timely support throughout their maternity journey.

The FFT results for 2024-2025 indicate high satisfaction overall from respondents: 93% of inpatients and day case patients, 94% of outpatients, and 91% of maternity service users would recommend the trust. Positive themes included staff behaviour and quality of care, while negative feedback focused on communication, food, and facilities.

Local surveys, including the 2024 Children and Young People’s Survey, showed performance broadly in line with other trusts. Feedback highlighted good waiting times and staff support, but identified a need for more engaging activities for older children in waiting areas.

Healthwatch feedback was generally positive about staff professionalism and kindness, but raised concerns about appointment delays, communication with relatives, and discharge planning.

During our inspections of assessment service groups we spoke with 65 patients, family members and carers. For maternity services, women and families reported positive experiences across the sites. Staff were described as caring, compassionate, and supportive, with clear communication and effective involvement in planning and decision-making about care. Women felt welcomed and reassured, with birthing partners able to provide additional support. Specialist support, including bereavement care, was highlighted as a strength, and women appreciated being able to raise concerns or complaints with confidence, knowing these would be taken seriously. Some delays were reported in the triage process, and there were occasional complaints about poor staff attitude.

For medical care (including older people’s care), patients, relatives, and carers described their experiences of medical care as generally positive, emphasising the kindness, attentiveness, and professionalism of staff. People felt multidisciplinary teams were collaborative, which helped patients feel involved in their care and confident about their treatment and recovery. Long-term patients appreciated the staff’s efforts to keep them comfortable and engaged, even when opportunities for activities were limited. Allied health professionals were praised for their role in supporting wellbeing and rehabilitation, and relatives valued the emotional support provided during challenging times.

Across all sites, the environment was described as clean, and patients felt their privacy, dignity, and individual preferences were respected. In services for children and young people, children, young people, and their families reported generally positive experiences with the care provided, highlighting the warmth, kindness, and professionalism of staff. Communication was typically effective, and staff were described as friendly, supportive, and responsive to individual needs. Some families highlighted long waits and lapses in attentiveness in outpatient areas, providing examples of staff using their personal phones during interactions.