King's College Hospital

Updated 4 March 2026

Date of assessment: 8, 9, 14,15 April and 1 May 2025. King's College Hospital is part of King’s College Hospital NHS Foundation Trust and offers a wide range of hospital services to people living in Southwark and Lambeth.

This assessment looked at maternity services, medical care and services for children and young people to assess the quality of the care received by patients using those services. The rating of maternity service, medical care and services for children and young people have been combined with the ratings of the other services from the previous assessments.

See our previous reports to get a full picture of all the other services at King's College Hospital.

The rating of King's College Hospital remains requires improvement.

Updated 15 January 2025

King’s College Hospital (KCH) is a tertiary hospital and part of King's College Hospital NHS Foundation trust. The trust serves a population of approximately 1,000,000 people and provides maternity services primarily for the people living in the London boroughs of Lambeth, Southwark, Bromley, Lewisham and surrounding areas. King's College Hospital NHS Foundation Trust employs around 15, 407 staff. The hospital's maternity services offer a wide range of specialised care, including consultant-led care, midwifery led care, an outpatient antenatal clinic, a fetal medicine unit (FMU), a maternity day assessment unit, a triage unit, antenatal and postnatal inpatient wards (including transitional care), and bereavement services. From April 2024 to March 2025, there were 4,000 babies born at this hospital.

We last inspected maternity services at King’s College Hospital 01, 02 and 11 August 2022. At the last inspection, we conducted a comprehensive inspection of all domains. Safe, effective, responsive and well-led were rated requires improvement and caring was rated good.

We conducted this announced focused inspection on 8 and 9 April 2025 as a follow-up of the rating in 2022.

We spoke with multidisciplinary staff of the maternity team including maternity assistants, midwives, resident doctors, registrars, consultant obstetricians and anaesthetists, student midwives, specialist midwives, consultant midwives, safeguarding midwives, matrons, safety champions and the quadrumvirate. We received feedback from 7 women who had used the maternity service.

The service was previously in breach of Regulation 12 (safe care and treatment), Regulation 15 (premises and equipment), and Regulation 17 (good governance) of the Health and Social Care Act 2008. Although some improvements had been made since the last inspection in August 2022, particularly on incidents management, local audits, cleanliness and infection prevention and control, there were still areas of concern that had not been resolved from the previous inspection:

Safe:

Systems, pathways and transitions were not always in line with guidance. Staff did not always manage clinical risks in a timely way. Safeguarding guidance was not in date. There were not enough staff with the right skills, qualifications and experience. There were gaps in completion of risk assessments, women records and equipment checks. Staff did not manage medicines well. The service had a good learning culture, however, staff were not supported to raise safety concerns.

However:

People were protected and kept safe. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. Since the assessment the trust have made a number of improvements.

Effective:

People and communities experienced good outcomes because their needs were assessed. People’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. Leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

Responsive:

People and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

Well-led:

Leaders and staff did not have a shared vision and culture based on listening and trust. Leaders were not always visible and supportive, to help staff develop in their roles. Staff did not feel supported to give feedback and were not treated equally, and experienced bullying or harassment from senior leaders. Risk was not always managed in a timely manner.

However:

Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas. People with protected characteristics felt supported. Staff understood their roles and responsibilities.

Updated 15 January 2025

King’s College Hospital is run by King’s College Hospital NHS Foundation Trust. The medical care service at King’s College Hospital provides care and treatment for general medical services and specialist services including renal, liver, hematology, cardiology, and stroke services, as well as care of older people’s services.

We carried out an unannounced inspection of medical care at King’s College Hospital on 8 and 9 April 2025 in line with our assessment priorities.

Overall, the service was rated as requires improvement.

We assessed all the quality statements from the safe, effective, caring, responsive, and well-led key questions. We rated safe and responsive as requirements improvement. Safe was rated as requires improvement due to insufficient nursing staff. The service was in breach of legal regulation in relation to Regulation 18 Staffing, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have requested an action plan for the trust to address this.

Responsive was rated as requires improvement due to capacity issues affecting access and flow on the unit.

We rated effective, caring, and well led as good.

We looked at nine sets of patient clinical records; we spoke with 12 patients, 8 family members or friends, and 39 members of staff. We visited 13 wards including the discharge lounge, acute emergency care unit (AECU), frailty ward, acute medical assessment ward and older people’s services.

We assessed quality statements within key questions. 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

Updated 15 January 2025

We carried out an unannounced comprehensive inspection of services for Children and Young People on 29 and 30 April 2025 to check learning from an adverse event had been acted upon and was now embedded in daily practices. We inspected all quality statements across the five key questions: safe, effective, caring, responsive and well-led.

During our inspection we visited the following wards: Lion Ward, Neonatal Intensive Care Unit, Philip Isaacs Day Case Unit, Princess Elizabeth Ward, Rays of Sunshine Ward, Short Stay Unit, Thomas Cook Children’s Critical Care Centre, and Toni and Guy Ward. We also visited the paediatric recovery and the Children’s Outpatient Department. We spoke with over 35 members of staff including nursing and medical staff of all grades, pharmacists, healthcare assistants, play specialists, and managers. We spoke with over 30 patients and their relatives.

We rated the service as Requires Improvement. We found 3 breaches of the regulations in relation to staffing, safeguarding and governance.

Low staffing levels in parts of the service negatively affected service provision, staff wellbeing and did not always comply with national guidance. Governance systems and audits were not always effective in identifying or addressing areas for improvement. The service did not always identify, understand, and respond appropriately to the risk of abuse and neglect to children and young people. However, people were treated with kindness and compassion. Care and treatment were centred around children and young people and their needs and staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving between services.

We have requested an action plan, this will be requested upon publication of the final report.

Updated 31 January 2018

Our rating of this service improved. We rated it as good because:

• The service had improved since our last inspection in 2015. Patient records were now comprehensive, with all appropriate risk assessments completed. Staff were aware of their responsibilities under the MCA and we saw appropriate records were in place in patients’ notes. Management staff had sight of risks on the units and mitigating plans were in place to address those risks.
• There were effective systems to protect patients from harm and a good incident reporting culture was in evidence. Patient records were comprehensive with appropriate risk assessments completed. The iMobile (critical care outreach) team provided rapid response and stabilisation to patients who needed immediate attention and transfer.
• Staff provided evidence based care and treatment in line with national guidelines and local policies. Patient outcomes were better than the national average.
• Patient feedback for the services we inspected was mostly positive. Staff respected confidentiality, dignity and privacy of patients. Patients were engaged through surveys and feedback forms and the response showed high satisfaction with the service.
• Services were developed to meet the needs of patients. Feedback from patients was taken into consideration in designing a new critical care unit. Overnight stay near the hospital was arranged for relatives, and patients had access to a follow up clinic after they were discharged from the units.
• The CCU had implemented a number of innovative services and developed these to meet patients’ needs. The CCU was engaged in research activities and had supported a significant amount of National Institute for Health Research (NIHR) portfolio studies.
• There was good local leadership on the CCU. Staff felt valued, they were supported in their roles and had opportunities for learning and development. Staff were positive about working in the CCU.

However:

• Medical staffing was stretched and did not comply with recommended guidelines. Pharmacy and therapy staffing levels were below the recommended guidelines.
• Although plans were in place to open a new critical care unit, current bed spaces did not comply with the Department of Health’s building note HBN 04-02 which sets out a minimum standard of space for effective infection control.
• The average bed occupancy on the CCU was consistently above 100% and there were delayed discharges from critical care units.

Updated 31 January 2018

We did not rate the service. Our finding are detailed as follows:

• The department had taken a proactive approach following the removal of some of their radiology registrars in April 2017. The potential negative impact on the service was greatly minimised by a robust action plan, reviewing of processes and development of staff.
• Staff knew how to use the incident reporting system, received feedback about incidents and there was evidence of learning from these where relevant.
• Staff were very patient focused and patients and carers spoke positively about the care and compassion shown by the diagnostic imaging staff.
• Managers were visible to their staff and provided opportunity for regular appraisals, support and professional development.
• New equipment had been and was in the process of being installed. Staff could see the progress being made to improve the quality of the service offered.
• We found evidence of strong local leadership and a positive culture of support, teamwork and focus on patient care.

Updated 29 April 2022

Updated 12 June 2019

Our rating of this service improved. We rated it as good because:

• The trust provided mandatory training in key end of life skills to all new staff at induction and at regular updates.
• There were enough staff with the right skills and experiences to ensure the delivery of care. Staff had access to professional development, were competent for their roles, and had opportunities for a review of their performance.
• Risk assessment of equipment and its availability had improved since the last inspection. There was greater oversight of competence for the use of specialised equipment.
• There was good multidisciplinary working. The specialist palliative care team worked closely with the local hospice and there was access to clinical expertise within the hospital.
• Care and treatment was delivered in line with evidence based national guidance such as National Institute for Health and Care Excellence (NICE) guidance.
• Patient outcomes were monitored and improved through participation in the national care of the dying audit and subsequent internal audits relating to the end of life care for the dying patient.
• There were a range of training initiatives available for a variety of staff groups involved in end of life care so that staff had the skills, knowledge and experience to deliver effective end of life care.
• Patients at the end of life and those close to them were treated with kindness, respect and compassion. They were involved in making decisions about their care.
• There was a clear vision and strategy in place with identified priorities and monitoring of action taken by the end of life care team.
• Governance structures around end of life care were in place to ensure continuous improvement.
• There was a strong culture of quality end of life care across the trust, with active engagement, involvement, commitment and representation from a range of staff groups.

Updated 12 June 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated outpatients as requires improvement because:

• The service did not take steps to ensure all staff completed the required mandatory training. Compliance rates for required safety related training amongst medical staff was poor.
• The service did not always have suitable premises or equipment and did not always look after them well.
• Patient’s privacy and dignity was not always maintained due to the environments staff were working in, although staff tried their best to maintain standards where possible.
• Outpatient services showed generally poor performance in referral to treatment (RTT) and cancer waiting times. The trust was performing worse than the England average and national standard for both the RTT incomplete pathway, where patients should be seen within 18 weeks, and for urgent cancer referrals, where patients should be seen within two weeks. This meant the service was not always responsive and could not always meet patient urgent clinical needs in a timely manner.
• Services did not always provide the right information to service users prior to their appointments. Incorrect telephone numbers were often printed on appointment letters.
• Morale amongst administrative staff across most services was low.
• Not all risks on the risk register for OPD had not been reviewed recently, and it was not clear if all risks were being addressed.
• There were some additional plans for the long-term future of the OPD, but these were not an immediate priority due to the current challenges faced by the department. Plans did not always have clear timescales, and staff could not give examples of being involved in such plans.

However:

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Services were delivered and co-ordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances.

• The trust used a mostly systematic approach to continually improving the quality of its service, with clear escalation and reporting structures.

Updated 12 June 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service provided mandatory training in key skills to all staff but did not make sure everybody had completed it. Compliance rates for medical staff were poor and we issued the trust with a requirement notice for them to address this matter.
• The service did not always control infection risks well. Staff did not always keep premises and equipment clean. They did not always use control measures to prevent the spread of infection.
• Staff did not always complete an updated risk assessment for each patient. The completion of malnutrition universal screening tool (MUST) scores did still not reach the trust target of 100% and this had not improved since our last inspection.
• Patient outcome targets did not meet the national benchmark and the trust were not performing well in key areas.
• People could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with good practice.
• Most managers at all levels in the surgical division had the right skills and abilities to run a service providing high-quality sustainable care. However, there was a distinct lack of communication and strategic level engagement with clinical staff from the senior executive team.

However:

• The trust had enough nursing and medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff cared for patients with compassion and took account of their individual needs. Feedback from patients confirmed that staff treated them well and with kindness.
• There were systems and processes for effective learning, continuous improvement and innovation.

Updated 18 February 2020