- NHS hospital
King's College Hospital
Report from 15 January 2025 assessment
Contents
Ratings - Maternity
Our view of the service
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.
People's experience of this service
Women, and their families we spoke to were all positive about the staff treating them with warmth and kindness and providing effective care and treatment. Staff were described as caring, compassionate, excellent and professional. Staff took time to explain things clearly in way they could understand.
Women, and their families knew how to make a complaint and felt that their complaint would be acted on. They did not feel anxious about raising concerns. Women felt involved in the planning and decision-making about their care, including when plans had to change. They spoke positively about the variety of food and drinks, specialist support available and would recommend service to friends and family particularly for women with complex cases and high-risk pregnancies.
The service had a new dedicated and well-equipped bereavement suite to meet the needs of women, and their families. Women could access maternity services through their GP, community midwives, self-referral by phone, or an online booking form. Women could access care and support when needed however experienced some delays before been reviewed by doctors in the maternity triage.
We refer to women in this report, but we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues’.