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Leading South London trust told to improve by regulator

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King’s College Hospital NHS Foundation Trust has been rated “requires improvement”, after the Care Quality Commission found overcrowding in emergency departments and patients waiting for long periods.

The trust was rated “requires improvement” in all areas except on whether services are caring, which was rated “good”.

“We are pleased the CQC praised the compassionate care our staff provide to patients every day”

Roland Sinker

The emergency departments were often overcrowded. Referral to treatment times were not met in a number of specialties and surgical procedures were cancelled and were not rescheduled within 28 days.

There were seven “never events” at the trust between February 2014 and January 2015, six of which were surgical errors. The inspectors found that all incidents were reported and investigated.

Inspectors found there was a transparent approach to investigating incidents, said the CQC’s report on the organisation.

The trust had worked to improve staff engagement at the Princess Royal University Hospital, which it acquired in 2013, but “more work was required for some senior medical staff”, the report said.

The inspectors found “significant improvements in the leadership and staffing of the hospital” since King’s had acquired it.

The critical care unit at the Denmark Hill site had positive patient feedback and above average outcomes.

However, inspectors said current facilities were “not adequate”, with a lack of bed and storage space. There was a lack of bed capacity and patient to nurse ratios in the high dependency unit were not always met.

There were longstanding issues in the maternity unit. Midwives worked hard to keep patients safe, but sickness levels among midwives had risen, the report found.

Consultant leave was not covered and this put extra pressure on the rest of the staff. Medical cover at night was “insufficient” to guarantee prompt review and treatment of patients.

Although the trust has a do not attempt cardio-pulmonary resuscitation policy, orders were not consistently completed in line with the policy.

“We were concerned about congestion throughout both the King’s College Hospital and the Princess Royal University Hospital emergency departments”

Mike Richards

However, inspectors found that patients reaching the end of their lives were treated with “dignity and respect”.

A number of areas were found to be outstanding, including trauma nurse coordinators visiting patients daily – this role included networking with other providers – and “pioneering work” was being done by neurosciences, liver and haematology specialist services.

Previous chief executive Tim Smart left the trust in April, shortly after the CQC made their inspection.

Nick Moberly, the current chief executive of Royal Surrey County Hospital Foundation Trust, will join the trust in November.

Roland Sinker, acting chief executive, said: “The rating is not where King’s wants to be. We want and need to do better. We are pleased the CQC praised the compassionate care our staff provide to patients every day.

“It is also positive that the CQC singled out some of our specialist services for praise, as well as finding significant improvements at the [Princess Royal University Hospital] compared to their last inspection in December 2013,” he added.

“Many of the issues the CQC has identified as requiring improvement are already known to us, and we have made significant progress since their inspection in April,” said Mr Sinker.

CQC chief inspector of hospitals, Professor Sir Mike Richards, said inspectors saw “a clear culture of providing compassionate care with dignity which was fully supported by feedback received from patients and carers”.

He added: “However we were concerned about congestion throughout both the King’s College Hospital and the Princess Royal University Hospital emergency departments. 

“We found that patient waiting times, the number of cancelled operations and delayed discharges within the emergency departments was too high,” said Sir Mike.

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