Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) has been rated Good overall by the Care Quality Commission.
The trust was rated Outstanding for being effective and caring. It was rated Good for being safe and responsive, while it was rated Requires Improvement for being well-led, following an inspection in January 2018.
CQC inspected two core services at GOSH, these were the outpatients department (OPD) and surgery. Inspectors decided to inspect these because during the previous inspection CQC rated those services as Requires Improvement. Inspectors decided not to inspect the other core services as they were previously rated as Good or Outstanding.
Caring was rated Outstanding. CQC received only positive comments from patients or their carers about staff throughout this inspection. They talked about the sensitivity demonstrated by staff when breaking bad news. They said they could, and frequently did, ring staff when they needed reassurance.
Parents said doctors and nurses made them feel like partners in their child’s care. They said they felt that when their views were sought, this was not just a token exercise and they were really taken into consideration.
Inspectors also rated the trust Outstanding for being effective. The trust provided care and treatment based on national professional standard, national guidelines and evidence based practice to achieve the best patient outcomes.
Inspectors saw evidence of very good multidisciplinary working between departments in the hospital and other hospitals and external agencies such as GPs and community teams to provide holistic care. The trust ensured staff were competent and supported in their roles.
CQC rated well-led at the trust as Requires Improvement. The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. However, there had been frequent executive leadership changes which affected staff morale.
Staff said they felt divisional structures were overly complicated. Staff felt this did not allow for clear lines of accountability and for cross divisional learning. The percentage of staff reporting good communication between senior management and staff was much worse than the national average in the NHS staff survey. Trust leaders did not appear to be aware of the wide concerns raised with the inspection team by nursing staff about leadership and morale.
Nurses felt they lacked leadership and they did not feel retention of nursing staff had been addressed by trust’s leaders.
The trust had not fully demonstrated their commitment to support the freedom of staff to speak up about their concerns. They did not fully comply with recommendations set in freedom to speak up guidance issued by the National Guardian’s Office. No trust guardian had been appointed.
The trust missed opportunities for engagement with some stakeholders. The trust did not demonstrate open and positive relationships with key stakeholders. It was not sharing information promptly and was often defensive when challenged on performance and safety.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“Great Ormond Street Hospital has a strong reputation for giving the children it looks after good quality care.
“We rated the trust’s effectiveness and caring as being Outstanding. It is impressive that only positive comments were received from patients or their parents and carers about GOSH staff.
“However, the trust must improve on well-led. This was highlighted at the last inspection and the necessary improvements have not yet been made. I hope that with a more settled senior management team in place, better results can be achieved in the future.”
You can see CQC’s ratings tables for GOSH on pages 12 and 13 of the report which you can read on our website.
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It is impressive that only positive comments were received from patients or their parents and carers about GOSH staff
Professor Ted Baker, Chief Inspector of Hospitals