Royal National Orthopaedic Hospital NHS Trust rated as Requires Improvement by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services run by Royal National Orthopaedic Hospital NHS Trust as Requires Improvement overall following a Care Quality Commission inspection, although several areas of the trust were rated as Outstanding.

The trust is the largest orthopaedic hospital in the UK, providing services from its main hospital site in Stanmore, Middlesex, and an outpatient clinic in Bolsover Street, London.

It provides specialist care to people from across the country – many of which have been referred from other orthopaedic services or who have complex or rare conditions. The full reports on the trust and on each site are available on the CQC website here.

CQC rated the trust as Requires Improvement for safety, responsiveness and leadership, although it was rated as Outstanding for being caring and effective. Inspectors rated outpatient services and children and young people’s services as Requires Improvement. Medical care was rated as Outstanding, and surgery and critical care were rated as Good.

CQC found that people using the hospital received effective care which led to good outcomes, and that services were designed in response to patient needs. Surgery and medical care were rated as Outstanding in two areas, and children’s care was rated as Outstanding in one.

Inspectors found, however, that the premises at the Stanmore site were not fit for purpose, and did not provide a suitable environment to treat and care for patients. CCQ found that this was the critical issue facing the trust in terms of providing good patient care across the board.

Inspectors also found that the children and young people’s service was not responsive to the needs of those using it and the environment was inadequate. Some patients waited too long at their outpatient appointments.

CQC found that staff were caring and compassionate and treated patients with respect. Patients praise for staff was overwhelming and consistent across the whole trust. Staffing levels and skills met people’s needs, and the hospital was clean and well maintained. Medical care for spinal injury patients and patients receiving rehabilitation was found to be outstanding.

A long term culture of bullying and harassment was reported, although in more recent times the trust had developed a significant focus on staff values and behaviour.

CQC identified a number of areas where the trust must make improvements, including making sure that:

• The design and layout of the Stanmore site meets the needs of all those who use it.
• It continues a significant focus on the culture of the trust.
• Robust risk management systems are in place and that the learning from incidents is widely shared.
• Outpatient clinics start on time and patients do not experience avoidable delays.
• The World Health Organisation (WHO) surgical safety checklist is used and completed at each stage of surgery and radiology.

Inspectors also identified a number of areas of outstanding practice, including:

• Outstanding clinical outcomes for patients, and effective multidisciplinary working which placed the patent first.
• The London Sarcoma Service, which was rated as Excellent or Good by the majority of patients.
• The London Spinal Cord Injury Centre, where the pathway of care was described as “world class” by patients and in independent reviews.
• Innovative surgery which was being carried out to improve quality of life. For example, limb lengthening for patients with skeletal malformation.
• The executive board, which demonstrated strong leadership, commitment and vision for the hospital.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“When we inspected the Royal National Orthopaedic Hospital, we saw some outstanding practice, but also some areas where improvements were required. The highest priority for the trust at this moment in time is to address the environmental issues that we identified.

“We saw that staff were caring and compassionate in their dealings with patients, and patients praised the care that they received. Some areas of the medical care provided at the hospital were found to be outstanding.

“We’ll return in due course to check that the improvements needed have been made, and hope to see that the good practice we identified will be sustained.”

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts made an announced visit in May.

CQC inspectors will return to the hospital in due course to check that the remaining improvements required have been made.

ENDS

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