• Hospital
  • NHS hospital

The Royal National Orthopaedic Hospital (Stanmore)

Overall: Good read more about inspection ratings

Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP (020) 8954 2300

Provided and run by:
Royal National Orthopaedic Hospital NHS Trust

All Inspections

30 October to 29 November 2018

During a routine inspection

Our rating of services improved. We rated it them as good because:

We rated safe requires improvement and effective, responsive, caring and well led as good.

  • Medicine went down to good from outstanding.
  • We rated outpatients as good. We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.
  • Services for children and young people went up to good from requires improvement.
  • Surgery remained at the same rating of good.

3 May 2014

During an inspection

7-9 May 2014

During a routine inspection

The Royal National Orthopaedic Hospital – Stanmore is the main location of the Royal National Orthopaedic Hospital NHS Trust. It is the largest specialist orthopaedic hospital in the UK, with 220 beds, and is regarded as a leader in the field of orthopaedics, both in the UK and worldwide. As a national centre of excellence, the trust treats patients from across the country, many of whom have been referred by other hospital consultants for second opinions, or for treatment of complex or rare conditions.

The Royal National Orthopaedic Hospital NHS Trust has been selected as one of the first specialist trusts to be inspected under CQC’s revised inspection approach. It provides surgery, medical care for spinal and rehabilitation patients, critical care and children and young people’s services.

The team of over 30 included CQC inspectors and analysts, doctors, nurses, Experts by Experience and senior NHS managers. The inspection took place on 7, 8 and 9 May 2014.

Overall, we rated this hospital as ‘requires improvement’. We rated it ‘outstanding’ for providing caring and effective care but it required improvement for the services to be safe, responsive and well-led.

We rated medical care as ‘outstanding’ and surgery and critical care as ‘good’. However the outpatient services and children and young people’s services ‘requires improvement’.

Our key findings were as follows:

  • The fabric of the building was not fit for purpose – it does not provide an adequate environment to care and treat patients.
  • There was a significant focus on culture, values and behaviours of all staff.
  • Patients praised staff and the good care they received. The NHS Friends and Family Test results were higher than the national average. The response rate was extremely high.
  • Staff were caring and compassionate and treated patients with dignity and respect.
  • Overall staff followed good infection control practices.  The hospital was clean and well maintained and infection control rates in the hospital were within a statistically acceptable range.
  • Staffing levels and the skill mix of staff met patients’ needs.
  • The medical care for spinal injury patients and patients receiving rehabilitation was outstanding.
  • Some patients had unnecessary waits at their outpatients appointments.
  • The children and young people’s service was not responsive to their needs.

We saw several areas of outstanding practice including:

  • Outstanding clinical outcomes for patients.
  • Innovative surgery was being carried out to improve patients’ quality of life. For example, limb lengthening for patients with skeletal malformation.
  • The executive board demonstrated leadership and vision for the hospital.
  • Staffing levels and the skill mix of staff met patients’ needs.
  • Effective multidisciplinary working putting the patient first.
  • The services provided by the Spinal Cord Injury Centre (SCIC) and on the Jubilee Rehabilitation Unit (JRU) were consistently person centred and responsive to their needs.
  • A hotel-based rehabilitation programme supporting patients to recover from surgery and have a normal daily life.
  • A ward dedicated to providing wound care to patients with appropriately skilled staff.
  • Some wards had started to use a drink container that attached to equipment and could be kept with patients at all times to ensure patients were kept hydrated, especially during rehabilitation sessions.
  • The training for surgical trainees was excellent
  • The education for children and young people’s was well integrated into the service, and inclusive and innovative teaching methods meant that children and young people could continue to access learning throughout their hospital stays.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The design and layout of the premises is suitable for all service users.
  • To continue focus significantly on culture, values and behaviours of all staff.
  • The paediatric resuscitation equipment is checked regularly to assure it is ready for use if required.
  • The World Health Organisation (WHO) surgical safety checklist is used and completed at each stage of surgery and radiology.
  • Staff that treat children and young people are up-to-date with the appropriate level of safeguarding training.
  • The needs of children and young people are considered in scheduling operations.
  • The learning from incidents is widely shared.

In addition the trust should:

  • Develop the services across seven days.
  • Review its use of opioids prescribed for pain relief for older people as it is recognised as can be a contributory factor in falls and increased confusion.
  • Consider the mechanisms in place for identifying if equipment including mechanical ventilators, cardiac monitors and mattresses used to prevent pressure ulcers are clear to all when testing is needed.
  • Ensure all staff are aware of support mechanisms such as the employee assistance programme. The RCN recommends there should be formal support mechanism available due to the challenging and highly specialised nature of the service provided, particularly with children and young people.

Professor Sir Mike Richards

Chief Inspector of Hospitals

31 January 2013

During a routine inspection

The inspection team included a pharmacist inspector. We inspected two children's wards, the pharmacy, a post operation ward and three inpatient wards. We spoke with 19 people who use the service, four visitors and 56 members of staff.

Most patients were satisfied with their care and treatment. They told us that these had been explained and that they were involved in their treatment. They said that their privacy and dignity was maintained. This was confirmed by the staff we spoke with and the records we viewed.

Most patients told us that they had access to their own medication and staff supported them with this when required. The hospital ensured medication was administered appropriately, however we found it was not always stored correctly.

Patients told us they were generally happy with the environment of the hospital but some commented that the premises were "restrictive" and "in need of repair". The environment was not suitably designed to meet the needs of patients.

Patients were happy with the staff who cared for and treated them. We found that staff appropriate recruitment checks were carried out on staff before they worked with patients.

There were opportunities for patients to give feedback regarding their care and treatment. The Trust undertook regular checks and audits to ensure it was providing safe care and treatment.

20 July 2011

During a routine inspection

Patients told us that they were treated with respect and their dignity was maintained.

They said that they were involved in decisions about their care and that staff answered their questions and supported their decisions.

One patient said 'the consultant explained the options available to me and gave me time to make my decision'.

Patients told us they felt safe in the hospital and were able to raise any concerns with staff. Patients were very complimentary about all staff working in the trust. Their comments included:

'They are marvellous, I cannot say enough about them'; 'They (the staff) never sit down' and 'they are all very good'.

20 October and 4 November 2010

During an inspection looking at part of the service

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.