Great Ormond Street Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service demonstrated a strong commitment to evidence-based care, patient-centred assessments, and collaborative working across specialities. Patients and their families were actively involved in preoperative assessments, with clear communication about risks and treatment options. Staff used structured assessment processes to ensure that care met individual health, wellbeing, and communication needs. Additional support was provided for carers, including accommodation and digital access to patient records through the MYGOSH application, improving engagement and continuity of care.

Care was delivered in alignment with national guidelines and best practice, with ongoing audits—including the WHO Surgical Safety Checklist—to monitor safety and compliance.

Multidisciplinary collaboration was evident across services, with effective handovers, ward rounds, and an electronic patient records system linking with external providers.

The service supported patients to live healthier lives, with preventative care, early intervention, and structured discharge planning.

The service followed structured consent processes, ensuring that patients and families fully understood their treatment options.

Monitoring of patient outcomes was well established in some specialities, particularly in Cardiac and Lung services. However, gaps in individual outcome monitoring were identified within orthopaedics, where consultants did not routinely compare surgical results or engage in peer review. There were limited initiatives to benchmark outcomes against other hospitals, raising concerns about clinical governance and data-driven service improvement.

Some staff noted that the trust did not always analyse or provide data effectively for service improvement, limiting opportunities for strategic planning. Which limited benchmarking of clinical outcomes, reducing opportunities for peer review and continuous service improvement. There were some gaps in trust-wide data analysis, impacting strategic planning and service evaluation.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

Staff used a structured assessment processes to ensure that patients received care tailored to their individual health, wellbeing, and communication needs. Patients and their families were actively involved in preoperative assessments, with risks and treatment options clearly explained in ways that were appropriate for their level of understanding.

All patients on the theatre pathway underwent a preoperative assessment to review risk and suitability for surgery. Staff provided clear, detailed explanations of potential surgical risks, ensuring that families were informed and engaged in decision-making as far as practicable. During observations, an assessment was conducted where the procedure and risks were fully explained to both the patient and their carer. The conversation was directed towards the child wherever possible, with the staff member demonstrating empathy, using communication tools to reduce anxiety, and ensuring the patient remained at the centre of the discussion.

The trust took steps to support carers of patients, recognising the importance of their physical and emotional wellbeing. Beds were made available in patient bedrooms, and a nearby hotel provided accommodation for parents and carers staying for extended periods. Additionally, carers of long-stay patients were offered access to gym facilities, supporting their mental and physical health while continuing in their caregiving role.

To enhance communication and access to information, the trust had developed ‘MYGOSH,’ an electronic application available on personal devices. This system allowed patients and carers to access medical records, receive updates, and contact the service directly, improving engagement and continuity of care.

The flexibility of staff deployment was also a key factor in meeting patients' needs. Leaders in Cardiac and Lung services described how they moved staff between units, allowing them to match skill levels and specialist expertise with patient needs. This adaptive workforce model ensured that patients requiring intensive care received appropriate support from staff with the relevant experience and qualifications.

Staff planned and delivered care in collaboration with patients and their families, ensuring that treatment was personalised and aligned with best practice standards. Care and treatment were provided in accordance with national guidelines and evidence-based practice, with staff demonstrating a strong understanding of clinical protocols and legislative requirements. Patients and families reported receiving care that adhered to recognised best practice standards, with staff involving them in treatment decisions and discussions about current clinical guidance relevant to their care.

The service had structured systems in place to ensure staff remained up to date with national legislation, best practice, and clinical standards. Staff followed current policies and protocols, ensuring that care delivery remained high quality and in line with national guidance. Leaders encouraged continuous learning and the adoption of new, innovative approaches to enhance patient care.

During 2023/24, Great Ormond Street Hospital (GOSH) participated in numerous national clinical audits, several of which were directly relevant to surgical services. These included audits such as the National Audit of Cardiac Rhythm Management, the National Congenital Heart Disease Audit, the National Audit of Pulmonary Hypertension, and the CRANE audit for cleft services. GOSH also actively engaged in the ongoing National Confidential Enquiry into Patient Outcome and Death (NCEPOD) for emergency procedures, having submitted all required anaesthetic reviews and partially completed surgical case submissions. Clinical outcomes were routinely monitored prospectively, with data made publicly available on the trust’s website to demonstrate performance and support transparency. Outcome data was collected and reported across multiple surgical specialties, including cardiothoracic, cleft, neurosurgery, ENT, ophthalmology, and plastic surgery.

To maintain surgical safety and adherence to best practice, the service conducted regular audits, including the World Health Organisation (WHO) Surgical Safety Checklist and local audits of surgical site infection prevention protocols. These audits were designed to identify potential risks, verify compliance with safety measures, and assess alignment with national standards. At the time of assessment, no significant issues were identified through these reviews, demonstrating consistent adherence to safety protocols

However, challenges remained in specific surgical specialities, particularly within orthopaedics. The Royal College of Surgeons (RCS) report, published in response to concerns raised about the Lower Limb Lengthening and Reconstruction (LLLRI) service, identified deficiencies in governance, surgical decision-making, and patient safety. The review found that some procedures, including limb-lengthening surgeries, had been performed without clear clinical benefit, raising concerns about adherence to evidence-based best practice. Issues identified included poor consent processes, a hierarchical culture that discouraged challenge, and inconsistent multidisciplinary team (MDT) discussions to support complex surgical decisions.

The trust had developed an action plan in response to the RCS findings, with a focus on strengthening clinical governance, ensuring MDT oversight for complex cases, and improving consent processes.

At the time of assessment, the trust had begun implementing these recommendations, but it was too early to assess the full impact of these changes. Staff acknowledged that historical governance issues within orthopaedics had contributed to concerns over surgical safety and decision-making, and there was an ongoing process to rebuild trust and confidence within the department.

Staff demonstrated effective collaboration between teams and services, ensuring continuity of care and patient safety. Staff had access to an electronic system that recorded patient pathways and care plans, which they reported as effective in maintaining clear communication and coordination between different teams. This system was linked to other healthcare providers and some GP records, enabling information sharing between primary, secondary, and tertiary care services.

Team-based approach was particularly evident during ward rounds, where staff worked together to review treatment plans, assess progress, and identify any ongoing support needs.

Handover processes between teams were observed to be thorough and well-structured, ensuring that key clinical information was communicated effectively as patients transitioned from surgery to post-operative care. Theatre staff were seen to assess patients prior to surgery, engaging with them to evaluate suitability and risk and ensuring that they were fully prepared for their procedure.

However, some staff raised concerns that the trust did not effectively analyse or provide data on request to review and improve performance. While real-time patient care coordination was supported by the electronic system, there were perceived gaps in how the trust utilised data for service improvement and strategic planning.

The surgical service supported patients and families in managing their health and wellbeing, maximising independence, choice, and control. Where possible, the service aimed to reduce future healthcare needs by promoting preventative care, early intervention, and patient education.

Staff had access to the hospital’s electronic health record system, which allowed real-time sharing of patient information. This system facilitated care planning and ensured that all relevant teams had access to up-to-date medical records. Staff reported that there were enough laptops and computers available on the wards, ensuring efficient access to digital patient records when required.

The service managed patient transitions effectively, ensuring that children received well-coordinated care between different specialties and services. We observed specialty teams, including nursing and allied health professionals, working together to assess patients' readiness for discharge. This multidisciplinary approach ensured that patients were discharged safely with appropriate follow-up care, where needed.

Within Cardiac and Lung services, patients were prioritised based on clinical urgency, which sometimes resulted in procedures being postponed for those in more stable conditions. However, Cardiac Nurse Specialists played a vital role in monitoring these patients at home, ensuring that they remained clinically stable while awaiting surgery. This approach enabled children to remain in a safe home environment while still receiving ongoing clinical oversight, helping to reduce unnecessary hospital admissions and support families in managing their child's condition.

Staff monitored patient outcomes, ensuring that care was aligned with national standards, evidence-based guidelines, and legislative requirements. Staff actively reviewed and adapted their approach to patient care, with a focus on achieving positive clinical outcomes and continuous improvement. However, some specialities lacked structured peer discussions and benchmarking which created a gap in clinical oversight, requiring further development to ensure continuous improvement and accountability in surgical outcomes.

Within Cardiac and Lung services, staff reported that patient morbidity rates were lower than the national average. As a result, they were required to submit reports detailing how they had achieved these outcomes for the second time, highlighting robust performance in surgical and post-operative care. Staff attributed this success to robust monitoring, early intervention, and multidisciplinary teamwork, which ensured that higher-risk patients were identified and prioritised for treatment in a timely manner.

The hospital worked on improving how quickly staff noticed and responded when a child’s condition started to get worse, especially on the surgical wards. Nurses made sure that important checks, like heart rate and temperature, were carried out on time so that any signs of illness were spotted early. Staff also used standardised tools to help them notice health concerns that might not have shown up in the usual checks. Between April and October 2024, the hospital responded quickly to emergencies, with the number of emergency calls staying steady and regular checks completed on emergency equipment. New initiatives, like special emergency phones and grab-and-go medicine bags, helped staff act faster when urgent care was needed.

Surgical site infection (SSI) surveillance was undertaken across neurosurgery, cardiac, and spinal specialties. The overall infection rate for neurosurgery was 1.01%, with a shunt infection rate of 0.5%, reflecting a continued year-on-year reduction. Cardiac surgery recorded one SSI from 193 cases, while spinal surgery reported three infections from 146 operations, equating to a rate of approximately 1.8%. A new in-house surveillance system was under development to enhance data quality and extend monitoring to additional specialties

Throughout the surgical pathway, patients were closely monitored before, during, and after surgery. We observed staff using appropriate monitoring equipment and ensuring that patients were cared for by clinicians with the relevant expertise and experience. This proactive approach to patient safety and risk assessment helped to identify complications early and facilitate rapid intervention when needed.

To meet patient needs and maintain safety, senior staff routinely reviewed workforce skillsets and reallocated staff accordingly. Staff were moved between teams based on clinical needs and patient risk, ensuring that specialist expertise was directed towards the most complex cases. This flexibility supported safe staffing levels and ensured that highly skilled personnel were deployed where they were needed most.

The trust also had structured mechanisms in place for monitoring patient outcomes beyond individual teams. Staff reported that patients were prioritised based on clinical urgency and acuity, allowing resources to be allocated efficiently. However, while the surgical service had systems for tracking clinical outcomes and identifying areas for improvement, some staff raised concerns about challenges in data availability for service review and planning.

Despite these structured monitoring systems in some specialties, challenges remained in individual outcomes monitoring within certain departments, including orthopaedics. Due to the specialist nature of the hospital, some benchmarking data was not governed by national standards, limiting opportunities for direct comparison with other centres. Within orthopaedics, a small group of consultants operated without a structured system for reviewing or comparing their outcomes, and there was a lack of specialty meetings to evaluate surgical results or share best practices. This meant that surgeons were not routinely learning from each other’s cases, restricting opportunities for peer review, quality improvement, and standardised outcome measurement.

Additionally, there were few initiatives to compare outcomes with similar hospitals or external organisations, which further limited the ability to assess performance, identify trends, or implement best practices from other centres. This lack of formalised outcome monitoring and internal collaboration raised concerns about clinical governance, data-driven decision-making, and the hospital’s ability to ensure continuous improvement across specialist procedures.

Referral to treatment (RTT) performance fluctuated over the 12-month period between December 2023 and December 2024. Compliance remained below the 92% standard for most surgical specialties across the 12-month period. Neurosurgery and orthopaedics showed persistent underperformance, averaging below 60% in several months. Dental, maxillofacial, and plastic surgery also demonstrated consistently poor RTT performance, remaining below 70% for most of the year. Ear nose and throat performed relatively better, fluctuating between 63% and 75%, but still failed to meet expectations. Overall, the trust's total RTT performance ranged from 66.1% to 70.5%, below the national standard.

Staff used structured processes for obtaining and respecting consent, ensuring that patients and their families were fully informed about their rights and treatment options. Staff consistently followed national guidance on consent, supporting patients and their parents or guardians in making informed decisions about the care and treatment required.

Patients and families were provided with verbal and written explanations of procedures, including potential risks and benefits. Staff were observed taking the time to thoroughly explain treatments, ensuring that patients and their parents understood the nature of the procedure before providing consent. This approach demonstrated respect for patient autonomy and supported person-centred decision-making.

The trust had systems to monitor and discuss patient pathways, risks, and treatment, using both face-to-face and electronic systems. We observed staff assessing patients, discussing procedures, and ensuring that treatment options were well understood. Staff were trained in effective communication techniques, and during the assessment, they were seen to handle difficult conversations with sensitivity and empathy. Patients were prioritised in discussions, and staff adapted their communication style to reduce anxiety where necessary.

For younger patients or those experiencing high levels of anxiety, the Nightingale Unit had play specialists available to support children before procedures. This additional support helped children feel more at ease during the consent process, particularly when discussing surgical interventions.

The service also had systems for obtaining consent for patients with communication difficulties. Staff had developed a pain protocol based on visual, vocal, and physical responses to pain, ensuring that patients who were unable to communicate verbally were still supported in expressing their needs. A pain protocol poster was displayed in the recovery area, providing guidance on identifying and managing pain levels for non-verbal patients.

Where appropriate, patient, and parental consent was observed to be sought before treatment, with clear explanations provided to ensure informed decision-making. Staff demonstrated an awareness of legal frameworks, including the Mental Capacity Act 2005, ensuring that decisions were made lawfully and with appropriate consultation of carers, families, or advocates where necessary.

The service conducted a trust-wide audit to ensure that patients and families were fully informed and appropriately consented before surgery. This followed concerns raised in an external review of one surgical team’s practice, where differences were found between what was written on the consent form and the procedure actually performed. The audit reviewed 50 surgical procedures across ten specialities carried out in July and August 2024. In every case, the procedure carried out matched the procedure listed on the consent form, showing that, across the surgical services, patients received the care they had been properly informed about and had agreed to. However, the audit also identified some challenges in the current system of record-keeping. In two cases, consent forms could not be found in the hospital’s electronic records system. A further search revealed nine similar cases reported over the past year. While this did not indicate that patients had not been consented, it highlighted the risks of using paper-based forms which can be misplaced. The hospital had already started work to reduce this risk by moving to digital consent, and this issue had been raised with the relevant teams leading that work.