Great Ormond Street Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service was responsive to individual patient needs, ensuring that care was personalised, well-coordinated, and accessible. Staff demonstrated a commitment to person-centred care, engaging with children and families to ensure they were fully involved in treatment planning and decision-making. Reasonable adjustments were made to accommodate patients with additional needs, including play specialists, sensory tools, and communication aids to reduce anxiety and improve patient experience.

Staff worked collaboratively across teams and services, ensuring smooth transitions between various stages of care. Electronic records supported information-sharing, enabling joined-up care between hospital departments and external healthcare providers. Patients awaiting treatment were monitored remotely, ensuring that they remained clinically stable while awaiting surgery.

The service aimed to promote equity in access and outcomes, ensuring that patients with complex needs or from diverse backgrounds received appropriate care. However, structured monitoring of inequalities in patient experience was limited, and there was room for improvement in assessing disparities in care delivery and outcomes.

Efforts were made to improve access to care, with weekend surgical lists helping to maximise theatre capacity. However, some patients faced delays for non-urgent procedures due to prioritisation of higher-acuity cases. Patients and families expressed frustration over cancellations and waiting times, though staff worked to provide ongoing support and clear communication about treatment plans.

Information and feedback mechanisms were in place, ensuring that patients and families could access up-to-date details about their care. However, access to multilingual materials and interpreter services was limited, potentially creating barriers for families with limited English proficiency.

Key issues:

• Delays in non-urgent procedures, leading to patient frustration over waiting times and cancellations.
• Limited access to multilingual information and interpreter services, creating potential communication barriers.
• Gaps in monitoring inequalities in patient experiences and outcomes, limiting opportunities for targeted improvements.

We have not awarded this service a score for Responsive.

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

Staff showed commitment to person-centred care, ensuring that patients and their families were actively involved in planning and decision-making about their treatment. We observed that staff engaged with patients and carers throughout their surgical journey, explaining procedures, addressing concerns, and adapting their approach to meet the individual needs of each child.

Staff made reasonable adjustments to care delivery where necessary, ensuring that children with communication difficulties, sensory sensitivities, or elevated levels of anxiety received additional support. Play specialists were available to help reduce anxiety before surgery and during the hospital stay, and staff used visual aids, sensory objects, and distraction techniques to help children understand and feel more at ease with their treatment.

The hospital’s use of digital systems allowed patients and families to access information about their care, treatment plans, and upcoming appointments, ensuring they were well-informed and able to take an active role in decision-making. Staff were trained in effective communication techniques, using clear, compassionate language to support understanding and reduce distress.

We observed that staff prioritised patients in discussions about their care, ensuring that children and young people were involved in decision-making to the extent that their age and understanding allowed. While parents and carers were actively involved, the service also encouraged young patients to express their preferences and concerns, reinforcing a sense of personal agency and choice in their treatment.

Staff worked collaboratively across disciplines to ensure that care plans addressed physical, emotional, and social needs, particularly for patients requiring complex or long-term treatment. Staff demonstrated a structured approach to monitoring and prioritising patients based on clinical urgency, ensuring that children who required urgent care were treated in a timely manner.

Observations and staff feedback indicated that patients' needs were carefully considered and incorporated into care planning. The hospital’s responsive and adaptable approach to care delivery helped to ensure that patients received treatment in a way that was appropriate for their specific needs, preferences, and circumstances.

Staff were committed to integrated and patient-centred care and ensured children and young people received the support they needed throughout their treatment journey. Despite challenges related to capacity and demand, the service worked proactively to minimise disruption, provide ongoing clinical oversight, and maintain safe and effective care for all patients.

Care and treatment were structured, co-ordinated, and responsive to patient needs. Treatment pathways were designed to prioritise those requiring urgent care while maintaining continuity for all patients.

Service operated a structured triage system to assess and prioritise patient needs, as demand exceeded capacity. Leaders explained that not all patients who applied for treatment via patient choice could be accommodated, and as a result, those with less urgent conditions faced longer waits for surgery. Staff reported that, at times, planned procedures had to be cancelled when more urgent cases took priority, demonstrating the need for flexible service delivery in response to clinical risk and patient acuity.

To maintain continuity of care for patients waiting for treatment, staff monitored patients remotely through telephone triage, ensuring that those waiting at home remained in a safe and stable condition. Clinical nurse specialists (advanced practice registered nurses with advanced clinical expertise) played a key role in supporting patients and families, providing clinical oversight, advice, and reassurance. For patients that were awaiting surgery, this approach allowed them to remain in familiar home environments while still receiving necessary medical support.

The service worked collaboratively with other healthcare providers, ensuring that patients transitioning between various stages of their care journey received joined up and well-coordinated treatment. We observed effective communication between teams, ensuring that referrals, admissions, and discharges were handled efficiently. Electronic systems supported seamless information-sharing between departments, reducing the risk of delays or miscommunication that could disrupt care continuity.

The hospital also recognised the diverse needs of its patient population, ensuring that services were tailored to meet individual requirements, including those with protected characteristics under the Equality Act. Staff made reasonable adjustments for children with additional needs, ensuring that care was delivered in a way that respected personal, cultural, and medical considerations.

While the hospital had effective processes in place to ensure continuity of care, some patients and families expressed frustration regarding cancellations and long waiting times for non-urgent procedures. Staff acknowledged these challenges and described ongoing efforts to improve efficiency and reduce delays, including optimising theatre capacity and expanding monitoring services for patients awaiting surgery.

Between July and December 2024, Great Ormond Street Hospital recorded a total of 5,484 surgical cases, of which 446 (8.13%) were cancelled. The cancellation rate for scheduled (planned) surgeries was slightly higher at 8.72%, while emergency surgery cancellations were notably lower at 2.76%. The most common reasons for cancellations were related to patient health and hospital operational issues. These included patients being medically unfit on the day (44 cases), no available ward beds (45 cases), and pre-operative assessments identifying unfit patients (44 cases). Administrative errors and operating theatre list overruns also featured prominently. A number of cancellations were due to families not arriving or initiating cancellation themselves. Additionally, a small but notable number were linked to surgeon unavailability or changes in treatment plans. The data highlighted peaks in cancellations in November and October, with over 10% of procedures affected during those months.

At the time of the assessment staff told us theatre utilisation was at approximately 65%, with managers citing patient availability and illness-related cancellations as key factors affecting capacity. Senior theatre staff used an electronic scheduling application that enabled theatre space to be utilised for weekend procedures where possible, ensuring that resources were maximised while balancing patient safety and demand. The hospital also noted that theatre utilisation was higher during warmer months, when the risk of respiratory illnesses and patient cancellations was lower.

Theatre utilisation across the Trust for the period July to December 2024 averaged between 67.00% and 73.74%, with a Trust-wide average of approximately 69% over the six-month period. Variation across individual theatres reflected differences in case complexity and capacity management.

The Trust explained that many procedures involved highly complex cases, often occupying a full theatre session with only one case. In addition, some patients required extended pre-operative optimisation, and short-notice cancellations due to illness meant that sessions could not always be reallocated, leading to underutilisation. Efforts to improve utilisation included the use of electronic scheduling systems, which allowed weekend theatre slots to be offered and helped maximise use of available capacity. However, seasonal trends, such as lower respiratory illness in warmer months, contributed to more consistent utilisation during those periods.

The out-of-hours service provision was sufficient to meet the needs of patients requiring urgent investigations, with systems in place to ensure appropriate access, support, and continuity of care across specialties. The hospital provided a broad range of diagnostic services outside of normal working hours to support safe and effective care. Haematology and blood transfusion operated 24/7, ensuring urgent testing and support were always available. Other services, such as microbiology, chemical pathology, and radiology (including X-ray, ultrasound, CT, and MRI), also offered urgent out-of-hours access. Although not all diagnostic areas ran full out-of-hours services—such as immunology and cell therapy—reasonable arrangements were in place where needed, including on-call support and planned handovers. The mortuary service was also responsive to needs outside of hours, with clear processes for coordination through clinical and support teams.

Staff provided patients, parents, guardians, and carers with precise and current information, helping them understand their care, treatment options, and any changes to their treatment plans. Information was made available through multiple formats, including face-to-face discussions, postal correspondence, email, telephone updates, and the electronic application. We observed clinicians dedicating time to answering patients' and families' questions, ensuring that information was clearly explained and understood.

Patients and families had access to a range of online resources, covering patient rights, care procedures, and post-treatment care. Staff were observed prioritising effective communication with patients, adapting their approach to ensure that information was conveyed in a way that reduced anxiety and enhanced understanding. However, there were limitations in the availability of information in different formats and languages. While translation services were available upon request, there was a limited number of printed materials in languages other than English. This may have created barriers to effective communication for families with limited English proficiency, highlighting a need for an expanded range of multilingual resources to improve accessibility.

Additionally, staff had limited knowledge related to the availability of interpreters, including British Sign Language (BSL) support or services for patients with additional communication needs. While staff worked to speak with patients in ways they could understand, the extent to which formal interpreting and accessible communication services were embedded into routine care was unclear.

The trust ensured that patient data was shared securely and met legal data protection requirements, allowing families to access their child’s health records and receive updates, as necessary.

The service had mechanisms for patients, families, and carers to provide feedback, ensuring that their voices were heard, and their concerns were addressed in an open and transparent manner. The hospital offered many ways for people to share their experiences, including formal complaint procedures, patient experience surveys, and direct feedback to staff.

As part of the NHS-wide patient feedback system, the Friends and Family Test (FFT) was available for patients and families to complete, providing a simple and accessible way to share their views on the quality of care they received. This test allowed parents, carers, and where appropriate, children and young people themselves, to express whether they would recommend the service to others based on their experience. Feedback from the FFT and other patient experience initiatives was expected to be used to identify trends, highlight areas for improvement, and recognise good practice among staff.

Families were encouraged to raise concerns, and the service aimed to handle complaints with compassion and sensitivity. The hospital's Patient Advice and Liaison Service (PALS) was available to support families in navigating the complaints process, offering guidance and mediation where needed. Staff responded to issues promptly and involved patients and families in discussions about potential improvements.

Between June and December 2024, the hospital recorded 23 surgery-related contacts via the patient liaison team’s system. These reflected feedback and queries from families across a range of surgical specialties. The highest number of contacts related to general surgery (SNAPS), followed by spinal surgery, anaesthetics theatres, cardiac surgery, and urology. The data gathered by the team helped the service understand which areas of surgical care prompted engagement from families and supported the identification of patterns or areas needing attention. The common themes were focused on communication and information gaps during the surgical journey. Several families contacted PALS due to missed or unclear details about admission dates, fasting times, or surgical scheduling, leading to confusion. In some cases, miscommunication between hospital teams or with external services contributed to cancellations, causing distress for families. Another recurring issue involved delays in responses, with families having to chase updates or wait for extended periods to receive essential information about pre-operative processes or appointment requirements.

Staff commitment to transparency in responding to complaints was reflected in their approach to keeping families informed about the progress of their concerns. Patients and carers were provided with timely responses and clear explanations of any actions taken because of their feedback.

The service ensured that patients could access the care, support, and treatment they needed in a timely manner, with services available 24 hours a day, year-round. The hospital demonstrated a commitment to equitable access, making reasonable adjustments to accommodate the needs of all patients, including those with disabilities and additional support requirements.

We observed that specialist paediatric-sized equipment was available where necessary, ensuring that medical devices and facilities were appropriate for children and young people. Staff worked closely with other healthcare professionals and specialist teams to provide multidisciplinary care for complex surgical needs, ensuring that children requiring input from multiple specialists received coordinated treatment.

The hospital environment was child-friendly, with visually appealing displays, age-appropriate designs, and waiting areas that were suitable for children and young people. However, some outpatient areas were less modern and in need of refurbishment, which may have impacted the overall patient experience.

While the hospital sought to remove barriers to access, we noted that some challenges remained. There was limited availability of patient information in multiple languages, which may have affected families with limited English proficiency in navigating their child’s care. Additionally, while translation services were available upon request, there was a lack of evidence regarding how frequently they were used or whether they were routinely offered to those who needed them.

Staff were alert to potential inequalities in access to care, ensuring that vulnerable patients and those with complex needs were prioritised appropriately. The service worked to tackle disparities by allocating resources based on clinical urgency, though some patients faced long waits for non-urgent procedures due to prioritisation of more critical cases. The Cardiac and Lung service, for example, employed telephone triage and remote monitoring to ensure that patients waiting for surgery remained in a safe and stable condition.

The service complied with legal equality and human rights requirements, aiming to remove barriers to care and create an inclusive environment for all children and their families. The service was committed to providing equitable care, ensuring that patients from diverse backgrounds and with varying needs received appropriate support.

While there was limited evidence of a structured approach to monitoring inequalities in patient experiences and outcomes, staff were expected to be alert to discrimination and potential disparities in care. The hospital aimed to identify and address barriers that could impact the experience of patients with protected characteristics, such as those with disabilities, neurodiverse patients, or those from non-English speaking backgrounds.

Staff sought to empower patients and their families by providing clear information about their rights and encouraging them to share their views on care and treatment. However, the extent to which patient feedback from diverse groups was actively used to drive improvements was unclear.

Staff supported patients and their families in making informed decisions about their future care, ensuring that children with complex or life-limiting conditions received the necessary support and planning for their ongoing needs. The hospital’s multidisciplinary teams worked to coordinate care and communicate with families about long-term treatment options, helping them navigate important transitions in care and prepare for future healthcare decisions.

For patients with progressive or life-limiting conditions, the hospital sought to identify those who may require end-of-life planning at an early stage. While there was no specific evidence available during this assessment regarding structured advance care planning, it was expected that patients approaching the end of life would have personalised care plans in place, ensuring that their wishes and best interests were considered. These plans would typically be shared with relevant services and staff to ensure continuity of care and respect for the patient’s preferences.

Where treatment options were changed, limited, or withdrawn, healthcare professionals communicated openly and sensitively with families, ensuring that decisions were made collaboratively and in line with what mattered most to the patient and their carers. Families were encouraged to express their wishes about care interventions, including preferences around cardiopulmonary resuscitation (CPR), with opportunities to review and revise their decisions as needed.

For children and young people transitioning to greater independence or moving into adult services, staff worked to support them in achieving their long-term care goals, ensuring that care pathways were structured around their needs and aspirations. Staff recognised the importance of supporting patients and families through these significant changes, ensuring that they were provided with guidance, reassurance, and access to relevant services during these transitions.