Great Ormond Street Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service was well-led, with leaders demonstrating a clear vision and commitment to high-quality, patient-centred care. Staff were engaged, motivated, and aligned with the organisation’s strategic goals, ensuring a positive and supportive working culture. Leaders fostered openness, transparency, and continuous learning, encouraging staff at all levels to contribute to service improvements.

Leaders were visible and approachable, with staff expressing confidence in their leadership. A Freedom to Speak Up (FTSU) Guardian was in place, and staff felt empowered to raise concerns without fear of reprisal. However, some staff reported limited opportunities for career progression, with managerial roles often occupied long-term, reducing upward mobility.

The service engaged with external stakeholders and healthcare partners, ensuring that care was integrated and aligned with national standards. The hospital’s specialist nature required strong collaboration with other providers, supporting continuity of care before, during, and after treatment.

Staff had access to career development funding, and learning from incidents and best practices was embedded into daily operations. However, some departments, particularly in orthopaedics, lacked structured benchmarking of clinical outcomes, reducing opportunities for peer review and service improvement.

We have not awarded this service a score for Well-led.

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

Leaders had established a clear and shared vision for the surgical service, ensuring that staff at all levels understood and supported the strategic goals of the trust. Staff we spoke with were able to articulate the organisation’s vision and values, demonstrating an awareness of their role in delivering safe, high-quality, and compassionate care.

The clinical strategy placed a strong emphasis on advancing surgical care, identifying "Advancing the Frontiers of Surgery" as one of four key strategic themes. Surgery was perceived as a core strength of the trust, supported by a history of pioneering techniques and multidisciplinary expertise. The strategy highlighted the growing importance of earlier intervention, particularly through foetal surgery and innovations like in utero stem cell or gene therapies. The trust aimed to remain a global leader in paediatric surgical care, leveraging its unique capabilities and co-located specialities. These plans were aligned with the Trust’s broader mission to serve children with complex and rare conditions through ‘world-leading’, innovative treatment.

The hospital fostered a culture of openness, compassion, and continuous learning, encouraging staff to raise concerns, share ideas, and contribute to service improvement. We observed genuine engagement between staff, patients, and carers, with clear communication and a commitment to patient-centred care. Staff demonstrated a well-developed understanding of equality, diversity, and human rights, ensuring that these principles were actively upheld in daily practice. Leaders also worked to identify and address workforce inequalities, supporting an inclusive environment for both staff and patients.

Patient safety and clinical effectiveness remained central to decision-making. Staff recognised the risks involved in implementing the hospital’s strategy, and action plans were in place to mitigate these risks. Staff explained that high risks were prioritised, and resources were allocated accordingly to ensure that those were minimised. Leaders maintained a focus on governance, monitoring progress against the strategy, and reviewing local and national developments that could impact the service.

We spoke with both frontline and indirect support teams, who described strong collaboration across departments. Staff reported feeling valued and empowered, with access to training and development opportunities to support their ongoing professional growth.

Local leaders were experienced, knowledgeable, and committed to delivering the organisation’s vision, ensuring that patient safety, quality of care, and staff well-being remained a priority. Staff told us they knew who their leaders were and that they were visible and approachable, which contributed to a culture of open communication and trust.

Leaders at all levels were expected to model inclusive behaviours and uphold professional integrity, fostering a positive and collaborative working environment. Staff reported that they felt supported in their roles and that leadership was responsive to concerns and dedicated to continuous improvement.

The Trust had safe and effective recruitment processes in place, aiming to ensure strong leadership continuity through succession planning and professional development. Leaders were expected to be proactive in identifying and addressing cultural issues that could affect staff morale and patient care.

The service fostered a culture of openness, ensuring that staff felt empowered to speak up without fear of reprisal. There was a structured system to support staff in raising concerns, including the appointment of a Freedom to Speak Up (FTSU) Guardian, who acted as a confidential and independent point of contact for employees wishing to report issues.

We found that all staff spoken with were aware of the FTSU Guardian and knew how to access support if needed. The service also promoted active staff engagement in the Freedom to Speak Up initiative, with staff observed moving between wards to promote awareness of the programme and recruit new Freedom to Speak Up Ambassadors. These champions were expected to assist the FTSU Guardian in advocating for staff concerns and fostering a culture of transparency across different teams.

Most staff reported feeling comfortable raising issues with their managers and expressed confidence that their concerns would be taken seriously. The hospital’s approach aimed to ensure that when concerns were raised, they were investigated sensitively and confidentially, with lessons learned shared appropriately.

There was evidence of a respectful and inclusive culture, underpinned by visible and approachable leadership. Staff described a positive working environment where they felt valued and able to raise concerns without fear of reprisal. Equality, diversity, and inclusion were embedded in the trust’s values, and leaders demonstrated a commitment to improving fairness and equity in the workforce. Staff had access to wellbeing support, training, and funded career development opportunities.

The staff in the directorate were aware of the diversity of populations and the challenges faced by its communities. Staff had access to multi-lingual sources such as translation services to support patient care.

There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which was accessible and promotes equality. The Workforce Race Equality Standard is a set of measures which enable NHS organisations to compare the workplace and career experiences of staff from ethnic minority groups with their white colleagues. The results for the trust show that a higher proportion of staff from the ‘global majority’ had experienced harassment, bullying or abuse,

Although the culture across surgical teams was broadly inclusive, further action was needed to ensure equity of opportunity, representation in leadership, and active engagement with underrepresented groups within the surgical workforce.

The surgical specialties experienced risks related to delayed access to care, primarily due to staffing shortages, limited bed and theatre capacity, and growing waiting lists. Prolonged waits for procedures such as spinal, orthopaedic, and urological surgeries posed a risk of deteriorating patient conditions, and psychological distress. While the trust confirmed that long-waiting patients were subject to a clinical harm review process, monitored through governance reports and board oversight, these pressures remained a concern at the time of the assessment. The risk register noted that limited availability of specialist-trained staff and inadequate infrastructure, such as pre-assessment services and anaesthetic facilities, could compromise both perioperative safety and patient flow. Although mitigation strategies, including recruitment efforts and business cases for additional capacity, were initiated, many risks remained unchanged over multiple reviews. The cumulative impact of these pressures was evident in the increased length of stay, some cancellations, and patient complaints, highlighting issues in managing surgical demand.

Staff recognised the importance of collaboration and partnership working to ensure seamless, high-quality care for patients. The service engaged with external stakeholders, specialist healthcare providers, and community organisations to enhance care provision, develop services, and support the needs of children and families both within and beyond the hospital setting.

Staff demonstrated a commitment to sharing information and learning with partners, working collaboratively to improve service delivery and patient outcomes. The hospital’s specialist nature required close cooperation with referring hospitals, tertiary care centres, and international healthcare providers, ensuring that patients received continuity of care before, during, and after treatment at GOSH.

In some specialties, the hospital facilitated outreach clinics and virtual consultations, ensuring that children who could not easily travel to London still had access to specialist expertise. This model supported closer working relationships with local hospitals and primary care services, enabling a joined-up approach to patient care.

The service was committed to continuous learning and professional development, ensuring that staff had opportunities to enhance their skills and contribute to service improvement.

Staff reported that they had 60 hours of protected study time per year, which allowed them to pursue relevant training and development opportunities. Where appropriate, financial support was available to help staff progress in their careers, reflecting a culture of investment in workforce skills and expertise.

Leaders encouraged a proactive approach to learning, ensuring that processes were in place to reflect on both incidents and examples of good practice. There was a culture of open discussion, collective problem-solving, and continuous reflection, which supported ongoing improvements in patient care. Staff described a positive environment where learning from mistakes was valued as an opportunity to improve rather than a reason for blame.

The service engaged in external partnerships, research initiatives, and evidence-based practice, ensuring that new developments in paediatric surgery were integrated into clinical care. Staff had opportunities to collaborate with external organisations, furthering innovation and improvement efforts. However, we found limited evidence of structured outcome monitoring in some specialties, such as orthopaedics, where surgeons did not routinely benchmark or compare their outcomes within the department or with other hospitals.