The Royal Orthopaedic 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support, and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice were part of their everyday work.

Staff reviewed records and ensured pre-assessment records showed that the service took account of children and young people's communication, health, and personal needs. Children and young people were involved in their care and treatment. The service provided clear information to support healthy living. The service made sure young people understood their care and treatment to enable them to consent to treatment.

At the last assessment we rated the service outstanding. During this assessment we rated effective as good. This meant children and young people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

We saw staff engaged well with children, young people, and their families and that they were engaged and involved in their care and treatment.

Data showed observations for monitoring young peoples’ vital signs and assessing the risk of deteriorating patients were safely undertaken in a timely way. They used different monitoring depending on the child’s age. For all 16- and 17- year olds they used National Early Warning Scores, version 2 (NEWS).

The service had systems in place to identify autistic patients and patients with a learning disability. Staff were aware of what to look for in people who had not been diagnosed and recorded these in a similar way.

The service took a proactive approach to assessing needs. One nurse told us, “It does not matter if a child has been diagnosed or not, especially if they showed autistic traits. “We treat everyone as an individual but also record to ensure we can get the support of the learning disability team if we need to. We also inform the child’s GP to get the ball rolling for assessment if necessary.” This included autistic people without a learning disability.

Patients’ protected characteristics were identified and recorded when they first started using the service and then re-confirmed at each appointment. Parents and carers protected characteristics were also identified and recorded.

The service had access to a translation service, to support patients whose first language was not English. The service was also able to print out leaflets in different languages if required.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Doctors discussed care, treatment and the next steps in the children, young person’s treatment, they ensured they gave time for people to understand what had been discussed and to ask questions.

The hospital used the ‘Ready, Steady, Go’ transition framework for children moving to adult services. When looking at 4 young people’s records, this had been documented in each of the patient files. The forms were completed for the appropriate stage for the young person care and the parent/ carer forms had also been completed. This programme documents the young person’s readiness at each stage of their transition and offers support and guidance where the young person indicates they need this. There was a leaflet available on transition and the Ready Steady Go programme, but there was not an easy read version.

Staff had access to up-to-date policies and procedures which enabled them to follow national guidelines and evidence-based practice.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

All staff we spoke with including managers told us they felt the team worked well together and supported each other. One staff member stated, “I feel very supported, and there is an open culture with supportive senior managers.”

We were told there was a professional nurse advocate team to support staff by creating thinking space around the day-to-day demands of working in clinical settings at the trust. Professional nurse advocate’s supported staff in delivering good quality care when faced with complex or challenging situations, offering opportunities to have reflective conversations, as a group or on a one-to-one basis. The outpatient team also had access to team clinical supervision for safeguarding and could be delivered individually if required.

The safeguarding and vulnerabilities team worked closely together as children and young people, as they pass through their journey, being supported by the different roles within the team. The team consisted of head of safeguarding and vulnerabilities, Names Nurse for safeguarding children and adults, safeguarding nurses, learning disability and autism clinical nurse specialist (CNS), learning disability and autism CNS, learning disability liaison nurse, transitions CNS, transitions nurse, the mental health and dementia practitioner and a domestic abuse and sexual violence advocate. The named nurse for safeguarding told us that “the team works very closely together”, and that being located in the same office helps with sharing of information as they all had access to each team’s recording and reporting of information and could pick up information quickly and easily.

The service worked well with other services throughout the trust, as well as outside agencies, these included mental health services, local children’s trust, and the local authority.

The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service used a quick response (QR) code which children and young people could scan for information about certain medications. The pharmacy team had recorded videos to help children and young people understand their medication.

The service displayed posters and information in relation to promoting healthy lives this included, eating healthily, managing their own medication and helpful resources for young people’s mental health. We also observed staff encouraging children, young people, and their families to manage their own health and wellbeing, this included how they could follow advice to ensure they would be ready for surgery when the time came.

The safeguarding team worked closely with children in care and or care leavers, providing them with a booklet with information on support available, tailored care plans and ensuring appointments were prioritised to reduce inequalities children in care faced. The safeguarding team provided updates to a named social worker and advocated for the child or young person within child in care meetings or MDT discussions.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We observed outcomes for children and young people within the outpatient department, which this had been clearly documented in children and young people’s records, However, we were unable to observe outcomes for young people on ward 3 as during our assessment there were no admissions for 16 and17-year-olds.

The service completed audits which monitored elective planned, booked or from the waiting list. Between the period from December 2024 to February 2025 there were 57 admissions from the waiting list. None were recorded as emergency admissions.

The service monitored discharges to ensure the right care and support had been given to the young person to minimise the risk of re-admissions, which for 2025 there had been one re-admission, the data did not show the month this had occurred.

The service monitored length of stay for the young people. Length of stay averaged at 4 nights, data had been compared to other orthopaedic trusts, where young people had slightly longer stay. However, length of stay for emergency surgery were lower than other similar trusts.

The service was part of the Getting It Right First Time (GIRFT) programme; a national NHS England programme which was designed to improve the treatment and care of patients.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The children, young people and their families told us they were asked about consent to treat. We saw that consent had been clearly documented in records. Which showed consent had been discussed and given where relevant.

Staff at the hospital understood the requirements of, and their obligations under, the Mental Capacity Act 2005.

Young people aged 16 and 17 had their capacity to understand and make decisions about their care assessed. Where young people did not have the capacity to understand and make decisions, hospital staff arranged for multidisciplinary meetings to determine decisions in the young person’s best interests. These took place as soon as possible once the patient had been referred, usually before they were admitted.

Staff were also aware of Gillick competence and followed the principles of this for children under 16. Parents and others with parental responsibility were asked to consent to care and treatment on behalf of children if they were not assessed as competent to understand and make decisions.