The Royal Orthopaedic Hospital

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• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

The service made sure children, and young people were at the centre of their care and treatment choices. Staff understood the diverse health and care needs of their patients and their local communities, which ensured flexible and supported choice and continuity.

Children, young people, and family members knew how to feedback and raise complaints about their care, treatment, and support. Children and young people were involved in decisions about their care. The service made sure people could access the care, support, and treatment they needed when they needed it.

At our last assessment we rated this key question good. At this assessment, the rating has stayed as good. This meant children and young people’s needs were met through good organisation and delivery.

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.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The reasonable adjustments digital flag was not fully operational. This was noted on the trust’s risk register. To mitigate this risk, the hospital recorded reasonable adjustments on the green learning disability and autism form at each appointment and on their electronic records systems.

Within the Learning Disability Improvement Standards September 2024 benchmarking report only 77% of staff said they felt confident to identify reasonable adjustments for autistic patients and patients with a learning disability. The service weas working with staff to support them to gain the confidence to identify when reasonable adjustments were needed.

We observed children and young people attending the clinics and saw person centred care had been given.

When a child or young person with a learning disability or autistic was referred to the hospital, work started with them two weeks before their first appointment. One of the learning disability nurses spoke with a parent, and the child if possible and appropriate, to find out about the patient, any of their fears or anxieties and any reasonable adjustments they might need. This information had also collected at the first appointment which had been a ‘nurse-led’ appointment.

Each appointment was recorded on a green ‘learning disability/ autism’ form including any reasonable adjustments, who was supporting the patient during their interactions with the hospital and whether the patient has a hospital passport.

The hospital passports there were clear, comprehensive, included information about the child’s life and family history, likes and dislikes, communication needs, reasonable adjustments and health and medical needs.

Young people in transition were also supported by the transition clinical nurse specialist. The learning disability and transition nursing teams worked out who was best placed to provide support to the young person and their family.

The hospital made changes to people’s care to ensure their needs relating to their conditions were met. For example, one autistic young person became distressed when they had been initially informed that their family member could not stay with them during their admission for surgery. They were moved to a side room on the ward and arrangements made for a family member to stay with them to support them during their admission.

The learning disability team at the hospital worked to ensure children and young people were familiar with the hospital before they were admitted. They arranged for a pre-admission walk around the relevant areas and meeting the consultants, nursing staff and social worker who would be working with them, before an autistic young person was admitted for surgery.

The service evidenced young people were also involved in developing their plan of care, and their capacity to consent to the surgery was assessed before admission. The young person reported to the hospital that they felt in control of their care, their anxieties were alleviated, and their admission went very smoothly.

Examples of reasonable adjustments provided included a hoist being arranged for a child to have an x-ray, a quiet space in outpatients being arranged for a child to have time and space to prepare for an appointment, and changes to appointment times to better facilitate a child’s need for quiet space.

The transitions team liaised directly with children and young people who required additional support or had long term health conditions, they built trusting relationships and advocated for their needs as part of care planning. Reasonable adjustment were put in place for admission which included, side room allocation, pre-meds, car parking passes for parents/carers and parents/carers granted permission to stay overnight. The transition team also offered hygiene packs this included sanitary products.

The service held youth forums which ensured they gained the young people’s voice, and included, young people sitting on staff employment interviews, being able to have volunteers’ experiences, discussion about, apprenticeships, work experiences, and what their experiences were and what they thought needed to be improved and what worked well.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

As a national specialist hospital, the hospital treated some children and young people who were ordinarily inpatient in mental health units around the country. Some of these children and young people were autistic and or had a learning disability. The safeguarding and vulnerabilities team worked closely with the child’s or young person’s mental health team to monitor their readiness for attendance at the hospital and to prepare them. The named nurse for safeguarding told us, “We may have to put off a young person’s surgery as they are not ready. We leave them open to the service, keep them on the waiting list and initiate contact with their team at least weekly to monitor how they are doing. We work with them to ensure they are ready, and everything is in place, so they are comfortable and feel well-supported to ensure a successful time at the hospital.”

The trust had identified on their risk register that they did not have formal support from the local mental health trust, nor a clear pathway for patients who experienced a mental health crisis while at the service to get the help they needed. This was especially noted as a risk for young people aged 16 and 17 who experienced mental health crises while an inpatient, often for the first time as this had been a typical age for onset of mental health symptoms, compounded by the anxiety and distress of being in hospital and having surgery.

The chief nurse and the medical director were in discussions with the local mental health trust to provide better support and clearer pathways for patients experiencing mental health crises. Where cases were identified, they were either seen face-to-face by the mental health and dementia practitioner if deemed at immediate risk of harm or contacted over the phone if they required low level of support and signposting. Risk assessments were carried out in conjunction with the young person’s mental health team. If they were out of region, they would liaise with the mental health team to ensure a package was in place prior to surgery.

The service worked closely with the local authority. Multiagency meetings took place when needed where social service staff attended, where there were decisions if community support had been required, particularly for a looked-after child.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Records showed interpreters were sourced and used where required for appointments. Staff could also access leaflets to ensure children and young people could take away any information that helped them make decisions on their care and treatment.

The learning disabilities clinical nurse specialist had put together a communication toolkit for each ward and service at the hospital. This included flash cards, emotions cards, Makaton signs and symbols, whiteboard and markers, and some social stories to facilitate better communication between staff and patients. Children’s outpatients staff told us they used the box regularly and found it very useful. One nurse said, “I have used the social stories and the whiteboard, and some of the cards. Sometimes patients cannot tell us how they are feeling so this supports them to communicate.”

Use of the communication boxes and hospital passports were audited within each department/ ward, these also showed that there was good use of these items.

The trust had a range of leaflets and information for patients and their parents/ carers, such as ‘A Young Person’s Guide to Scoliosis’ and information on the Ready, Steady, Go transition programme. Not all of these leaflets were available in alternative formats such as easy read; however, some were.

The hospital ran a periodic ‘Scoli School’ session to better support children and young people with scoliosis, and their parents and carers, to understand their condition.

A young person with autism had fed back to the Trust to explain they had difficulty identifying different staff due to different uniforms and not knowing which staff were on each day in the ward. To address this, the Trust produced a photo board with pictures of the different staff on shift for that day, as well a general informational poster about the uniforms worn by different staff members and a description of each of their roles.

There were easy information posters in the outpatient department. For example, one about learning disabilities and autism and how the hospital could support patients with additional needs.

One parent told us, “The information I received about my daughter’s appointment was very clear and easy to understand.”

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff involved people in decisions about their care and told them what had changed as a result.

The service completed NHS Friends and Family Tests (FFT). They had received 920 responses from children and young people, between 1 April 2024 and 31 March 2025; 602 of those responses were from children and young people who reported they were 16 years old or younger. There were 318 responses from young people who were aged between 16 and 24 years and did not leave their age or if they have been completed by parents/carers.

The service identified 91% of all responses received for the service were rated 5 stars and 8% were rated 4 stars. The feedback identified were.

• Treatment with dignity and respect.
• Timely information about your care.
• Treated with kindness and compassion.
• Involved in decisions about you.
• Clean location.

The service monitored complaints to the service. Between 1 April 2024 and 9 May 2025 the service received 76 contacts for children aged 17 years or under there were 9 complaints and 67 Patient Advice and Liaison Service (PALS) cases.

The main themes for complaints from children and young people were appointments, clinical query, and communication.

The service evidenced how they dealt with complaints. Once the complaint had been investigated the service completed a final complaint action plan and final risk rating. These were completed thoroughly.

One parent told us about how their feedback had been listened to, and changes had been made to their child’s care as a result. They said, “My child has built a rapport with one healthcare assistant (HCA) in particular and responds very well to her. I asked that appointments be scheduled when the HCA are in, and they have been ever since.”

The service used a number of ways to gather feedback on patient experience including insight gained through the complaint analysis, feedback from the patient advisory and liaison service, compliments, quality and safety audits, freedom to speak up feedback, department services accreditation and FFT. The service also used the ’15 steps challenge’ toolkit to guide their evaluation of patient experiences. They had a youth forum where they gathered feedback. There was a poster campaign called “Seen Alone” which was used to gather insight into a child’s lived experience to support risk assessment.

The chief nurse told us about how the hospital had tried to develop a ‘children and young person’s experience forum’ for autistic and learning disability children and young people for several years, however, had not yet been able to due to lack of interest from children and young people.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The NHS performance standard was that 92% of patients on the waiting list should wait no longer than 18 weeks from referral to treatment. For the service, referral to treatment scores were 46.6%, which meant the service had 390 children and young people who were over the 18 weeks waiting times. However, other spinal services had no children and young people waiting lists over 52 weeks.

The trust monitored LUNA data quality with their average’s levels referral to treatment at 98% against the target of 90%, with no areas of concerns reported.

The service monitored cancer performance for 2024/2025, the trusts target for patients receiving treatment within 31 days were 96% which the trust met at 100% all year. For cancer patients treated within 62 days of referral the trust scored 70% which had been met with the highest score being 89.4%. For fast diagnosis standard the trust target was 77% which the trust met with the highest score being 83.6%.

Between January 2025 to March 2025 the trust had 1,308 outpatient appointments for children and young people under 18-years-old. During this period, the trust had cancelled 60 (5%) children and young people’s appointments at short notice over the 3-month period, averaging at 20 children and young people per month. The service told us the main reason for cancellation was due to last minute unexpected surgeon absence.

The service had a standard operating procedure which explained the procedure for cancelling/rescheduling of outpatient clinics. The service also had an up-to-date patient access policy.

The service provided care in line with evidence-based practice, quality standards and legal requirements. The trust’s policies met these requirements and those of quality and human rights legislation.

The service had a very good understanding of reasonable adjustments, and these were made for children and young people with disabilities. The service was accessible for anyone to use safely.

The service was open Mondays, Tuesdays, Wednesdays, and Thursdays between 7.15am to 8pm and on Fridays, the service was open from 7:15am to 5pm.

The service records showed they completed emergency surgeries, and that all other surgeries were elective, which meant all surgeries were planned in advance, and all young people aged 16- and 17-years-old were placed on ward 3.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

The service encouraged children, young people, and their families to give feedback on their care and treatment. The service also provided data on the amount of feedback they had received, this included themes, of what they were doing well and areas they could improve.

The service employed leads to support children and young people including transition CNS, mental health and dementia practitioner, learning disability and autism CNS, and learning disability liaison nurse.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The children, young people and their families said they felt staff supported them to make informed choices relating to their care and treatment, this also included plans.

The service worked with a local cancer charity support breaking bad news as part of staff training, this covered the importance of how staff spoke to children and young people, and to ensure that information that may be hard to hear had been understood correctly.

We observed clinics where staff treated children and young people as individuals and looked at their individual needs to ensure their appointment took place and there were post appointment plans in place if required.