The Royal Orthopaedic 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred, and sustainable, and to reduce inequalities.

The service had a shared direction and culture managed by capable, compassionate, and inclusive leaders. Staff felt safe to speak up and understood where to go for support if required. The service valued diversity in their workforce and worked to promote inclusive and fair culture. There was good governance and close working with partners and the community. The service monitored risks and were aware of potential future risks. The service clearly showed learning, improvements, and innovations.

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 Well-led.

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

The service had a shared vision, strategy, and culture. These were based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a strategy dated from 2023 to 2028 with a review taking place in 2025. The strategy identified the trust’s mission, objectives, delivery phases, important enablers, and what the trust would achieve if they delivered their strategy. The service had a quick response (QR) code so staff and patients could gain easy access to the strategy and would be able to design and develop the service in the future.

The trust had a learning disability and autism strategy. They had a summary and easy read document on the website for people to access. The chief nurse told us “It is an integral guide to the work of all at the trust, as so many of their patients have complex disabilities and are patients for life.”

We observed there were positive relationships between nursing staff and medical staff, with the children and young people being the focus of the service.

Staff told us they enjoy working at the trust, and lots of staff had worked there for long periods of time, and working at the service feel more like a family.

Staff told us they felt supported by matrons and all managers, and they felt there were good team working within the service. They had a strong children and young people-focused culture within the service.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness, and honesty.

The service had a clear management structure, and staff were given the opportunity to develop their roles. All matrons, managers and all staff knew their job roles and understood the accountability requirements.

Staff told us senior managers were visible and approachable. Staff told us ward managers and matrons were supportive, and they could speak to them regarding any concerns they had.

Each of the trust’s executive staff took a turn on a rota basis staffing the tea trolley. We observed the chief executive officer and the chair of the board staffing the trolley, chatting with patients and staff, and serving them tea and biscuits. Children and young people and staff told us they appreciated this.

There had been a positive atmosphere in the hospital. We observed the chief nurse and the named nurse for safeguarding greeting staff by name and chatting with them.

One nurse told us, “You do not feel like a number here. It’s a small trust so it’s easy to get to know everyone. It’s a bit like a family; we all care for each other and work closely together to provide the best for the patients.”

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they knew how to contact the freedom to speak up guardians if they had any concern, however, they felt they could approach managers for support and to raise any concerns.

Data showed there were no concerns raised with freedom to speak up in relation to children and young people service and the standard of care in last 12 months. Staff told us “There was a positive culture within the service and staff morale was high.”

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had the Achieve Believe Lead and Empower (ABLE) network for disabled and neurodivergent staff. They used a workplace passport system for staff to record formal and informal reasonable adjustments.

The network produced a ‘Beyond the Stigma’ poster highlighting the stories of different colleagues with disabilities and their experiences at work.

The trust has been nominated for an Award in the Inclusive Workforce category.

There was a racial equality staff network, the Multi Minority Ethnic Group. This group produced an exhibition highlighting some of the different stories and cultural touchstones of trust staff from around the world, called many cultures one, which was displayed at the main entrance to the hospital.

The NHS Staff Survey between 4 October and 25 November 2024 had a response rate of 59%, which 836 staff had completed, this was an increase from 2023. The staff survey showed 71.7% of staff would recommend the trust as a positive place to work.

The trust staff survey was aligned with 13 other local NHS trusts, where all the scores were compared to other trusts scores. The results showed staff engagement scored 7.12 and was lower than the sector scores. The scores for feeling safe and healthy were 6.54 and working flexibly were 6.66. Both these scores were significantly higher than sector scores.

The staff survey showed there had been significant improvement in the 3 following areas, people receiving appraisals, people feeling they could work flexibly, and staff feelings of sexual safety at work. The trust also had 6 areas to focus on which included, staff development, more opportunities to show potential and initiative, more training opportunities and working with staff groups experiencing discrimination because of their ethnic background.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment, and support. Staff act on the best information about risk, performance, and outcomes, and share this securely with others when appropriate.

The managers operated effective governance processes, throughout the service and with partner organisations.

Staff at all levels had a good understanding and were clear about their roles and accountabilities, they had regular opportunities to meet, discuss, and learn from the performance of the service.

Data showed the service was completing Infection prevention and control audits, however, there were date of completion identified, so we were unable to identify how often they had been completed, or on a regular basis.

The service had a good system in place to monitor and share information regarding safety alerts.

The service had a risk register in place with 3 risks identified, this had a clear action, and measures put into place to mitigate the risk.

The managers operated effective governance processes throughout the service and with partner organisations. They had structures and systems of accountability, so all levels of the management knew and understood their roles and responsibilities.

The service held monthly division 1 governance meetings, where the following were discussed, risk register, any investigations, patient experience, any open incidents, quality safety and patient safety. These were clearly documented and what actions needed to be address.

The service had a process for escalating reviews of deaths and were involved with the morbidity and mortality reviews. However, data showed there were no children and young people deaths, for either inpatient death or death within 30 days post discharge had occurred within last 12 months.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learnt with partners and collaborated for improvement.

The mental health and dementia practitioner liaised with GP’s and mental health services to ensure young people’s health and wellbeing needs were met in the community and during their admission.

The service had very good links and relationships with local authorities and local children’s hospitals.

The service provided Rubery swop shop, where people could donate school uniforms and these are given to anyone who needed help and support in Birmingham and the local community. They worked with 291 different schools. The Swop Shop was intended to help families and the environment, by providing free preloved school uniforms, reducing waste.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. Staff actively contributed to safe, effective practice and research.

Some actions were arising from the benchmarking exercise report which was published in September 2024 that have not yet occurred:

• better engagement with autistic patients and patients with a learning disability (or their parents/ carers) at board level to improve governance and contribute to co-designing services.
• improve monitoring of waiting times for autistic patients and patients with a learning disability.

The trust had a Health Inequalities action plan which was dated for the year between 2023-24.

There were 2 actions which were behind target:

• Producing easy read information for patients.
• Creating a dashboard to monitor and support health inequalities insight and improvement.

The NHS Staff Survey 2024 showed staff felt the service had continuous learning, rising from 5.58 in 2023 to 5.70 in 2024.

The safeguarding and vulnerabilities team were well-connected with current research, local and national partnerships, and communities of practice. They attended relevant meetings, although team capacity impacted on whether they were able to always attend these meetings.

The service had a vulnerabilities team Champions’ Day held in February. There were sessions facilitated by each of the departments within the team including a session where an autistic patient came in to speak about their experiences as well as representatives from a local advocacy group who worked with autistic patients and patients with a learning disability. Feedback had been very positive about the day, saying it had been “educational” and “thought-provoking.”

The trust participated in the national Learning Disability Improvement Standards annual benchmarking exercise.

Although the hospital had approximately 10 deaths per year, and none of these were an autistic person or a person with a learning disability, the trust participated in local Learning from Lives and Deaths – People with a learning disability and autistic people (LeDeR) learning meetings to ensure any good practice and learning were shared amongst the trust staff.

The survey undertaken as part of the Learning Disability Improvement Standards benchmarking exercise in January 2024 showed 100% of patients with a learning disability that responded said they were treated with respect.