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CQC inspectors call on Royal Hospital for Neuro-disability to improve services

4 November 2015
  • Media,
  • Hospitals

The Chief Inspector of Hospitals has identified areas in need of improvement at the Royal Hospital for Neuro-disability, in South West London, following an inspection by the Care Quality Commission.

The Royal Hospital for Neuro-disability, an independent medical charity, provides neurological services to adults across England, ranging from people with challenging behaviour and complex care needs, to those in a minimally aware state or requiring mechanical ventilation.

The full report for the inspection is available at:

CQC Inspectors found that the hospital environment was visibly clean and records demonstrated that equipment and medicines were safely managed and regularly checked.

While most staff treated patients with dignity and respect, and provided excellent support for patients and their families, there were some areas for improvement. At times, there was a failure to acquire patient consent before treatment, or to protect patients from the risks of unsafe care or improper treatment.

Inspectors found that the hospital had a heavy reliance on agency nurses and healthcare assistants and that staff members were not always trained to deliver required neuro-rehabilitation services or to provide care to patients requiring long term assistance with breathing.

Record keeping was inconsistent across different areas of the hospital. Incidents were reported and investigated; however, a newly implemented electronic reporting system provided limited analysis and feedback for use on hospital wards.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"Our recent inspection has found that the Royal Hospital for Neuro-disability has made significant changes in leadership, governance structure, senior staff and organisational culture within the last year. It is clear that the new leadership team is still in the process of embedding changes to processes and procedures.

“Patients told us that the majority of staff treated them with dignity and respect, and that the hospital chaplain in particular provided excellent support to them and their families.

“However, we have concerns about the reliance upon agency nurses and healthcare assistants to maintain sufficient staff levels, and that staff members were not always trained to deliver the services required by patients.

“We are concerned that record keeping is inconsistent across the hospital, with decisions about patient care often being taken without the appropriate supporting documentation or without capacity assessments being completed appropriately.

People are entitled to services which are safe, effective, caring and of high quality. We have identified a number of areas for improvement and we will return in due course to check that the hospital has made the improvements we require for the benefit of their patients.”

The hospital has been told that it must make improvements including:

  • Appropriate medical cover must be in place for all patients at all times, in particular, for those who need long term assistance with breathing for whom there was no in-house medical expertise available.
  • Staff must have a better understanding about the range of potential safeguarding concerns that can arise for patients that require long term assistance with breathing.
  • All staff must comply with the Mental Capacity Act 2005, with regards to consent, mental capacity assessments and Deprivation of Liberty Safeguards. This must include recording the detail of decision-making meetings about patients' mental capacity and their best interests; and arrange for appropriate patients to have Independent Mental Capacity Advocates.
  • Staff must understand the legal requirements of the Duty of Candour in relation to being open and honest with patients and their families when things go wrong with care and treatment.

Inspectors found one area of outstanding practice:

  • The hospital made excellent use of eye-gaze technology. The innovative form of electronic assistive technology is used to help patients with limited or no physical movement, to communicate with others.


For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. Journalists wishing to contact the press office can find out how to contact the team here.

For general enquiries, please call 03000 61 61 61.

Last updated:
29 May 2017

Notes to editors


About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.