Great Ormond Street Hospital for Children NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Good

Our view of the service

Great Ormond Street Hospital (GOSH) is one of the best-known tertiary children’s hospitals in the world. GOSH is an international centre of excellence in child healthcare. The patient group is made up of 89.9% NHS patients and 10.1% private and international patients.The trust sees around 76,000 children each year covering around 250,000 admissions and appointments. GOSH provides several outreach clinics across many providers in England, Scotland, Ireland and Gibraltar. Cardiology, endocrinology, rheumatology and gastroenterology are the specialties with most locations offered.GOSH provides more than 67 clinical specialities specialised services, the widest range at any one site in the UK. Specialised services support children with a range of rare and complex conditions, including patients with: rare cancers; genetic disorders and complex medical or surgical conditions. Most of its services are delivered at a single site in Great Ormond Street. The trust has over 6,000 staff and over 1,000 volunteers. The trust has an annual budget of around £700m. Most recently the trust has taken on a Children and Young People Identity service as part of a London network.We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust using our current framework.We identified positive findings within 7 of the eight quality statements and areas for improvement within 1 of the 8 quality statements. The well-led review followed an assessment of the trust’s frontline surgical service (assessment service groups - ASGs). The initial assessment of the trust’s services was triggered by concerns raised following a high-profile case concerning a large number of children who received poor care from a specific paediatric lower limb surgeon at the trust. Before we carried out our well led assessment, we assessed the trust's surgical service to ensure we had a thorough understanding of the full range of services provided by the trust ahead of our well-led review. During our Surgery inspection we found;

• Staff across surgical services described a strong culture of safety. Most reported feeling comfortable raising concerns, and there were clear systems for reporting incidents. Regular mortality and morbidity (MM) meetings took place, where staff reviewed incidents and shared learning across departments.
• Care was delivered in line with national guidance. Multidisciplinary working was well established in most areas, with teams collaborating effectively to support children before and after surgery. However, oversight varied across surgical specialties. In some areas, clinical audits were delayed or not consistently used to review outcomes from complex procedures, limiting opportunities for learning and improvement.
• Staff treated children and families with kindness and respect. Age-appropriate communication and play specialists helped reduce anxiety. However, emotional support was not always available to the extent staff would have liked. In busy areas, such as theatres and recovery, staff said they often did not have time to support families following difficult news or cancellations.
• Staffing remained a concern in some parts of the service. There were shortages of tracheostomy-trained nurses. In some cases, only one trained nurse was on shift, which limited the ability to provide safe cover during breaks. The trust was aware of these risks and had initiated a recruitment programme.
• Leaders in surgery were described as visible and supportive. However, governance remained inconsistent across some specialties. In several areas, staff were unclear about who held clinical responsibility. These concerns were consistent with the earlier Royal College of Surgeons' review. While the trust had started to improve governance, this work was still in progress at the time of inspection.
• Overall, the surgical service was committed to learning and improvement, but key risks remained. These included staffing shortages, ongoing theatre maintenance issues, and variation in clinical oversight.

These findings informed the focus and scope of our well-led review and helped with our understanding of the trust’s services and the leadership challenges facing surgical care ahead of it.