Royal National Orthopaedic Hospital (Bolsover Street)

The Bolsover Street location is the central London outpatients facility of the Royal National Orthopaedic Hospital NHS Trust. The purpose-built facility was opened in December 2009. It offers modern healthcare facilities for patients, which include clinics, imaging - both X-ray and ultrasound, orthotics, occupational therapy, physiotherapy, pre-operative assessment and plaster services.

The trust was selected for inspection as it is an example of a specialist trust and a ‘medium risk’ trust.

Before visiting, we reviewed a range of information we held and asked other organisations to share what they knew about the hospital. These included the trust’s key referrer of patients, NHS Trust Development Authority, the General Medical Council (GMC), the Nursing and Midwifery Council (NMC), the Health and Care Professions Council (HCPC), Parliamentary and Health Service Ombudsman (PHSO), NHS Litigation Authority, the royal colleges and the local Healthwatch.

The CQC inspection model focuses on putting the service user at the heart of our thinking. We held a publicised listening event on 6 May 2014. This was held before the inspection began and helped inform the thinking of the inspection team. Approximately 13 local residents and service users attended the listening event, and each had the opportunity to tell their story, either in small groups or privately with a member of the inspection team.

We carried out an announced inspection at Bolsover Street on 8 May 2014. At the Stanmore location we held focus groups with a range of staff in the hospital, including senior nurses, junior doctors, consultants, student nurses and healthcare assistants, administrative and clerical staff, physiotherapists, occupational therapists, and pharmacists. We also spoke with staff individually as requested. Most staff worked across both locations.    

We talked with patients and staff. We observed how people were being cared for, talked with carers and/or family members, and reviewed patients’ records of personal care and treatment.

To get to the heart of patients’ experiences of care, we always ask the following five questions of every service and provider:

• Is the service safe?
• Is the service effective?
• Is the service caring?
• Is the service responsive to people’s needs?
• Is the service well-led?

The inspection team inspected the following core services:

• Outpatients

What patients say

A total of 20 comments cards were received regarding the outpatients services. The majority of these were positive and related to the good or excellent care that patients received. Patients told us that staff were kind and caring and that staff at all levels and professions had time to listen and help them. However, patients also told us that clinics often did not run on time.

Overall, The Royal National Orthopaedic Hospital NHS Trust – Bolsover Street location was rated as ‘requires improvement’. We rated it ‘good’ for providing caring and safe care and it required improvement for the services to be responsive and well led.

Our key findings were as follows:

• The service was safely managed and the environment was clean and hygienic. The building was purpose built for outpatients and accommodated a variety of patient needs.
• Some clinics often ran late these were longstanding issues that the trust were working on.
• There was an unnecessary delay in letters being sent to GPs following appointments. The trust did not have a standard timeframe to which the letters should be sent.
• An overwhelming majority of patients told us that staff were caring and kind. Patients felt included in their care and treatment.
• Patient records were available at least 99% of appointments; they were transported and stored securely.

We saw areas of outstanding practice including:

• The environment was designed with the patient at the centre of service.
• Medical records were available for nearly all appointments.
• Some patients were given pagers on arrival so they were free to wait in an area that suited them – children’s play areas, the café or different departments within the building – and not miss their appointments.

However, there was also an area of practice where the trust should make improvements.

• The trust should consider carrying out formal proactive audits of cleanliness and infection control in the outpatients clinics.

Professor Sir Mike Richards

Chief Inspector of Hospitals