The Royal Orthopaedic Hospital

Updated 20 December 2019

The Royal Orthopaedic Hospital is one of the largest providers of elective orthopaedic surgery in the UK and is one of five specialist orthopaedic centres. It offers three tiers of service: routine orthopaedic operations for a local population of 4 million people in Birmingham and North Worcestershire; specialist services, such as spinal surgery; and diagnosis and treatment of malignant bone conditions.

The trust is a tertiary referral specialist orthopaedic centre, providing elective orthopaedic care to its local catchment area in South Birmingham, nationally and internationally. The trust specialises in planned treatments of large and small joint replacement, spinal services, orthopaedic oncology and paediatric orthopaedics. The hospital has a specialist bone infection unit. The hospital is one of five centres in England for the diagnosis and treatment of malignant bone tumours and the bone tumour service commissioned by specialised commissioning. The trust is one of 12 centres in England for the treatment of soft tissue sarcomas.

The Royal Orthopaedic Hospital has 10 operating theatres and 106 beds across six wards, six of which are on a high dependency unit. The trust employs just over 1,000 staff, including more than 40 consultant medical staff.

(Source: Routine Provider Information Request (RPIR) – Acute context tab)

The trust had 12,392 surgical admissions at the Royal Orthopaedic Hospital from March 2018 to February 2019. Emergency admissions accounted for 301 (2.4%), 6,727 (54.3%) were day case, and the remaining 5,364 (43.3%) were elective.

There were 94,143 outpatient attendances at the Royal Orthopaedic Hospital from March 2018 and February 2019.

This trust does not provide an Accident and Emergency service.

Updated 20 December 2019

During our inspection, we inspected surgery and critical care. We did not inspect medical care, services for children and young people or outpatients at this inspection, but we combine the last inspection ratings to give the overall rating for the hospital.

Our rating of services stayed the same. We rated it them as good because:

• Our rating for safe remained good overall. The service addressed the improvements we suggested in our last inspection. It had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. However, staff did not always have training in key skills including all required levels of safeguarding training.
• Our rating for effective remained good overall. Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Our rating for caring remained good overall. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• Our rating for responsive remained good overall. The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment. However, the environment had not been adapted to meet the needs of patients living with dementia.
• Our rating for well led remained good overall. Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually

Updated 17 May 2018

Our rating of this service stayed the same. We rated it it as good because:

• Staff understood how to protect patients from abuse, had training on how to recognise and report abuse. There were systems and processes in place to support staff in safeguarding patients.
• There were clearly defined and embedded processes, systems and standard operating procedures for ensuring cleanliness and hygiene.
• Staff carried out comprehensive patient risk assessments and risk management plans were in line with national guidance.
• Records were accurate, complete and up to date, legible and securely stored.
• Staff understood and fulfilled their responsibility to raise concerns and report incidents including being open and honest with patients when things went wrong.
• Incidents were reported and investigated appropriately and lessons learned and shared locally.
• The hospital had lower than expected risk of readmission compared to the England average.
• There was effective and co-ordinated multi-disciplinary team working across the service that ensured patient care was assessed, planned and delivered based on individual needs.
• Staff cared for patients with care and compassion. Feedback from patients confirmed that staff treated them with kindness and involved them and those close to them in decisions about their care and treatment.
• The ROCS team visited patients at home to deliver intravenous therapy. Without this service patients would have to stay in hospital for the duration of the treatment, therefore occupying a hospital bed.
• We found that the service had improved dementia assessments and communication aids for those with disabilities since our last inspection.
• We saw honest and transparent action to address breaches in the national referral to treatment (RTT) targets during the previous 12 months. The trust was meeting the planned trajectory to meet the target. The arrangements for recording and managing risks and actions to reduce risk were resilient. The recorded risks on the medical service risk register were aligned to what staff had said was on their “worry list”.
• Local leaders were knowledgeable about issues and priorities for the quality and sustainability of the service, and had a good understanding of the challenges they faced. We saw they were responding to address these challenges and this work was ongoing.
• The service was transparent and open with all relevant stakeholders about performance and building a shared understanding of challenges to the system.

However;

• Staff were not aware of the term ‘never event’ or of the never events that occurred in 2016. There was a clear lack of shared learning trust-wide.
• The trust used several IT systems that did not interface with each other which meant that there was duplication of information and extra workload for staff. Not all staff had the required access for all systems.
• Staff did not understand the principle of duty of candour despite the trust providing  training as part of mandatory training days.
• Staff were not knowledgeable or confident in providing care to patients detained under the Mental Health Act. There was a lack of supporting information and guidance for staff to follow to ensure patients additional mental health needs were met.
• A lack of medical cover on weekends affected patient access to pain relief.
• The Bone Infection Unit was not monitoring patient outcome data and therefore could not demonstrate the service effectiveness.
• As previously found in our last inspection, staff did not have access to professional development for example, specialist oncology training and mentorship training for staff.
• Not all staff utilised translation services to support patient communication needs.

Updated 16 October 2014

Children and young people received safe, compassionate and effective care from appropriately trained and competent staff. Care and treatment was based on national guidelines and directives and were monitored for quality and effectiveness.

Children and young people and their parents/carers were treated with dignity and respect. Parents and carers were satisfied with the care and treatment delivered to their children and told us they felt included and involved. Staff were positive about working in the family care division of the trust and felt supported and valued in their roles by line managers. Risks were managed at a local and trust level.

The children’s ward was being refurbished and due to re-open in July 2014. The temporary ward for children and young people was cramped with limited facilities for them and their families and carers.

Updated 20 December 2019

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Staff did not always have training in key skills.
• All staff had not completed all required levels of safeguarding training.
• Staff did not always have access to reliable information systems.

Updated 17 May 2018

Our rating of this service stayed the same. We rated it it as good because:

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated it as good because:

• Staff understood how to protect patients from abuse, had training on how to recognise and report abuse and they knew how to apply it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean.
• The service made sure staff were competent for their roles. Managers worked with staff to provide support and monitor the effectiveness of the service. Staff felt involved in the appraisal process.
• Staff cared for patients with care and compassion. Feedback from patients confirmed that staff treated them well and with kindness and involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people. Extending clinic times and flexing the length of appointments to meet the individual.
• People could access the service when they needed it. Staff worked hard to provide patients with appointments that suited their needs and reduce any unnecessary stress.
• The service took account of patients’ individual needs offering interpreter services and quiet rooms.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However:

• Lessons learned from trust wide incidents were not shared. Staff were unable to describe duty of candour and were unaware of learning from recent incidents.
• Patient records were not kept in a secure environment.
• The premises provided little space for wheelchair users.
• Trust policies were not kept up to date and there was no policy covering the Mental Health Act. The service followed the 2008 Mental Health Act Code of Practice which had been superseded by the 2015 edition.

Updated 20 December 2019

Our rating of this service stayed the same. We rated it as good because:

• The service addressed the improvements we suggested in our last inspection. It had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually