RNOH Vision Summary
A World Class Centre of Excellence
Draft for Agreement
May 2009
Rob Hurd
Chief Executive
May 2009
In association with the Institute of Orthopaedics and Musculo-Skeletal Science, University College London
1. Background
1.1.
The purpose of this document is to summarise the RNOH vision agreed by the Trust
Board during Board Development sessions in February and May 2009. The vision is a
high level document to inform the Trust’s response to the current environment and the
Integrated Business Planning process that the organisation utilises to plan its activities.
2. RNOH Background
2.1.
The RNOH is a world renowned specialist hospital for the diagnosis and treatment of
complex orthopaedic conditions. These range from the most acute spinal injuries,
bone tumours and complex joint reconstruction to orthopaedic medicine and specialist
rehabilitation for those with chronic back pain.
2.2.
We have an internationally unique mix of academic & clinical activity (linked to
University College London (UCL) and the developing Academic Health Sciences
Campus (AHSC)) driving high quality patient outcomes and low infection rates.
2.3.
We treat a high proportion of the sub-specialist work carried out in the UK – for
example a third of UK spinal scoliosis surgery and two thirds of specialist peripheral
nerve injury work takes place at the Trust. The RNOH is one of 5 NCG designated
bone tumour centres and one of 8 Spinal Cord Injury Centres in the country.
2.4.
The Trust is a national provider. 48% of the Trust’s patients live in London, a further
20% from the remainder of the south east and 30% from further afield in the UK.
2.5.
We are the largest of the five stand alone Specialist Orthopaedic Hospitals in the
country with the highest proportion of tertiary/complex work.
2.6.
The overall aim of the RNOH is:
“To be the specialist orthopaedic hospital of choice by providing outstanding patient
care, research and education.”
3. RNOH Vision - A World Class Centre of Excellence
3.1.
The RNOH’s purpose is to meet patient needs and demands through building a strong
academic evidence base supported by an appropriate range and scale of high quality
accessible neuro-musculoskeletal service lines.
UCL Partners
AHSC
High Quality
Accessible
Clinical Excellence
Academic
Strength –
Integrated
Research &
Education
External Focus
Clinical and
Operational
International
Expertise
Scale & range of neuromusculoskeletal service
lines that ensure clinical
volume & complexity is
appropriate to a world class
service
Specialist Orthopaedic
Alliance
Federation of Specialist
Hospitals
Partnership working on other
sites
In association with the Institute of Orthopaedics and Musculo-Skeletal Science, University College London
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4. Measuring our status as a World Class Centre of Excellence
How will we measure whether we are a world class centre of excellence?
4.1.
The exemplar status of high quality and accessible clinical excellence will be
evidenced by measurable outcomes e.g. low infection rates, low readmission or
recurrence rates & survivorship, low error/negligence rates, levels of tertiary services
not provided elsewhere and low waiting times.
4.2.
The status of the RNOH as a source of expertise & support to services provided
elsewhere nationally and internationally at an organisational level (not just individual
clinicians) will be measured by level of joint working with other organisations e.g.
franchising, off site partnership working and joint appointments.
4.3.
Integration of clinical practice, education and research – “academic strength” – will be
measured by grants attracted to support the Joint Academic Plan agreed by the Trust
Board.
5. Academic Vision
The RNOH’s academic vision is
“To be recognised as a world leading Clinical Centre of Excellence for complex neuromusculoskeletal disease through translational research and multi-disciplinary education.”
This vision is supported by a Joint Academic Plan approved by the Trust Board which aims to
deliver a programme of neuro-muscular orthopaedic research across the following themes:1.
2.
3.
4.
5.
Innovative implant design
Cell therapy and tissue engineering
Disability science and improvement of quality of life for independent living
Building the musculoskeletal evidence base
Sarcoma medicine in collaboration with the Cancer Institute
To support the partnership with UCL the RNOH is in the process of applying for formal
membership of UCL Partners, linked to the UCL Academic Health Sciences Campus.
6.
Clinical Vision
The RNOH’s clinical vision is
“To provide the scale & range of service lines that ensure clinical volume, complexity and
outcomes are appropriate to a world class service.”
This is supported by the following key themes:




High quality routine work to support training & research (the current strategy is to maintain
c20% routine work to support this)
High quality complex specialist work that others cannot do to meet patient (&
commissioner) demand
Continue to lobby for a higher proportion of work to be commissioned on a regional /
national specialist commissioner basis rather than individual PCTs
Supplement NHS work with private and international work to make a financial contribution,
attract the best consultants, and support reputation. The current strategy is to hold this
within c7% of total income as required by the Foundation Trust income cap. Most of this
income is joint reconstruction or spinal surgery work.
In association with the Institute of Orthopaedics and Musculo-Skeletal Science, University College London
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Within this vision, the RNOH needs to consider the potential for expanding or eliminating
smaller aspects of current services:

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






Marketing for a higher proportion of routine patient choice work
Multi-disciplinary rehabilitation programmes
Occupational Health & Vocational Rehabilitation Services to employers (Department of
Work & Pensions Initiative)
Sports injuries
Specialist Rheumatology
Advanced imaging equipment & techniques
Plastic surgery
Hand Surgery
Tender for limb fitting services current run by NWL Hospitals on RNOH site
7. Conclusion - Strategy to support the Vision
There are two main constraints currently facing RNOH in implementing this vision:
Inadequate estates and facilities. It is not currently possible to sustain or expand
capacity without major capital investment. Once this investment is secured there will
inevitably be a period of 3-5 years whilst the redevelopment of the estate is implemented
during which capacity will remain constrained.

Organisational status uncertainty. The Trust Board has agreed that Foundation Trust
status will enhance the ability of the Trust to deliver the vision and maintain the future of
the RNOH clinical model of care and reputation of our clinical services as a national centre
of excellence. The RNOH received strong support for its proposals during the Foundation
Trust consultation period but the current timetable is dependent on agreeing a
redevelopment solution and demonstrating clinical and financial sustainability to Monitor.
The Trust Board has agreed the following response to these key constraints to delivering the
vision.
1. Next 2 years: to continue urgent implementation of Stanmore and partnership capacity
expansion projects, including RNOH working on other Trust sites.
2. 2 years+: to continue to pursue non-PFI mixed economy funding (PDC and borrowing) and
implement the preferred redevelopment solution as soon as possible.
3. If capital funding secured, continue with our Foundation Trust application as soon as
possible – target 1st December 2009.
4. Gain NHS London support for Foundation Trust application. This is likely to require active
participation in the current North Central London (NCL) review to demonstrate RNOH FT
viability and is therefore major risk to FT timetable. The formal Trust Board response to the
NCL Review will be to support centralisation of all elective orthopaedic services onto a
single North London site with the Stanmore site currently representing the only option
which has demonstrated a viable solution. The Medical Director has indicated that this is a
pre-requisite for clinical engagement in the review.
In association with the Institute of Orthopaedics and Musculo-Skeletal Science, University College London
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