Royal National Orthopaedic Hospital

The Royal National Orthopaedic Hospital NHS Trust (RNOH) provides a comprehensive range of neuro-musculoskeletal health care, ranging from the most acute spinal injury or complex bone tumour to orthopaedic medicine and specialist rehabilitation for chronic back pain sufferers. This broad range of neuro-musculoskeletal services is unique within the NHS.

As a national centre of excellence, the RNOH treats patients from across the country, many of whom have been referred by other hospital consultants for second opinions or for treatment of complex or rare conditions.

The RNOH plays a major role in teaching, 20% of all UK orthopaedic surgeons receive training here. Our teaching and our clinical effectiveness are enhanced by our work in research and development and our academic links with University College, London. Research departments at Stanmore include the Institute of Orthopaedics, the Centre for Disability Research and Innovation, the Institute of Human Performance and the Centre for Biomedical Engineering.

The Trust also works closely with other hospitals and has many joint appointments with other Trusts to ensure maximum availability of specialist skills for patients. Patients of the Trust also benefit from access to the ASPIRE (Association for Spinal Injury Research, Rehabilitation and Reintegration) National Training centre which is located on site and hosts first-class sporting and other facilities for able-bodied and disabled people.

History of the RNOH
The Royal National Orthopaedic Hospital NHS Trust (RNOH), based in Brockley Hill, Stanmore and Bolsover Street, central London, is a National Centre of Excellence, which treats patients from across the UK, many of whom have been referred by other hospital consultants for second opinions or treatment of complex or rare conditions. Patients are also referred to the hospital from many other parts of the world.

The RNOH was founded in 1905 with the amalgamation of London's three specialist orthopaedic hospitals into a single centre of excellence and can thus trace its history back over 150 years to 1838.

The hospital is located on two sites. The main site; the 'country branch', is located in 112 green belt acres at Stanmore with the 'town branch' located on Bolsover Street, central London. The town branch was also located at 234 Great Portland Street up until 1984.

During the First World War, the hospital became an emergency hospital for the military and in early 1918 also housed discharged disabled soldiers. King George V and Queen Mary visited the hospital on two occasions.

1920 saw the start of an hospital funds appeal, with the first annual fundraising day 'Buttercup Day' being launched by HRH the Duke of Gloucester, Patron of the RNOH.

In the 1930's the hospital became known as the leading centre for the treatment of poliomyelitis and tuberculosis and in 1936 the building of the Stanmore Cripples Training College was started.

The RNOH was at the forefront of significant advances in the treatment of orthopaedic conditions in the first quarter of the twentieth century. Advances in scientific investigations made the diagnosis of disabling conditions more accurate, and often at an earlier stage in the patients illness. This meant that patients for whom there would be no possible cure then had the opportunity to be relieved of their pain and deformity.

The RNOH saw the outbreak of the Second World War with many 'Nissen' huts being erected to house civilian orthopaedic cases and casualties. Patients were brought from across the country, including those from hospitals near the coast, areas close to airfields and other military installations.

In 1945, the RNOH was recognised as a postgraduate teaching hospital and it was recommended that an Institute of Orthopaedics should be founded and that it should be associated with the RNOH. With the formation of the Institute came a joint appointment between the two centres, that of Mr Herbert Seddon, who in 1964 was awarded a Knighthood for his work in Orthopaedics.

1948 saw the start of the National Health Service from which time the RNOH became an independent teaching hospital.

The RNOH's work into orthopaedic care continued when in 1950 the hospital moved into the treatment of scoliosis, back care, leg inequality, hand and peripheral nerve injuries.

Training and research has played an important part in the hospital's work, resulting in the development of dedicated units, the training and teaching of consultants overseas as well as UK medical students and nurses.

In 1979, HRH The Prince of Wales opened a Rehabilitation Assessment Unit, built with funds raised by the British Motor Racing Drivers Association, in memory of Graham Hill who had once been a patient of the hospital and a Council member of the Friends.

Following years of research and treatment into spinal injures, the RNOH opened one of the first of its kind, Spinal Injuries Unit. The London Spinal Unit was officially opened by HRH the Princess of Wales in 1984.

In this new millennium, patients continue to benefit from a team of highly specialised consultants, many of whom are nationally and internationally recognised for their expertise and experience. Consultants are supported in their work by nurses, therapists and other specialist clinical staff, who are trained under our experts in their fields of orthopaedic care.

Introduction
The RNOH is reputed to be a jewel in the crown of NHS neuro-musculoskeletal care with an international reputation for pioneering treatment and excellence in both routine and complex patient care delivery. Staff at the RNOH undertakes a remarkable job by maintaining and improving high standards of care and pushing the boundaries in education and research, from accommodation that is old, inefficient, inflexible and clearly unsuited to modern clinical practice.

The hospital redevelopment will allow the RNOH to deliver neuro-musculoskeletal (Orthopaedic) care more effectively and efficiently with greater capacity for treating more patients in an environment that fits the hospital's international reputation.

OBC (Outline Business Case)
Since the SOC (Strategic Outline Business Case) was approved by the Department of Health in July 2004, the Trust's redevelopment team has been working with its clinicians (in excess of 97 have participated) and non clinical staff and patients to develop a hospital design which will deliver its projected clinical activity and new clinical model.

This work feeds into the Public Sector Comparator (PSC) model which will be set out in OBC, currently being prepared. The PSC sets out how the Trust would deliver clinical services including staffing and how it would design, fund and construct the new hospital, if it could be funded through central government.

The new Royal National Orthopaedic Hospital will be funded via the Private Finance Initiative (PFI) and land sales which is now the standard method of financing large public projects. The Trust will advertise in the European Journal to seek a private partner (through competitive tendering) to fund, design, construct and operate the new hospital. The PSC developed for the OBC will be used during the selection process as a benchmark to measure the quality of the bids received from the private sector. The PFI bidders bring their experience (from other projects) to the table in order to deliver innovative solutions which should exceed the Trust's expectations as set out in the PSC.