The Royal National Throat Nose and Ear Hospital provided care and treatment to local patients as well as those travelling from further afield. We saw evidence that the hospital was responsive to individuals' needs and patients' comments were mainly positive. For example, one person had written 'Thanks to all the staff who have made what could be a frightening experience very calm and relaxed' in a comments book.

The hospital was based in an old building and, since it took over the running of the hospital in April 2012, Universities College London Hospitals Trust (UCLH) had started to refurbish the premises. Two patients noted that the hospital was kept clean despite its age.

We observed that some patients were experiencing difficulty with the way the Urgent Referrals Clinic was organised. We also thought that the hospital needed to get rid of some old paper files to eliminate the risk of staff looking at outdated policies and procedures. There was an over-reliance on bank and agency staff in theatres, but senior staff were aware of this issue and it was in the process of being addressed. Out-patient waiting times were sometimes too long.

A small on-site pharmacy was available during office hours and there was an out-of-hours medication cupboard and an on-call service at other times.

We saw that there were robust systems in place to assess and monitor quality and safety and the staff members we spoke to had a good knowledge of them.