The Royal National Orthopaedic Hospital (RNOH) is committed to putting the service user and carer at the centre of everything we do and strives to improve patients' and service users' experience of our service.

The Trust takes all issues of abuse or neglect of adults at risk and children very seriously. It is committed to dealing with them effectively to minimise the risk of harm to all its service users, including those who are at risk of domestic abuse.

The Care Act (2014) defines Safeguarding adults as, protecting a person’s right to live in safety, free from abuse and neglect. The Care Act 2014 defines an adult at risk as a person:

  • Who is 18 years and over
  • Who has needs for care and support (whether or not the local authority is meeting any of those needs)
  • Is experiencing, or at risk of abuse or neglect
  • Who as a result of those care and support needs is unable to protect themselves from either the risk of or the experience of abuse or neglect.

The Care Act promotes ‘Making Safeguarding Personal’ which means that the adult at risk should be at the centre of all enquiries and decisions being made throughout the safeguarding process.

Abuse can be something that is done to a person or omitted from being done. Abuse may consist of single or repeated acts and can be carried out by anyone, in any setting. It may result in significant harm to or exploitation of, the individual.

Abuse can include one or more of the following:

  • Physical Abuse: This includes hitting, pinching, deliberately giving too much medication or physically restraining someone in an inappropriate way - for example, being locked in or force-fed.
  • Financial Abuse: This includes taking another person's money or possessions - for example, having money or property stolen, being pressured into giving people money or changing a will, misuse of benefits, not being allowed access to money.
  • Sexual Abuse: This includes any sexual act to which the vulnerable adult has not consented and may not understand. For example, being touched or kissed when it is not wanted, being made to touch or kiss someone else, being raped, being made to listen to sexual comments or forced to look at sexual acts or materials
  • Psychological Abuse: This can happen where someone is isolated, verbally abused or threatened.
  • Discrimination: This includes racism, sexism or acts based on a person’s disability, age or sexual orientation. It also includes other forms of harassment, slurs or similar treatment such as disability hate crime.
  • Organisational: Neglect and poor care practice within a care setting such as a hospital or care home or in relation to care provided in someone’s own home ranging from one-off incidents to ongoing ill-treatment. It can be neglect or poor practice as a result of the structure, policies, processes and practices within a care setting.
  • Neglect and Acts of Omission: This includes ignoring or withholding physical or medical care needs. Examples are failing to provide appropriate food, shelter, heating, clothing, medical care, hygiene, personal care; inappropriate use of medication or over-medication.
  • Self-neglect: Self-neglect covers a wide range of behaviour including neglecting to care for one’s personal hygiene, health or surroundings and behaviour such as hoarding.
  • Abuse of Individual Rights/discriminatory abuse/racial abuse: Abuse of individual rights is a violation of human and civil rights by any other person or persons. Discriminatory abuse consists of abusive or derisive attitudes or behaviour based on a person’s sex, sexuality, ethnic origin, race, culture, age, disability or any other discriminatory abuse - this includes hate crime. Forced marriage is also an abuse of human rights and falls within the definition of adult abuse.
  • Domestic Abuse: The government defines domestic violence and abuse as ‘any incidents or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over, who are or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to psychological, sexual, financial or emotional abuse’. In addition, the Serious Crime Act 2015 includes a new offence of coercive and controlling behaviour which can impose a maximum sentence of 5 years imprisonment, a fine or both. Click here for more information on domestic abuse.
  • Modern Slavery: Encompasses slavery, human trafficking, forced labour and domestic servitude of the adult at risk.
  • Hate and Mate Crime: Hate crime is where a crime is committed against a person specifically because of their gender, ethnicity, disability, religious belief or sexual orientation. If an adult at risk is specifically targeted as a victim of crime this is a hate crime.
  • Mate Crime is where someone befriends an adult at risk with the intention of exploiting or abusing them. The person often believes they are their ‘friend’ but will go on to be abused e.g. financially, physically or psychologically.
  • Forced Marriage is where one or both people do not or cannot consent to the marriage and pressure or abuse is used to make sure the marriage takes place. Under The Anti-Social Behaviour, Crime and Policing Act 2014 Forced Marriage is now a criminal offence to force someone to marry; therefore the Police must always be contacted as quickly as possible.
  • Honour Based Violence: Honour Based Violence is a crime; therefore if it is suspected or the person discloses abuse, the Police must always be contacted as quickly as possible. Honour Based Violence (or killing) is used by people who want to defend the reputation of their family or community. It can also include enforced isolation from their community.
  • FGM (Female Genital Mutilation): FGM involves procedures that involve total or partial removal of the female external genitalia or other injuries to the female genitalia for non-medical reasons. Predominantly carried out on young girls, it is considered child abuse and is illegal in the UK.


If you think an Adult in the RNOH is a victim of abuse or neglect, please raise your concerns with the Local Authority, safer neighbourhood team or police website in the borough where the service user is living right now. If the incident happened in one of the RNOH sites, then raise your concerns with:

Access Harrow Adult Services for RNOH Brockley Hill
Telephone No. 020 8901 2680 or 020 8424 0999 (out of hours)
Fax No. 020 8420 9674

For further information about Safeguarding Adults in Harrow visit Harrow Safeguarding Adults Board Website

Contact Westminster Safeguarding Adults Team for RNOH Bolsover site
Telephone No. 020 7641 2176

The Trust works in partnership with two local authorities where abuse has been identified: Harrow Council for RNOH Brockley Hill site and Westminster City Council for RNOH Bolsover site.

Safeguarding Adult Executive Lead:
Louise Morton, Chief Nurse 

Deputy Lead for Safeguarding and Staff Allegations 
Mercy Wasike, Deputy Chief Nurse

Head of Safeguarding, Named Nurse Adult:
Christina Kelly
020 8909 5337

Specialist Advisor Safeguarding Adults:
Chaya Kissoondary

Named Doctor Safeguarding Adults:
Dr Charlotte Pratt

Safeguarding Administrator:
Jack Lo: 020 3947 0100

Out of hours, please call our Duty Matron via switchboard number on 020 3947 0100, ask for bleep 765

Royal National Orthopaedic Hospital (RNOH) has a commitment and a duty, to safeguard adults at risk, as stipulated in Regulation 13 of the Care Quality Commission, and to follow the statutory legislation laid out in the Care Act (DH, 2014), the guidance stipulated in the Care and Support Statutory Guidance (DH, 2014) and the London Multi-agency Adult Safeguarding Policy & Procedures (December 2015).

The Trust is accountable to patients, who are unable to uphold their rights and protect themselves from harm and abuse. RNOH is legally obliged to ensure adults at risk receive safe high-quality care and must effectively respond when harm or abuse occurs by following and supporting the ‘enquiry’ process led by Harrow Local Authority. This declaration identifies the Trust’s commitment to safeguarding and protecting adults at risk and shows the number of arrangements in place.

Governance Structure

The Trust Safeguarding Committee oversees the adults at risk activity in the Trust. This is chaired by the Director of Nursing, Quality & Patient Experience and reports to the Clinical Quality and Governance Committee. The Trust Board receives monthly and annual reports in order to monitor safeguarding adults at risk activity across the organisation.

DBS Disclosure and Barring

Royal National Orthopaedic Hospital meets statutory requirements in relation to safer recruitment practice. All Trust job descriptions include a statement on safeguarding adults at risk.

The Trust works to ensure that there are robust systems, policies and procedures in place to guide and support staff. Relevant policies include those relating to Safeguarding Adult at Risk, Mental Capacity Act, Deprivation of Liberty Safeguards and Restraint. All policies are available on the Trust intranet site for all staff to access.

The Trust has a robust training strategy in place. Currently, all staff have been assigned a level from 1 to 4 to ensure they receive the appropriate training to meet competencies for the job in accordance with the final draft of the Safeguarding Adults: Roles and competencies for healthcare staff – Intercollegiate Document. A training database for all staff is maintained and monthly compliance reports are provided to the Trust Board.

RNOH actively engages with partner agencies and organisations and contributes to the Local Safeguarding Adult Board multi-agency partnership arrangements.

On the basis of this work, Royal National Orthopaedic Hospital confirms that the Board has considered its own position in regards to safeguarding adults at risk and has the necessary assurance that it is meeting its statutory requirements and is following good practice.