Claremont Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People who used the service were involved in assessments of their needs. Staff reviewed assessments taking account of people's communication, personal and health needs. Care was based on latest evidence and good practice, policies were updated and referenced to national guidance. Patient reviews took place with other healthcare professionals to ensure patients were able to receive their treatment. Staff made sure people understood their care and treatment to enable them to give informed consent.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a comprehensive pre-operative assessment policy for staff to follow. It clearly outlined the roles and responsibilities of staff and that all pre-operative assessments must be undertaken by registered staff who have successfully completed relevant supervised practice.

Patients told us they had a pre-operative assessment, with their involvement, prior to admission to the service. The pre-operative assessment process identified key risks and allowed staff to assess their needs and preferences. The service had a clear inclusion and exclusion criteria in place to determine who could be treated safely at the hospital. As part of the pre-operative assessment process, people with certain medical conditions were excluded from receiving treatment at the hospital. This meant the majority of people treated at the hospital were considered to be “low risk”.

The service used paper records and completed regular documentation audits for patient records. All audits we reviewed showed consistent compliance.

We were told by the service leads that the wider organisation were undergoing a transfer of system for electronic record keeping, therefore their plan was to wait for the transfer to complete before moving over to electronic records.

We looked at the care records for 5 patients. All of the records were well structured, legible and up to date. The assessment records included clinical details, medical history, prescribed medicines history, allergies, infection history, mobility, contact names for next of kin and other healthcare professionals (such as their GP).

Staff used a national early warning score system (NEWS2) and carried out routine monitoring based on the patient’s individual needs to ensure any changes to their medical condition could be promptly identified. The service monitored compliance of NEWS2 assessment and documentation which showed good compliance.

Staff carried out individual risk assessments and care plans were put in place where risks were identified. Records showed risk assessments and care plans were routinely reviewed.

The service monitored the number of unsuitable referrals that came from the partnering NHS hospital and shared this information regularly with them to reduce reoccurrence.

Patients received care according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and Royal College of Surgeons (RCS) guidelines.

Patients told us staff carried out regular monitoring and observations and that they received good care and treatment. Patients told us that staff asked them if they had any pain during and after their surgery. They said staff administered pain relief in a timely manner and were given information about their pain medication following discharge from the hospital.

Staff assessed patients for their preferred post-operative pain relief and used a pain assessment score to assess the comfort of patients. We observed pain score charts for patients in the recovery area after surgery and the anaesthetist supported pain management. We looked at 5 prescription charts and they documented the time pain relief had been prescribed and administered.

The service completed audits for pain management and the most recent data showed 100% compliance.

Patients nutritional needs were assessed as part of their initial assessment and staff completed fluid and nutrition charts where needed. The service completed audits for nutritional assessments and data showed that they scored 100% consistently. Patients told us they were offered a choice of food and drink and spoke positively about the quality of the food offered. Dietary requirements for patients were considered during pre-admission and the service had options available for patients with specific requirements. Patients told us they were given clear advice on what to eat and drink prior to surgery.

Staff followed up-to-date policies based on national guidance, such as National Institute for Health and Care Excellence (NICE) and The Royal College of Surgeons (RCS) standards. The hospital received regular updates on national guidance, drug alerts and policy changes from the corporate provider and shared these with staff.

Patients spoke positively about the way their care and treatment was coordinated. They told us the staff across the service worked well together as a team and shared information with their GP.

Multidisciplinary meetings took place with medical staff to discuss particular risks highlighted at patients pre-operative assessments. There was effective daily communication between multidisciplinary teams within the ward and theatres. Staff carried out ‘safety huddles’ on a daily basis to ensure all staff had up-to-date information about risks and concerns. There was daily communication between the pre-operative assessment staff and ward and theatre staff so patient care could be coordinated and delivered effectively.

Staff told us they had a good relationship with consultants, RD's, pharmacy and allied health professionals, such as physiotherapists. They told us that they did not encounter any issues with accessing medical advice when required. The healthcare assistants told us they received good support and worked well with the nursing staff and the managers.

We saw theatre staff work together to complete the safer surgery checklist and patient preparation prior to surgery. Patient records showed and we saw, that there was routine input from nursing and medical staff and allied health professionals.

Staff worked across health care disciplines and with other agencies when required to care for patients. Ward staff liaised with several different services when co-ordinating a patient’s discharge. This included hospitals, GP’s, community services, and social services.

Feedback from stakeholders, such as the partnering NHS hospital was positive. They told us they worked very well together to ensure effective care pathways. This included a good working relationship with consultants who worked at both hospitals and regular meetings maintained strong relationships with management.

Patients told us they received good support from staff and were provided with information around healthier living. Staff told us they routinely discussed health promotion and lifestyle choices with patients. They told us people needing additional support could be referred to other healthcare professionals, such as dietitians.

Staff told us they provided patients with advice on how to refer or gain access to external NHS services, such as for counselling, smoking cessation or alcohol liaison services if required.

The service had relevant information promoting healthy lifestyles and support on the wards. The provider’s admission booklet signposted patients to the NHS website for information and guidance for eating a healthy, balanced diet.

Patients completed a health questionnaire prior to treatment and this was used to identify areas of support. They were provided with relevant health information materials, such as leaflets on smoking or alcohol use. This included information on how to access local support services. Staff and consultants were able to signpost patients to a variety of other health promotional materials for conditions such as Parkinson’s disease, multiple sclerosis, asthma and epilepsy.

Patients said they felt listened to and were involved in discussions about their care and treatment. Patients spoke positively about the quality of the care and treatment they received. They reported positive outcomes after surgery such as an improvement in mobility and being able to do daily household tasks. They were pleased with their rate of recovery and said they had been fully informed about the recovery process and what to expect.

Patients told us they did not have to wait long for appointments and had no delays. They told us they had received after care support from consultants and physiotherapists.

The service monitored clinical indicators and performance standards for patient safety, IPC, incidents, patient experience, audits and staffing. The electronic system allowed the service to benchmark against the provider’s other hospitals.

The service had processes in place to monitor outcomes and post-operative infections. They completed audits and surveillance of surgical site infections (SSI’s) and worked collaboratively with the local NHS hospital IPC team to monitor outcomes and investigate readmissions for SSIs.

The service participated in national audit programmes such as performance reported outcomes measures (PROMs) and the National Joint Registry (NJR). Audit findings were reviewed and monitored at clinical governance and Medical Advisory Committee (MAC) meetings to drive improvement and learning.

The national joint registry (NJR) data for 2023/2024 showed that patient outcomes, revision rates and mortality rates for hips and knees at the hospital were within the expected range.

The hospital performed better than the England average for obtaining patients consent, valid NHS number and time taken to enter date.

The service had a comprehensive audit programme that included audits for VTE, falls, nutrition, hydration, fasting and NEWS2. The service shared audit results at team meetings and audits had associated action plans to drive improvement.

Patients told us they provided written consent prior to commencing treatment and all the risks and benefits of the treatment were clearly explained to them.

Staff had the appropriate skills and knowledge to seek consent from patients. Staff were clear on how they sought verbal informed consent and written consent before providing care or treatment. The consultants sought consent from patients undergoing surgery during the initial consultation and again on the day of surgery.

Staff told us they had received training in and understood how to obtain informed verbal and written consent from patients before providing care or treatment.

Staff were aware of the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberties Safeguards (DoLS). This was incorporated within safeguarding training. People who could not give consent were not routinely referred to the service for treatment.

Staff clearly recorded consent in the patients records and made sure people consented to treatment based on all the information available. Consent forms showed the risks and benefits were discussed with the patient prior to carrying out a surgical procedure. Records we looked at showed that consent forms had been signed and patients had received a copy.

The provider’s policy for consent to examination or treatment provided guidance to staff on how to obtain consent. Staff told us they also sought advice from managers and the safeguarding lead if they needed support and guidance around consent to care and treatment.