Sulis Bath Hospital Limited Also known as Circle Bath

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

We looked for evidence that patients had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used a range of clinical assessment tools, including care plans, pain management tools and surgical pathway specific assessment tools. These were designed to involve patients in the assessment of their needs at every step of their care pathway. However, there was inconsistency between some documents used for recording care plans and assessments. Some documents had not been reviewed and updated in over 3yrs. The joint replacement pathway documentation booklet had not been revised in 10yrs and used different standardised systems to calculate risk of deterioration and pain scoring, compared to the rest of the hospital. This meant staff might not be using clinical assessment tools consistently across a patients’ pathway or as recommended by current best practice guidelines and standards.

The preoperative assessment team identified patients who required reasonable adjustments and communicated this with relevant teams. In 3 reasonable adjustments forms we reviewed, patient needs were identified early in the perioperative journey and where possible patients were supported to advocate for themselves. Each department had their own stock of resources, enabling staff to tailor adjustments at each stage of the patients’ care journey. Staff could describe incidences of patient care, where they were able to provide individualised support to patients with autism or a learning disability.

Staff understood how to identify individuals with communication or information needs and the services’ expectations for meeting the accessible information standards. The service had installed hearing loops across the hospital to provide assistive support for people with hearing needs. Staff could describe how to use the live translation tool, to enable effective communication, with patients who did not speak English.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. When national guidelines were updated, leaders reviewed these against current practice to ensure the service remained compliant.

Patient selection criteria had been set according to national guidelines on mortality risk indicators appropriate to a service delivering planned surgery. Leaders reviewed these at multidisciplinary meetings to ensure this remained appropriate to the service. This ensured that patients accessing care at this service had been screened and considered to have needs which could be met.

Although the service assessed patients’ nutritional status and frailty, there were no formal arrangements for dietician or nutritionist advice. However, there was informal support available from the nearby NHS Trust. Despite this, patients who may require support at short notice might not receive the nutrition and hydration support they need. There were no incidents of harm identified by the service due to this.

Leaders reviewed local audits monthly to monitor whether staff followed best practice guidelines. These covered areas like infection prevention and control, health and safety and safety checklists. Staff were observed to undertake the World Health Organisation safety checklist effectively. There was a good culture of speaking up and challenge to ensure high standards were maintained.

The service submitted data to national databases like the National Joint Registry and had achieved a gold quality data provider award in 2024. The most recent quality indicators recorded between 2023 and 2024, indicated the service was performing better than peers in most quality measures.

The service ensured care and support was planned well, with patients at the centre of discussions. During pre-assessment, the service identified patients with complex needs or who lived alone. Occupational therapists worked with patients to assess and plan for ongoing support that might be needed at discharge. Information was shared across teams, promoting a multidisciplinary approach to patient care. This meant patients identified to have needs that could not be met at this service, could be referred to an appropriate service earlier.

Patients who were identified as unsuitable candidates at initial screening or pre-assessment, were safely handed over to relevant care providers. There were clear processes outlined for each route of referral into the service. This identified when the service began to hold responsibility for organising and delivering the patients’ care pathway. Clerical staff initiated inter-provider transfer when patients needed to be redirected from this service to an NHS or other private service. If the service rejected a patient referral, staff confirmed this with the patient and their GP surgery by telephone and confirmation letter. This ensured patients were not lost in the referral process.

The service supported people to live healthier lives and where possible, reduce their future needs for care and support. Patients were signposted to smoking and drinking support services in line with national guidelines.

Patient education booklets and videos were provided to patients who were having a joint replacement. The booklet contained information about what patients could do to prepare for surgery and how this might impact them. This meant that patients were informed of what to expect at each stage of their healthcare journey and could begin practicing physiotherapy exercises to optimise them for surgery. After orthopaedic operations, staff gave postoperative advice leaflets to patients and shared post operative protocols with relevant community therapy providers.

The service routinely monitored people’s care and treatment to continuously improve it. Patients were asked to fill out questionnaires before and after surgery to determine whether their care had led to improvements in their quality of life. Leaders used local and national patient outcomes data to measure whether the service was performing well. Benchmarking exercises were undertaken against the local NHS Trust to monitor any variations in patient reported outcomes. When the service did not perform so well, leaders investigated why this occurred and what could be done to improve.

The service achieved Getting It Right First Time (GIRFT) accreditation as an elective surgical hub in 2023 and Joint Advisory Group accreditation in 2016. GIRFT is a national programme designed to improve the treatment and care of patients by reducing unnecessary variations in services. Staff and leaders have continued to maintain these high clinical and operational standards. Leaders collaborated with external stakeholders and GIRFT to develop and deliver a same day discharge pathway for patients having joint replacement surgery. Staff worked together to identify barriers to successful implementation. Outcomes monitoring between April 2022 to June 2024 showed that average length of stay decreased from 2.3 to 1.1 days. Suitable patients had faster access to joint replacement surgery, were able to mobilise early and be discharged home on the same day as surgery. This reduced the risk of certain postoperative complications related to inpatient stay, like venous thromboembolism.

The service had been working towards the Anaesthesia Clinical Services accreditation, although this had not been achieved yet. This is a voluntary scheme which evidences the services’ commitment to quality improvement through benchmarking against nationally recognised standards.

Policies in use to support consent did not always reflect current best practice standards. The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff and leaders were able to explain what informed consent meant and shared examples of when patients were supported to advocate for themselves.

Various policies covering consent, the mental capacity act and deprivation of liberty safeguards had not been fully reviewed in several years. The consent policy did not include the best practice standard for cosmetic surgery regarding patient reflection. For cosmetic surgery, the Royal College of Surgeons recommend a minimum cooling off period of 2 weeks between the patient’s decision to give consent and surgery. This meant cosmetic surgery patients might not have sufficient time to allow reflection on their decision. On the services’ website, the service encouraged prospective patients to consider carefully, but the expected minimum standards were not made clear. However, patient information leaflets for patients seeking cosmetic breast surgery provided details of the 2-week minimum cooling off period. Following inspection, leaders reviewed cosmetic surgery records between October and December 2024. They were assured that all patients were provided with cooling off periods of greater than 2 weeks. The service's website was also updated to include this information.

However, there were effective systems and practices to ensure that patients understood information about care and treatment options. Following consultation, staff shared information booklets and copies of clinic letters with patients, so they had the appropriate resources to make informed decisions. Patients told us they ‘did not feel rushed and felt listened to'.