Rivers Hospital

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this registered service. This key question has been rated good.

We looked for evidence that people and communities 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.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 9 care records and found inconsistencies in the documentation of assessments completed by consultants. Two of the 9 records did not contain any documented assessment. This meant people’s needs were not always fully or clearly recorded. Missing records increased the risk that other clinical staff may not have the information they needed to provide safe and effective care.

We also found that information security and clinical record‑keeping policies were out of date. This further reduced assurance that assessment and documentation standards were clear and consistently followed across the service. Staff told us this issue had been identified previously, and leaders had introduced a new standard operating procedure to improve documentation. However, staff said compliance among consultants remained inconsistent at the time of our assessment.

Following inspection feedback, the provider took action to address these concerns. Leaders issued a communication to all consultants reminding them of their responsibility to share clinical records with the hospital in a timely manner. The provider also scheduled a full audit of outpatient records to identify any remaining gaps in documentation and to target improvement actions where required. In addition, record-keeping compliance was added to the agenda of the next Medical Advisory Committee meeting to strengthen oversight and accountability.

Where care records were completed, they included personalised care plans. Documentation completed by other clinical staff was comprehensive and recorded in a timely way, which showed that good practice was in place in parts of the service.

We scored this quality statement 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service provided a range of consultant‑led specialist clinics, supported by nurses and healthcare assistants. It also had a physiotherapy service that accepted self‑referrals as well as pre‑ and post‑operative patients, which helped people access timely support.

Staff told us they regularly reviewed how services were delivered and identified opportunities to improve care. This had led to service developments, including the introduction of an ‘integrated holistic back school rehabilitation programme’. This programme formed part of the aftercare for patients receiving spinal injections.

Staff redesigned care pathways by moving ankle injections from an inpatient setting to an outpatient procedure. Leaders planned for experienced surgical nurses to train and support outpatient staff, which helped maintain safe and effective practice as services changed.

Staff told us that appraisals were not always completed on time due to recent staffing pressures. At the time of our assessment, the appraisal completion rate was 80% which was below the providers target of 85%. Leaders told us that staff sickness absence had affected appraisal completion and that the return of staff from sickness absence, together with the appointment of a deputy manager, would increase management capacity and support improvements in appraisal compliance.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff supported several hundred patients each day, with clinics often running into the evening. Consultants worked with practising privileges and had their own administrative arrangements, including personal secretaries. Staff told us this meant that clinics could change at short notice, sometimes with large numbers of patients added the day before. Despite this, staff told us they were able to accommodate changes and there was no identified impact on patient care or clinic delivery.

Staff told us they worked flexibly with consultants to accommodate these changes to ensure clinics continued to run. Staff described adapting quickly to revised clinic lists and supporting patient flow to maintain effective care. However, they told us that frequent late changes created inefficiencies and increased pressure on hospital staff.

Staff also told us that clinics sometimes overran significantly and at times did not finish until close to 10pm. This had been identified as an ongoing issue. Leaders had introduced a process whereby late-running clinics were reported as formal incidents rather than recorded informally. This improved organisational oversight and enabled the service to identify trends and understand the impact of extended clinic times on staff and service delivery.

We scored this quality statement 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff provided people with information and advice relevant to their treatment and ongoing care. This helped people to understand their condition and make informed decisions about their health.

We scored this quality statement 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service collected patient satisfaction feedback to monitor outcomes. Data showed that 92% of patients said they would recommend the service to friends and family. The physiotherapy department also collected patient‑reported outcome measures to track improvements in people’s conditions and assess the effectiveness of treatment.

Staff used daily medical alerts to stay aware of new or emerging risks to patients. This information was shared across teams, including pharmacy, therapy services and allied health professionals. Staff told us this helped teams adjust care plans promptly to support safe and effective care.

We scored this quality statement 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained patients’ consent for their care and treatment in line with national guidance and local policies. Information was provided to patients when surgery was recommended as part of their treatment pathway, which supported informed decision-making about future care. During our assessment, we observed staff seeking verbal consent before providing treatment.

We spoke with 5 patients who told us they were involved in decisions about their care and treatment. They said staff explained treatment options clearly and provided information in advance of appointments to help them make informed choices.

The service had access to interpreters, including British Sign Language interpreters, and used these when needed to support patients to understand information and give consent.