The Droitwich Spa 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 people’s care, treatment and support achieved good outcomes and
promoted a good quality of life, based on best available evidence.
At our last assessment we rated effective as good. At this assessment, the rating has remained the
same as 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.

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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff promptly identified and assessed people’s needs prior to surgery through structured pre‑operative assessment processes. This included multidisciplinary assessment delivered through the service’s joint replacement “Joint School,” where staff assessed people’s mobility, pain management needs, social history and anticipated post‑operative support requirements, such as the need for walking aids or raised toilet seats. These assessments supported effective planning of care and equipment needs before admission and helped ensure people understood their procedure and recovery.

Patients gave consent at each stage of treatment, including pre‑operative assessment and on the day of surgery, and people we spoke with told us they felt well informed about expected outcomes and risks.

Patients could access pain support. Staff identified and assessed people’s pain using recognised tools and provided pain relief in line with individual need and best practice.

We reviewed a sample of patient care records from wards and theatres. The records demonstrated that staff had assessed people’s individual health, wellbeing and social needs, including medical history, rehabilitation requirements and home circumstances, which informed discharge planning and post‑operative support.

Where risks were identified, staff carried out individual risk assessments and put care plans in place. Records showed that risk assessments and care plans were reviewed as people’s needs changed, supported by multidisciplinary working between nursing and physiotherapy staff.

Staff used the NEWS2 system and had received appropriate training. They carried out routine monitoring based on people’s individual clinical needs to ensure any changes in medical condition could be promptly identified.

Staff also used intentional rounding to review people’s comfort, hydration and support needs. Leaders monitored compliance with NEWS2 assessment and documentation, which provided assurance that deterioration could be recognised and escalated appropriately.

We scored the service as 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 planned and delivered people’s care and treatment in line with current legislation and nationally recognised evidence‑based good practice. Care was delivered consistently and supported good patient outcomes.

Staff followed up‑to‑date policies and applied recognised best practice guidance in day‑to‑day care. For example, staff consistently completed the World Health Organisation (WHO) surgical safety checklist for all patients undergoing surgery, which we observed being carried out appropriately during theatre activity. This supported effective communication, shared decision making and patient safety throughout the peri‑operative pathway.

The service worked effectively with external partners to support evidence‑based care delivery. Managers and staff described positive working relationships with local acute and mental health Trusts, enabling access to specialist advice and continuity of care when patients transferred between services.

Clinical leaders demonstrated oversight of national guidance and best practice standards. For example, Getting It Right First Time (GIRFT) recommendations for total primary hip replacement had been embedded into local clinical pathways at Droitwich Spa Hospital. In addition, the hospital was awarded gold level status as a National Joint Registry (NJR) quality data provider in November 2025, providing national assurance of high-quality data submission and alignment with recognised standards.

The theatre service had been re‑awarded Association for Perioperative Practice (AfPP) Theatre accreditation in February 2025, providing independent assurance that care and practice met recognised perioperative standards. The ambulatory theatre had also been re‑awarded Joint Advisory Group (JAG) on Gastrointestinal Endoscopy accreditation in November 2025, providing further independent assurance that endoscopy services met nationally recognised quality and safety standards.

The service routinely monitored the effectiveness of care and patient recovery. Staff used a patient outcomes dashboard to track recovery following procedures, including pain reduction, symptom improvement and infection risk. Patient Reported Outcome Measures (PROMs) data were within the expected national range, assuring that patients achieved good outcomes from their treatment.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Teams had effective working relationships, including good handovers with other teams within the organisation, which included wards, theatres, recovery areas, imaging, physiotherapy and administrative teams. Structured handovers, daily huddles and meetings known locally as “comms cell” meetings focused on clinical detail, anticipated needs and risk awareness, supporting smooth and coordinated transitions. Comms cell meetings were structured, multidisciplinary coordination meetings, bringing together clinical, operational and administrative leads to review patient flow, staffing, theatre activity and emerging risks, and to support timely decision‑making and escalation where required.

The multidisciplinary team included doctors, nurses, resident medical officers and physiotherapists. The hospital undertook surgery over the weekend; theatre leads and ward managers planned adequate senior staffing and resources to support this. This process worked well to anticipate gaps and prevent a lack of resources during or after surgery. Senior staff were on call out of hours on a rota basis, and a resident medical officer was always available on-site.

We saw theatre staff work together to complete the safer surgery checklist and prepare patients for surgery. Patient records showed routine and coordinated input from nursing and medical staff, as well as allied health professionals. Nurses and physiotherapists worked closely together to deliver multidisciplinary rehabilitation and recovery care informed by patients’ clinical and social needs.

Staff worked across healthcare disciplines and with other agencies when required to care for patients. Ward staff liaised with hospitals, general practitioners, community services and social services when coordinating discharge, ensuring care was continued when people moved between services.

We scored the service as 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.

The service had relevant information promoting healthy lifestyles and support on the ward. For example, information was available to people about post‑operative care and recovery.

Patients completed a health questionnaire prior to treatment, which staff used to identify health concerns and tailor care appropriately. Staff gave people relevant health information and materials, and the pre‑screening programme included the Joint School, which provided structured education to support preparation for surgery and recovery, as outlined further in the outpatient’s report.

Following surgery, patients were supported by the multidisciplinary team to optimise recovery. Physiotherapists visited the ward and provided post‑operative advice and exercises to help people regain mobility and confidence and support their recovery.

We scored the service as 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.

Staff routinely monitored patients’ health following surgery, including the use of the National Early Warning Score (NEWS2), which supported the early identification of deterioration and timely clinical response.

Patients told us they experienced positive outcomes following surgery, including improved mobility and a return to daily activities. They described being well informed about recovery and what to expect following treatment.

The service routinely monitored performance through a structured programme of clinical audit activity. These included audits relating to venous thromboembolism prevention, falls, nutrition, pain management and the use of NEWS2. Findings were reviewed and used to identify areas for improvement and inform changes to practice.

The service produced an annual audit report, which was shared with staff and patients. This report summarised audit activity and compliance across the year and identified actions taken to improve performance. This demonstrated that audit findings were reviewed systematically and used to drive continuous improvement in care and patient outcomes.

Staff shared audit findings and learning through team meetings, and managers implemented action plans where improvements were identified. This supported a consistent approach to improving care and maintaining positive patient outcomes.

We scored the service as 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.

People told us staff explained their planned treatment, including risks and benefits during pre‑operative appointments and Joint School sessions prior to treatment. People said staff encouraged questions and provided clear explanations.

Staff had the appropriate skills and knowledge to seek consent from people. Staff were clear on how they obtained verbal informed consent and written consent before providing care or treatment. Consultants and anaesthetists sought consent during pre‑operative assessment and again on the day of surgery.

Staff had received training in and understood how to obtain informed verbal and written consent before providing care or treatment. Staff knew the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, which were included within safeguarding and mandatory training. Staff described how best interest decision‑making would be supported where people were unable to give consent.

Staff recorded consent in people’s records. However, some consent records did not clearly record risks or alternatives, and interpreter support was not always arranged early in the pathway for people with limited English proficiency.

Staff followed the local policy for consent to examination or treatment, which provided guidance when required. Staff could seek advice from managers and safeguarding leads if needed.