The Hampshire Clinic

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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

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

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.

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.

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

Patients told us they had a pre-operative assessment prior to admission to the service. Patients described being actively included in the assessment. They said 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.

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

We looked at the care records for 10 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 consistently completed timely and comprehensive individual health and risk assessments at or shortly after admission, with documentation initiated during the pre-operative assessment. Risk assessment tools such as moving and handling and Venous Thromboembolism (VTE) were used for all patients who needed them. Records showed risk assessments and care plans were routinely reviewed.

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.

Patients received care according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and Royal College of Surgeons (RCS) guidelines. Policies and standard operating procedures (SOP) supported evidence-based practice and standards.

Patients said staff carried out regular monitoring and observations and they received good care and treatment. Patients said staff asked them if they had any pain during and after their surgery. Staff checked pain levels using a pain scale of 0 to 3 (zero being no pain and 3 being the most severe). Patients 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 10 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.

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.

Patients’ nutritional needs were assessed as part of their pre-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 had meal options to choose from during their stay, which met a range of specific dietary needs. These were offered flexibly around their medical needs and care. For example, we observed housekeeping staff offer a variety of options for breakfast and preference on time to allow medications to be administered. Patients told us they were given clear advice on what to eat and drink prior to surgery.

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.

Patients spoke positively about the way their care and treatment had been 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’ daily 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 described a good relationship with consultants, resident doctors, pharmacy and allied health professionals, such as physiotherapists. Staff were able to request and receive medical advice in a timely manner. Healthcare assistants told us they received good support and worked well with the nursing staff and the managers.

There was 24 hour medical cover with a resident medical officer (RMO) on site. The medical and nursing staff worked together to provide safe care that met people’s individual needs. For example, we observed a request for a repeat blood test to be taken by a nurse and the RMO facilitated the request without delay.

Patient records showed, and we saw, 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.

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 conducted health screening at the pre-assessment stage to ensure that patients’ health was optimised prior to elective surgery. For example, deficiencies in iron were addressed with supplements.

Where patients lived independently but may need support on discharge, this was identified pre-operatively to ensure people had the required support necessary for a safe and timely discharge.

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

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.

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.

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 routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. Staff identified deteriorating patients using tools such as the national early warning score 2 (NEWS2).

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.

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.

Patients said they were pleased with their rate of recovery and told us they had been fully informed about the recovery process and what to expect. They told us they had received after care support from both consultants and physiotherapists.

The service monitored clinical indicators and performance standards for patient safety, infection prevention and control (IPC), incidents, patient experience, audits and staffing. The service used this data to benchmark themselves 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 had a comprehensive audit programme that included audits for venous thromboembolism (VTE), falls, nutrition, hydration, fasting and NEWS2. The service shared audit results at team meetings and audits had associated action plans to drive improvement.

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.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

The hospital had a consent policy which outlined all staff’s roles and responsibilities. This was in line with national guidance and legislation, such as the Mental Capacity Act (2005).

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 understood how to obtain informed verbal and written consent from patients before providing care or treatment and had received training for this. Staff took all practical steps to enable patients to make their own decisions. Consent for sharing information with the patient’s GP and other health care professionals involved in their care was obtained and documented within the care record booklet.

Pre-assessment staff would confirm patients’ understanding of the procedure and surgical site corresponded with details on the booking form. Where concerns for a patient’s capacity was identified, staff would apply the Mental Capacity Act principles and this was supported by the local policy.

Staff were aware of the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty 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 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.