The Priory 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

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 as good. At this assessment the rating remained the same. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The electronic system used at the service flagged patients with additional needs. Staff completed risk assessments for each patient on admission and reviewed this regularly.

Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice. Staff utilised a paper based visual pain scoring tool. Patients received pain relief soon after it was identified they needed it, or they requested it. All patients were assessed in respect of their pain management. This included observing for the signs and symptoms of pain.

They had standardised patient pathway booklets which prompted staff to update risk assessments daily following surgery. Nursing staff used nationally recognised tools to assess patient’s risk of developing pressure ulcers, malnutrition, falls, as well as risks associated with moving and handling.

Records were up to date and showed comprehensive assessments undertaken leading to effective ongoing care.

Patients were given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally.

An enhanced recovery programme (ERP) had been introduced 6 weeks prior to our assessment. An ERP is an evidence-based approach to improving the recovery process after a major surgery. Pre-operative staff and physiotherapists saw patients on the same day to ensure they had equipment in place prior to discharge. Patients had a functional rehabilitation prior to their procedure which included postoperative management advice and physiotherapy equipment such as crutches.

Regular multidisciplinary meetings were held to discuss patients and improve care. Staff collaborated across healthcare disciplines and with external agencies.

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.

Staff gave people clear information about their care and treatment needed to support both their physical and mental health. People felt their expectations and needs were considered during decision-making. People told us staff provided nutrition and hydration that matched their needs.

There was a scheduled comprehensive auditing programme. The content of the specific audits, such as surgical site infection or infection prevention and control were aligned to measurable outcomes of NICE guidance. Where there was non-compliance or inconsistency raised by audit data, learning was implemented, and outcomes monitored. Audit outcomes were reviewed at relevant clinical governance committees by leaders and key stakeholders.

Leaders told us they were assured safe and effective care was being delivered as they undertook benchmarking exercises and participated in local and national audits. They were confident staff embodied the organisational values and were passionate about ensuring they were kept updated of any emerging changes.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was a daily huddle for all heads of departments and the senior management team to share any risks with their service. The teams worked together to prepare patients for what to expect post-operatively and when they returned home.

We saw evidence of good support with staff working as supernumerary for the first 2 weeks. Staff had online and face to face opportunities for career development including leadership courses.

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, reduce their future needs for care and support.

Patients attended pre-operative assessment appointments where their suitability for surgery was checked. This included the completion of a health questionnaire, and an opportunity for the nurse to provide advice or refer patients on to other appropriate services if they required.

The service encouraged people to join the ‘Big Circle Move’ challenge for 30 minutes every day from June to July 2024. The move and the ‘Big Circle Talk’ highlighted the importance of looking after mental health, physical activity and well-being.

The Priory hospital offered free 30-minute physiotherapy consultations for patients experiencing musculoskeletal concerns. People were encouraged not to let pain hold them back and to book their free consultation to receive expert assessment and advice on treatment options. It was a great opportunity to discuss conditions with a specialist and explore potential solutions tailored to individual needs.

A small hydration station was available for staff and patients to use in theatres. Patients who were able to eat and drink were offered a drink and biscuits before leaving theatre recovery area.

The service routinely monitored people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Managers and staff carried out a programme of repeated audits to check improvement over time. Managers used information from the audits to improve care and treatment and they shared and made sure staff understood information from the audits.

The service participated in relevant national clinical audits, which they generally performed well in. Managers used the results to improve services further. Patient-Reported Outcome Measures (PROMS) cumulated activated procedures from May 2023 to December 2024 was 857 with a total of 96% improvement rate for hip replacements and 95.5% improvement rate for knee replacements. These were better than the NHS average of 95.8% for hip replacements and 93.3% for knee replacements respectively.

The standardised mortality ratio (SMR) indicator showed the expected number of mortality events within 90 days following surgery against the observed number of mortality events. The indicator was based on the latest five years of data submitted to the National Joint Registry (NJR). The SMR for the service was at 99.8% which was inside control limits. The NJR routinely collected shoulder PROMs data using the Oxford Shoulder Scores tool. In 2023, a total of 15 shoulder procedures were carried out. The compliance rate achieved for the latest three completed annual Data Quality Audits was 100%. The compliance rate is calculated by comparing the number of procedures in the NJR to those contained in hospital or theatre systems. In addition to providing the compliance rate achieved, the report also includes the number of missing procedures.

From January to December 2024 there were 30 unplanned return to theatres, 19 unplanned transfers from February to December 2024 of which 6 patients were transferred due to clinical deterioration, 3 due to surgical complication, 9 patients for other reasons and a patient due to resuscitation.

From January to December 2024, there were 40 unplanned readmissions within 28 days of discharge at NHS trust or hospital within the last 12 month. Staff recorded readmissions as incidents, and readmissions were mostly due to post-operative complications.

The service had introduced an app to help patients record their pain levels. The patient's profile was linked to a staff member's email address. Staff monitored these and responded to patients as required.

The service did not undertake a separate sepsis audit as this was built within the incident reporting system. Any incident relating to escalation of patient deterioration or suspected sepsis automatically triggered questions following sepsis 6 and if the bundle had been completed. However, staff carried out NEWS2 score audits regularly to ensure there was regular monitoring in place for recording and escalation of patient's vital signs.

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

People felt supported by staff, who took time to explain treatment and decisions. Staff were sensitive and knowledgeable when giving updates to families.

Staff obtained consent for care and treatment, ensuring informed decisions. They made sure patients consented to treatment based on all the information available. Staff understood how to assess a patient’s capacity to make decisions.

The service introduced a digital consenting platform which provided consultants with a wide autonomy of procedures which they were able to consent from in November 2024. The digital consenting platform included indications, purpose, alternative, risks and anaesthetic options. All templates were fully customisable, giving consultants a way to ensure consent was fully informed with the patient. The system allowed patients to have the opportunity to either consent in clinic with the consultant or have it sent to them so they could remotely consent, once they had looked through the information provided to them, before finally re-confirming consent on the day of surgery.

Consultants consented their patients in clinics and on the day of admission. In the period from 2023/2024, the consent rate of cases submitted to the NJR with patient consent confirmed for Priory hospital was 99% which was better than the national average of 92%. The benchmark figure was 95%.

Staff received Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training. They understood relevant consent and decision-making requirements. Staff knew how to access policy and advice on these topics. Managers monitored compliance with the MCA and made necessary changes. Patients who lacked capacity were identified during the pre-operative assessment process, where it was determined whether they could be admitted for treatment at the hospital.