Spire Little Aston 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

The service had a determined focus on ensuring that people’s needs, preferences and aspirations were fully recognised and met. Staff ensured that the patient, their families and carers were equal partners in the assessment of their needs. Patients were confident that what mattered to them had been accurately captured and meaningfully reflected in their care plans.

People received a range of care and treatment options that were based on substantiated evidence and were responsive to their individual needs, preferences and aspirations. There were rigorous, inclusive and evidence-driven systems that continually enhanced patient’s care and treatment.

Staff were empowered to participated in quality improvement programmes and developed and share innovations with other services, both locally and nationally.

Outcomes for patients who used services were consistently better than expected, when compared with other similar services. There are comprehensive, effective, and inclusive approaches to monitoring and improving, treatment and outcomes.

Staff worked proactively to enable equally good outcomes for all by recognising barriers that prevented this. They act on information by taking purposeful steps to listen and respond to patient’s experiences of discrimination or inequality. They allocated resources and embedded continuous learning and innovation to reduce inequalities in outcomes.

The service used audits, benchmarking, and quality improvement initiatives creatively and innovatively to support consistent improvement in outcomes. Opportunities to participate in benchmarking and peer review were proactively pursued, including participation in approved accreditation schemes.

The service’s high performance was recognised by credible external bodies and was shared to inspire improvement on a local and national scale. Continuous improvement and evaluation were embedded throughout the service.

Care and treatment were delivered in line with national guidance and evidence-based practice. Multidisciplinary working was strong. Staff worked effectively across teams and with specialty services, which supported positive patient outcomes.

Staff made sure patients understood their care and treatment to enable them to give informed consent.

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.

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

The service made sure patients’ care and treatment was effective by comprehensively assessing and reviewing their health, care, wellbeing and communication needs with them. Patients were involved in the assessment of their needs, and support was provided where appropriate to maximise their involvement.

Staff ensured patients were able to share their individual needs when completing the pre-assessment and admission process. Staff told us about the comprehensive approach to assessing the needs of the patients.

The weekly theatre scheduling meeting ensured all patients were discussed, their needs identified, and care planned such as those with allergies and diabetic patients.

We reviewed 11 sets of patients medical and nursing notes and found these they had a comprehensive health assessment of the patient soon after admission. Care plans were personalised and identified the patients’ needs and how staff could assist the patient. They were updated as necessary.

Risk assessments, such as nutritional needs, falls and moving and handling, skin integrity and pain management were assessed daily and any updates recorded in line with best practice. Patients’ mobility was rated red, amber, green and displayed in the patient’s bedroom for all staff to see. We saw throughout the day as physiotherapy staff worked with patients their risk assessment would be updated. For example, a patients returned from theatre was identified as a red risk when they started to get out of bed and walk with assistance their displayed risk was updated to amber and when they had been assessed to be able to walk independently their risk poster was updated to green.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

Discharge plans were discussed during the patients preassessment appointment as well as on admission to the ward. Staff would also discuss their medicines and provide equipment such as antiembolism stockings when needed. Patients with mobility issues and any patient that had orthopaedic surgery, physiotherapy staff would visit patient prior to discharge to ensure they were safe and had appropriate mobility aids. This ensured patients were aware of discharge dates and arrangements and were prepared to go home.

The service had a transfer policy for any patient that required transferring to an NHS hospital for ongoing treatment. In the last 12 months there had been 15 patients transferred. All transfers were reported as incidents and reviewed by the MAC chair, consultant and anaesthetist involved in the care.

Staff assessed patients’ pain and used recognised tools to do so. Staff gave pain relief in line with individual needs and best practice and assessed how effective this was. Patients’ pain and ongoing prescribed pain relief was addressed before they left the operating theatre.

Pain relief medicines were timed for maximum effect before painful procedures or to allow the patient to sleep at night. Patients told us they received pain relief soon after requesting it and felt their pain was well managed.

The service planned and delivered patient’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 followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The service followed National Institute for Health and Care Excellence (NICE) guidelines. Policies we reviewed were up to date and had been approved by the appropriate governance processes. Staff were able to access policies, processes and guidance easily through the hospitals electronic system. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance to staff. Policies were monitored at a corporate level to ensure they were updated, reviewed and consistent for each Spire hospital. Policies and processes took account of changes to the Royal Colleges guidelines and National Institute for Health and Care and Excellence (NICE) guidelines.

Patients were assessed in line with national and best practice guidelines, and we saw evidence in the patient records that we reviewed. Patients waiting to have surgery were not left nil by mouth for long periods of time. Staff provided patients with information about the requirements for being nil by mouth (which means nothing to eat or drink) prior to their surgery. This was in line with national guidance and was checked as part of the ward checks, perioperative checks prior to surgery and was also audited every 3 months.

Staff fully and accurately completed patients’ fluid and nutrition charts where needed. The information was used to inform care planning and delivery.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition and used this to inform care planning and delivery. Patients requiring special diets for clinical reasons, were assessed and advice given.

The service reported information to the Private Healthcare Information Network (PHIN). Intelligence reports were reviewed by service leaders. These reports contained data on PHIN’s existing performance measures, including patient activity volumes, length of stay, never events, Patient Reported Outcome Measures (PROMs), infections and data submission levels. In addition, it also included complaints data received from private insurers.

There was a corporate audit programme with monthly, quarterly, biannual, and annual audits scheduled. Results were benchmarked with other hospitals within Spire. These were discussed at the weekly Rapid Response meeting, monthly senior management meeting and reported to the MAC. Any audits out of range would have action plans and be repeated more frequently.

Average length of stay ranged from 1.2 to 1.9 days, indicating a predominantly short stay, elective model of car. This demonstrated the hospital had rapid recovery pathways to support faster and effective patient recovery.

The service worked well across teams and services to support patient. Staff shared thorough assessments of patient’s needs when they moved between different services, so patient only needed to tell their story once. Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support.

Pre assessment, in patient ward, theatres, physiotherapy, pharmacy outpatients, diagnostics and administrative staff teams worked collaboratively to make sure patients' healthcare needs were met.

Managers and staff prided themselves on good teamwork and communication throughout the multidisciplinary team. We observed this throughout all areas of the hospital and within surgery.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support.

Teams worked effectively together with the daily hospital wide safety huddle sharing key information between departments around activity and mitigate against any immediate risks for example staff sickness and moving staff when needed.

We observed a ward handover, each patient was discussed including care plans, physiotherapy needs, discharge plans, observations and medication. Staff were allocated patients to care for and tasks to carry out.

There was a weekly theatre meeting during which every patient scheduled to have surgery in the next 7 days was discussed. The meeting was attended by a representative from each department who were involved in the patient pathway to theatre (theatres, ward, diagnostics, preassessment, administration and equipment (including prothesis) stores and was led by the theatre manager.

When patients were transferred back to the ward staff were given verbal and written information on the operations and ongoing care needs.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care. Consultants told us they frequently did this alongside their colleagues in the NHS to consider all treatment options.

The physiotherapy staff visited patients on the ward throughout the day. We saw physiotherapists and nursing staff discussing patient care needs, mobilisation and ongoing plans. The ward displayed staffing levels, the nurse in charge and staff competencies, including those trained in intermediate life support (ILS) and advanced life support (ALS). Safeguarding contact details were also clearly displayed, ensuring staff could easily identify and access key information when required.

During our onsite inspection, we observed staff within theatres working effectively together with clear direction from the lead surgeon and scrub nurse and clear communication with each other.

The hospital had support from specialist teams such as specialist nurses.

Staff told us that patients care and ongoing treatment needs could be discussed at the consultants practicing NHS MDT (multi-disciplinary team) meeting. This included patients with complex care needs and a cancer diagnosis. The hospital had a service level agreement (SLA) with local trusts to provide MDT services. We saw SLA for transfer of patients to local NHS trusts and independent ambulance specialist intensive care transfers when required.

Staff reported healthy working relations across staff groups including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust. Consultants told us about access to other consultants to discuss patient management within the hospital. One consultant told us about speaking to both a consultant cardiology and gastroenterologist about concerns about a patient. They went on to say both their consultant colleagues came to see the patient the same day to give their advice on patient management.

Plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. For example, patients were aware there must be another adult with them for an identified time when they were at home. Discharges were planned at an early stage to ensure they were safe and appropriate for the person’s needs.

Patients’ records showed there was input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways.

When patients were due to move between services, all necessary staff, teams and services participated in assessing their needs to maintain continuity of care. Written and electronic information was shared with other care providers such as the patients GP.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Patients were empowered and supported to manage their own health, care and wellbeing by staff who understood their needs and preferences.

Patients had access to physiotherapy services and other support services to promote people to maximise their wellbeing and independence.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health Patients also said that information including videos in “My Spire” had provided invaluable information.

Information leaflets were available in hard copies and online which included weight management, smoking cessation, mobility and avoiding falls and endometriosis awareness. Patient information leaflets of a variety of conditions and post-operative care were available in different languages. These included wound care.

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

The service’s high performance was recognised by credible external bodies and was shared to inspire improvement on a local and national scale. Spire Little Aston Hospital had been accredited under relevant clinical accreditation schemes. The hospital was a Robotics Centre of Excellence, using a robotic system for hip and knee replacement surgery, British Society for Gynaecological Endoscopy accredited endometriosis centre, Spire Eye Centre, and onsite rehabilitation services. It had achieved NJR Gold Award status (2025).VTE Exemplar Status (national recognition), BUPA Breast Care Centre Macmillan Quality Environment Mark, sterile service department was accredited to national standards for disinfection, assembly, packaging and moist heat sterilisation of theatre trays, procedure packs and supplementary instruments.

The service used audits, benchmarking, and quality improvement initiatives creatively and innovatively to support consistent improvement in outcomes. The service had undertaken a quality improvement project to improve foot drop following total joint replacement surgery. Foot drop as a post operation complication was within expected range, but staff were trying to improve this. Initially in 2025 affected patients were provided with conventional orthotic management. Patient feedback indicated that, despite these interventions, mobility and quality of life remained significantly affected and reported the devices initially provided were uncomfortable, difficult to use, and provided limited functional benefit. In response to this feedback, staff sought specialist advice from a podiatry expert regarding best practice management of foot drop. The recommendation was to consider a different specialist device to manage the condition. To evaluate the impact of the intervention, outcome measures were collected before and after one month of use. The project identified significant improvement to patients’ functional mobility as well as improvement to their quality of life including increased confidence when mobilising, improved ability to participate in work and social activities, reduced fear of falling, fewer trips and falls and greater overall independence. As a result of these positive outcomes, the use of the specialist foot device was incorporated into the treatment pathway for patients who develop foot drop following joint replacement surgery. The service continued to monitor patient outcome data to support continuous service improvement.

Outcomes for patients who used services were consistently better than expected, when compared with other similar services. The hospital participated in national clinical audits and registries (including National Joint Registry (NJR), Private Healthcare Information Network (PHIN), Patient Related Outcome Measures (PROMS), and the Breast Implant Registry to benchmark performance against national standards. Spire Healthcare benchmarks all its services against Spire’s Clinical Effectiveness Framework. Spire Little Aston performed better than most similar services.

The hospital submitted Patient Related Outcome Measures (PROMS), which helped the NHS measure and improve the quality of care patients experienced during and after elective surgery. In the PROMS survey, patients were asked whether they felt better or worse after receiving the following operations hip replacements knee replacements. The PROMS data showed that the hospital was not an outlier and overall, most patients reported an improvement following their surgery.

Hospital reported adverse events at Spire Little Aston Hospital were low, with mortality, returns to theatre, unplanned transfers and readmissions all reported at negligible rates when considered against total activity of the hospital. The service had a low number of unplanned readmissions within 30 days of discharge (0.4% of all patients treated). In the last 12 months 11 patient returned to theatre, 5 patients returned to theatre within the same admission and 6 patients returned to theatre following a readmission. 1 patient was admitted to the NHS and returned to theatre. All returns to theatre were reported as incidents under the NHS Patient Safety Incident Framework (PSIRF). Each incident was reviewed with staff and any lessons learnt shared.

The service submitted data to the National Joint Registry (NJR) which records, monitors, analyses and reports on performance outcomes in joint replacement. The hospital was awarded the NJR’s “Gold” Quality Data Provider Certificate in 2025, for submitting high data quality data and was 100% compliant. Spire Little Aston Hospital was identified as an outlier for NJR (Hip revision) in 2024 (latest 10 years of data). The hospital had reviewed all consultant patient records for revision of hip replacement. Following the review changes were made from the use of uncemented hip prosthesis. The revision rates at five years had improved and were within required limits.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Consent for surgery was sought by the most appropriate doctor and included discussion about the benefits, potential complications, the risks and alternative options. Patient consent was checked at various points before they went to the operating room and immediately prior to surgery. There were consent audits completed and outcomes shared with staff.

Patients received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Patients we spoke with told us they received enough information to give their consent for procedures.

Patients said they were involved in decision making about their care and treatment. They could describe the risks and benefits they were told about prior to surgery. Relatives said they were kept informed about the care and treatment of their family member when they lacked capacity to consent to surgery. Interpreters were available to support patients to give informed consent if needed, including for British Sign Language, and face to face interpreting when necessary.

We reviewed 11 consent forms and found they were all completed correctly and had the relevant details and risks identified.

Staff understood the Mental Capacity Act (MCA) and their responsibilities when assessing capacity to consent. Staff recognised that a patients’ capacity may change due to the nature of treatment and their clinical condition, so they ensured that capacity was assessed at each interaction. Staff followed the services policies related to consent, mental capacity and restrictive practice, as relevant. 100% of staff had completed training on MCA and DoLS.