Spire Norwich 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.
At our last assessment this key question not rated. At this assessment we rated this key question as 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 people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.
We reviewed 5 patient care records, care needs were identified, risk assessments for falls, Venous Thromboembolism and pressure ulcers were completed where applicable. If a patient had completed a pre assessment questionnaire and additional requirements were identified before the appointment support was put in place. For example, staff and the head of department told us if a patient required the use of a hoist because they could not stand, arrangements would be made for their appointment to be completed on one of the wards of the main hospital where lifting aids and a hoist were available.
Communications needs were supported by the service. Information relating to an interpreter service, written in different languages, was displayed around the department for people who did not speak English. Hearing loops and a neurodiversity box that contained ear defenders and fidget toys were available. Staff had received training in Learning disabilities, autism and dementia. People could also request the use of a quiet room.
Wheelchairs were in the entrance of the department for people with mobility issues. Staff were observed assisting people from the waiting room into the consultation and treatment rooms.

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 department participated in clinical audits and quality improvement initiatives. Out of 16 audits completed in the last 12 months 15 achieved over 95% compliance. An audit relating to consultant documentation achieved 88% compliance. Action plans were developed for this to be discussed at the Medical Advisory Committee (MAC). Heads of Departments reminded consultants of the importance of completed documentation.
Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the people they were treating. Staff said they worked well together as a team, got to know the consultants, building a rapport that aided with the care and treatment people received.
Clinicians worked within their clinical scope of practice; staff said if they were presented with something outside of their clinical scope of practice they would request assistance from a colleague with the required training and skills to treat the patient.
We spoke to patients who told us that they felt confident in the treatment they were receiving and the knowledge and competence of the staff treating them.
Staff used national tools National Early Warning Scores (NEWS2) and Paediatric Early Warning Scores (PEWS) when treating patients to aid them in observing any deterioration in their health. They also used National Institute for Health and Care Excellence (NICE) guidelines to assist with the decision making and management of patient conditions.

The service worked well across teams and services to support people.
The Director of Clinical Services and the Registered Manager engaged in daily morning meetings with all Heads of departments. Staffing, equipment, patient numbers, incidents, and complaints were amongst the topics discussed across the widespread hospital.
The outpatient’s department had a daily morning safety huddle and briefing. Staffing, expected clinic numbers, learning from incidents or safeguarding would be shared by the head of the department. Staff on a later shift would read the briefing of the daily huddle and sign to acknowledge it.
Learning from incidents and safeguarding was shared hospital wide regardless of department to enable cross department learning.
Every 3 months staff within the outpatient department would rotate around the 3 outpatients’ sites. If staffing within any of the hospital departments was below target, appropriately trained staff would be deployed across the departments enabling good collaborative team working.
Staff we spoke to reported good department and inter-department staff relationships. Staff described the working environment as busy and said that staffing levels usually made the workload manageable.

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.
The department had a health promotion display board. This gave people information to improve their health and wellbeing. The board gave advice on how to get support to stop smoking, reduce alcohol, blood pressure and heart disease, reducing the risk of blood clots, getting active and losing weight. Each health topic had a Quick Response (QR) code that took people to an NHS website.
The board also had information on improving mental health and telephone numbers to call for urgent support if a person was in a mental health crisis or contemplating suicide

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.
Clinic lists were printed daily for staff to refer to. This enabled staff to monitor appointment times and the potential for clinic overruns. Patients were updated of any delays in appointment times with significant clinic overruns being reported as an incident. Patients were always seen unless they chose not to stay for the late running appointment, in this instance a new appointment would be rebooked.
The department also had signage for patients to inform the receptionist if they were waiting 10 minutes longer than their arranged appointment time. This was an initiative put into place after a patient waited a considerable amount of time to be seen as the consultant was not aware they had arrived. There were no reported incidents of patients waiting longer than 30 minutes for their appointment in the last 12 months.
There were 4 instances over the last 12 months where clinics started late. All patients were seen.
Staff would monitor the recovery of patients following minor surgical procedures in the department. If a patient felt well they would be discharged home with a “minor op post procedure advice” leaflet with telephone contact numbers for the department and hospital and advice to call 111 or 999 if necessary. If a patient felt unwell following a minor surgical procedure they would stay in the treatment/recovery room. Staff would use equipment to monitor them, responding to observations to achieve a positive recovery outcome.
Staff told us changes in observations could indicate changes in a patient’s condition, and they would get the consultant who performed the procedure to review the patient. Monitoring would be continued until the patient improved. If patients did not approve they would follow the deteriorating patient algorithm and if needed call 999.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.
The service had a consent policy that staff had access to, which gave information and guidance around gaining consent. Information regarding consent and best practice was displayed around the department.

Staff understood the importance of obtaining consent before delivering care and treatment, ensuring that people fully understood what they were consenting to. Consent was gained verbally and in writing. The service had consent forms that patients signed. The form had a place for recording the signature of an interpreter if one had been used to help with the gaining of consent. There was also a section on the form to record when consent was withdrawn should a patient no longer want to go ahead with a procedure.
We observed verbal consent being taken and written documentation in patient care records.
Staff in the department had completed training in the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLs) with a compliance of 85%.
Staff and consultants said that if they were concerned about the capacity of a patient they would call in a second member of staff to aid them with a capacity assessment. Following this, discussions would be had for a best interest decision to be made for the patient regarding their care and treatment.
Patients we spoke to told us that consent was gained at their consultations; they were given time to discuss any concerns and understood what they were consenting to.