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.

We looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient 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. This meant patient’s outcomes were consistently good, and patient’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 usually made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

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.

Staff with appropriate seniority had discussions about the patients’ preferences and wishes if their condition deteriorated. Decisions about care were made with consideration of wishes of the patient and/or their family.

A “door sign communication” tool was devised by the governance team in conjunction with physiotherapists, occupational therapists and the director of clinical services, to support staff in understanding patients’ needs regarding their risk of a fall. Staff assessed patients’ pain and we observed positive staff interaction with patients when addressing pain needs.

We saw patients were generally calm, their faces appeared relaxed, and they were moving around comfortably, suggesting that they were not in significant pain. There was support available from the anaesthetist when a patient had complex pain needs.

The service usually 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. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and newsletters.

Polices and processes took account of changes to the Royal Colleges guidelines and National Institute of Care and Excellence (NICE) guidelines.

The organisation had a cosmetic intervention policy. Compliance for the cooling off period of 2 weeks from consent to procedure for cosmetic surgery over the last 6 months was 100% (target 95%).

We reviewed 5 care records on the wards for evidence of completion of care plans and risks assessment of patients and found all had been completed. In theatre, 5 care records were also reviewed and were completed satisfactorily. Patients waiting to have surgery were not left nil by mouth for longer than necessary. Intravenous fluids were used to ensure pre-operative optimisation for emergency surgery, when necessary. Patients were monitored for potential deterioration and sepsis using the national early warning score (NEWS).

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.

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 experience, never events, Patient Reported Outcome Measures (PROMs), infections and data submission levels. In addition, it also includes complaints data.

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

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

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.

Plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Discharges were planned to ensure they were safe and appropriate for the person’s needs.

Information was shared between teams and services to ensure continuity of care. Multidisciplinary reviews and meetings were held for some specialities, for example an admission assessment meeting was held to discuss patients who had been identified from pre-assessment and required support. Patients who had early onset dementia would typically be discussed to plan for their care needs. Also, staffing for enhanced recovery of patients was planned in advance.

We viewed examples of 5 patients who had been reviewed by a multi-disciplinary team who did not meet the admission criteria for surgery following the pre-operative assessment standards. This provided assurance that the healthcare team worked together to plan to optimise the patients care and treatment.

Peoples’ 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.

The service generally 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.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control. Staff supported them to live healthier lives and where possible, reduce their future needs for care and support. For example, for joint replacement surgery patient's. A session was held to inform patients on what happens on the day of surgery, how to prepare for joint replacement surgery, what to bring to hospital and details of after care and on-going recovery.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. For example, pre-operative patients who were undergoing joint replacement surgery were encouraged to be physically fit and strong. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health.

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

Staff monitored the effectiveness of care and treatment through audit and benchmarking to compare with other similar services. The service used the findings to make improvements and achieved good outcomes for patients. The service participated in relevant national and local clinical audits at varying frequencies. For example, sepsis audit (quarterly), venous thromboembolism audit (monthly) and reducing surgical site infection (bi-annually).

The service had a low number of readmissions for patients having elective care within 31 days of discharge i.e. 20 patients over the period March 2025 to March 2026. The number of returns to theatre for unplanned/unexpected reasons was 11 over the same period. Only 1 return to theatre was graded as causing moderate harm. There was assurance of comprehensive review of these events with learning and improvement actions taken in response to risks.

The surgical site infection rate was reported elsewhere in the report for national mandatory surveillance but for those not included in this surveillance there were 12 superficial infections for general surgery and 1 for urology reported over the period March 2025 to March 2026.

The endoscopy service was working towards Joint Advisory Group (JAG) accreditation. The hospital was also a National Joint Registry Quality Data provider and was awarded the Joint Registry’s “Gold” Quality Data Provider Certificate in 2025.

The service monitored and reacted to avoidable deaths and harms. All deaths underwent an initial case review and then reviewed by an Associate Medical Director. A structured judgement review (SJR) was completed and presented to the corporate mortality committee. Learning points and improvement actions were put in place.

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

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff followed the services policies related to consent, mental capacity, deprivation of liberty and restrictive practice, as relevant.

Where possible, staff gained consent from patients for their care and treatment in line with legislation and guidance. The hospital has an up-to-date consent policy.

There were consent audits completed and discussion about consent issues at team governance meetings. In the preceding 6 months the consent audit compliance was 96% against a target of 95%.

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.

Chaperones were provided if requested.

Interpreters could be used to support patients to give informed consent.