Spire Portsmouth Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses in line with provider policy. We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. The service had a current provider level incident reporting policy, which reflected national guidance.

Staff reported 218 incidents between 1 May 2025 and 30 April 2026. Most involved pathology sample problems, medicine incidents, skin integrity and infection control. Other themes related to treatment issues, theatre concerns, appointment delays or cancellations. All incidents resulted in no harm or low harm, with one resulting in moderate harm. None met the threshold for a CQC notifiable safety incident.

Following a review of the pathology sample incidents, the service started a project designed to improve rejection rates of mis-labelled samples. This included revisiting training for staff and improved labelling requirements. The project was in its early stages however initial results showing rejection rates were improved.

Staff understood the duty of candour. They could describe when to be open and transparent and when to give patients and families full explanations when things went wrong.

Staff received feedback from internal and external incident investigations. Leaders shared learning widely across hospitals so changes could be implemented quickly and consistently. Staff told us they felt able to speak up when something was wrong.

Leaders shared feedback from the weekly meetings so staff could quickly learn from new risks or incidents both from within the hospital or the wider organisation. Leaders also distributed monthly colleague safety bulletins summarising policy updates and implementation dates.

Duty of Candour training at corporate induction. Duty of Candour requirements were built into the incident management system, which prompted staff automatically when conversations with patients or families were needed. Duty of Candour is a legal requirement that healthcare organisations are open, honest and transparent with patients and their families when care has resulted in a notifiable safety incident. This includes providing a timely explanation, an apology, and information about any subsequent investigation or actions taken.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff worked together to ensure patients had everything arranged for their treatment to avoid delays or cancellations to their surgery. Referrals for treatment were accepted based on individual Spire-wide or consultant-led assessment or triage.

Spire had transitioned to a centralised booking service during the 12 months prior to the inspection. Staff within outpatients described this new process generally worked well. Some of the consultants we spoke with were less positive about the move to centralised booking. They told us it slowed their clinics down which sometimes led to clinics overrunning. This was reviewed and managed as part of a project to improve timeliness of clinics.

The service worked with the local NHS provider and Integrated Care Board to optimise the service they could provide for patients in the local area. Staff within the hospital liaised with NHS colleagues to support access for NHS patients. Hospital staff monitored capacity and utilisation of clinics across outpatients. Spire had developed dashboards to support staff in monitoring capacity and utilisation metrics. Staff told us the dashboards were relatively new but were helpful and useful.

There were processes to ensure high risk patients using the service were carefully planned for to ensure their safety. Pre-operative assessment nurses arranged for all high‑risk patients to be discussed at an Admission Assessment Meeting, with evidence recorded in the notes and tracker. The service worked with consultant anaesthetists and the pre-operative assessment team to provide guidance to the nursing team. They reviewed patients to ensure they were fit for surgery. The morning hospital huddle enabled the team to raise any concerns and actions needed to mitigate them.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to raise a safeguarding alert and did so when required. Staff gave clear examples of how they protected people from harassment and discrimination, including those with protected characteristics under the Equality Act (2010).

Leaders reviewed safeguarding events in quarterly clinical governance meetings. There were no adult or child safeguarding incidents reported by the hospital in the 12 months prior to the inspection.

Managers described a clear safeguarding structure within the hospital. The named safeguarding lead was displayed each day, so staff always knew who to contact. Level 4 practitioners were always available, with a trained children and young people safeguarding lead providing cover when needed. Staff routinely checked the board, so they knew who to escalate concerns to.

Safeguarding processes were embedded in daily practice. All new starters received safeguarding training.

Leaders ensured safeguarding training reflected current risks. Leaders added content on coercive control and complex situations so staff could identify emerging patterns. Leaders promoted a safeguarding culture. Staff said they felt confident raising concerns, even when unsure. Staff looked out for signs that something did not feel right.

The outpatient team used daily huddles and department meetings as an opportunity to discuss safeguarding learning. Consultants highlighted the number of children and young people attending each day to ensure safe processes were followed.

Safeguarding systems were integrated into organisational governance. The electronic incident system captured safeguarding concerns and Duty of Candour requirements. Themes were shared through leadership meetings, boards and compliance activity.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff worked with people to understand their individual needs and managed risks in a way that kept them safe. Staff supported them to have the procedures that mattered to them. Staff used an electronic pre-operative assessment system that allowed patients to complete an online health questionnaire before attending the hospital.

Pre-assessment leaders and heads of department reviewed each submission. The system generated risk flags so staff could decide whether patients needed a full telephone assessment, a brief follow up call or no further contact for low-risk procedures such as routine cataract surgery.

When risk flags were triggered, nurses carried out more detailed assessments to ensure the needs of the individual patient could be safely met. Nurses gathered full medical and medicine histories. They checked for any recent changes that could affect safety. Staff also confirmed patients were suitable for a Level 0 hospital, which did not provide intensive care or high dependency support. Teams used anaesthetic risk scoring to guide safe decision making. They considered co‑morbidities, frailty and previous reactions to anaesthesia. Patients assessed as higher risk were booked for an in-person review with a consultant anaesthetist.

Staff took part in safety huddles at specific times, twice a day to make plans to manage any know risks throughout the day. The outpatient nursing team met before clinics started in the morning. They used the meeting to raise alerts, discuss high‑risk patients, review national safety updates and share changes to policies or medicines. Heads of Department across the hospital met at 10:00am to review operational risks, including staffing and children’s clinic requirements, and agreed actions to keep the service safe.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Clinical rooms were clearly labelled and secured with coded locks. Staff kept doors closed when rooms were in use to maintain privacy. Workspaces were organised with equipment stored on shelves and trolleys for easy access. Examination chairs were prepared with paper roll and relevant patient information posters were displayed.

Hand hygiene stations were widely available inside and outside clinical rooms alongside hand basins, soap dispensers and pedal bins. Colour coded clinical waste bins were used effectively, and emergency call buttons were positioned in treatment areas.

Fire extinguishers were mounted, labelled and in date, electrical equipment was tested and labelled. Flooring was even and free from trip hazards.

The outpatient clinic rooms were arranged to protect dignity. Privacy curtains were fitted inside clinical rooms to prevent accidental entry during sensitive procedures. Procedure couches, lighting and monitoring equipment were positioned safely within reach.

Staff displayed clinical checklists, schedules and reminders where needed. Safety signage was also displayed, including chemical store warnings.

Daily equipment checks supported preparedness. Staff raised emergency calls through red buttons and call bells, which alerted nurses, the resident doctor and Advanced Life Support trained staff. Staff carried out daily buzzer tests to ensure alarms and pagers worked reliably. Staff had access to a resuscitation trolley and knew where it was.

Emergency exits and fire wardens were clearly displayed, and information was shared during morning meetings. Staff escalated faulty equipment promptly, and items were repaired or replaced quickly to keep clinical areas safe.

Risks linked to the planned building works were recorded on the risk register, and weekly rapid response updates helped staff stay aware of environmental or equipment risks.

The outpatient department included 12 consulting rooms, 2 procedure rooms and physiotherapy gym. Clinical environments were purpose designed for specialist services such as ophthalmology, ear nose and thoat, audiology, plastic surgery and gynaecology, supporting high‑volume daily activity.

The service had a plan for the prevention and management of unplanned and emergency situations. We saw there was good supply of oxygen which was safely stored and used.

There were arrangements for the handling, storage, and disposal of clinical waste, including sharps. Sharps bins were placed at the point of use and labelled with assembly and closure dates. The service complied fully with the Control of Substances Hazardous to Health (COSHH) practices.

The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

The organisation had completed a restructure of the outpatient staffing model. This had resulted in a reduction in substantive staffing numbers through voluntary redundancies. Although actions had been taken to maintain service delivery, some staff who had left subsequently returned as bank staff to cover shifts. This provided short-term flexibility and supported clinic capacity. However, it did not fully mitigate the risks associated with reduced permanent staffing. Reliance on bank staff affected continuity of care, team cohesion, and consistency of practice within the department.

Leaders reviewed staffing requirements daily against planned activity. Staff were rostered to meet demand. Staffing levels in clinics showed an effective balance between Registered General Nurses and Healthcare Assistants. Most clinics operated with dedicated chaperones.

Medical cover was always appropriately maintained. Shift rotas ensured nursing staff were allocated to specific consultants to ensure clinics were safely staffed. Staff adapted and worked flexibly across early and late shifts to maintain coverage.

However, in the 12 months prior to the inspection the nursing leadership in outpatients had been reduced for an extended period due to long-term sickness. This absence had not always been sufficiently mitigated, resulting in a lack of visible leadership, management oversight, and clinical governance within the department.

Data provided by the service showed staff were compliant with outpatient competencies. Due to the long-term absence of leadership within the service, the service reported challenges completing staff appraisals. Hospital leaders were aware of the issue and had provided additional nursing and leadership support. Staff told us they had not had an annual appraisal but had had 1-2-1 discussions with nurse leaders in the interim.

The absence of visible leadership oversight alongside changes to the workforce and reliance on temporary staffing, resulted in limited opportunities for effective communication, dissemination of safety information, and shared learning from incidents.

Consultants worked at the hospital under the terms of the hospital’s practising privileges policy. The service had processes to check consultants met the terms of this policy and had completed relevant training. This was overseen by the hospital’s Medical Advisory Committee (MAC). Consultants were available on-site during clinic hours. The hospital also had a resident medical officer (RMO) available on site 24 hours a day. The RMO was up to date with Advanced Life Support training and all other staff were up to date with their required level of life support training.

Mandatory training was role‑specific and staff completed required modules before undertaking further development. Evidence showed that 100% of nursing staff were compliant with mandatory training requirements. All staff had completed revalidation with their professional bodies.

Training related to equipment, learning disability, mental health and autism awareness also showed strong engagement. Staff accessed a wide range of clinical skills training, including phlebotomy, cannulation, airway management and pre-operative assessment.

Staff also completed additional courses relevant to their clinical duties, for example cleaning of endoscopic equipment needed for treatment clinics.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff assessed and managed infection risks effectively. There were systems to detect concerns early, prevent the spread of infection and share information through the appropriate governance routes.

All infection prevention and control policies were in date. Leaders identified infection prevention leads and local champions who supported staff and reinforced good practice. Routine audits, including regular hand hygiene audits, were carried out to monitor compliance, and results were used to prompt improvement where needed.

Cleaning schedules were displayed in the correct areas and showed routine cleaning had been completed and recorded. Staff maintained equipment to a high standard and kept it visibly clean. All items checked were clinically clean with in‑date “clean” stickers attached.

Staff followed infection control principles, including effective hand hygiene. Handwashing stations were available throughout clinical areas, with wall‑mounted soap dispensers, hand sanitiser units and instructional posters.

Clinical waste was disposed of correctly using colour‑coded bags and pedal bins. Clinical sinks were available, and one room contained a stainless‑steel scrub sink with wall‑mounted gloves and aprons.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Medicines were stored safely and access was well managed. Cupboards and rooms containing medicines and medical gas cylinders were secured when not in use. No controlled drugs were used or stored in outpatients' clinical areas. Sharps bins were safely managed and secured in line with national standards and guidelines. All sharps bins were recorded with complete and correct information for tracking and traceability purposes.

Emergency resuscitation trolleys were checked daily and were in date and sealed. Pharmacy also held a list of items which were due to expire in emergency trolleys, to guarantee they would be available before the current drugs expired.

Temperatures were recorded daily in areas where medicines were stored. Prescription stationery was securely managed by the outpatient department and records kept for monitoring.