Spire Portsmouth Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment, the rating has remained good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff were familiar with the hospital’s site‑specific strategy, which described its purpose of making a positive difference to people’s lives through outstanding, personalised care.

Leaders reinforced a culture focused on patient safety and improving patient experience, so the hospital became a provider of choice. Staff said the senior leadership team communicated this vision clearly and they understood how it applied to their own roles.

There was an emphasis on inclusion, respect and collaboration. Staff described a supportive culture where colleagues checked in on each other, shared information and helped part‑time staff stay up to date with organisational changes. Staff we spoke with were generally positive about the service. However, they did not always feel included in some organisational changes but told us they could offer suggestions to improve services locally.

Staff, including clinical and support staff, we spoke with liked working at the hospital and had positive experiences throughout the hospital. Staff had worked there for varying amounts of time, but all reported similar experiences of good team working and described it as a family.

There were positive working relationships between clinical and support staff across the outpatient department that included a diverse workforce.

The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation.

The service did not always support staff wellbeing and enablement to perform their roles effectively. The prolonged absence of outpatient leadership due to long-term sickness, resulted in limited leadership visibility and reduced day-to-day support. Staff reported a lack of consistent managerial oversight, and formal team meetings had not taken place. This limited opportunities for engagement, feedback, and shared learning. One member of staff told us, “We haven’t had regular team meetings for a long time, so it’s hard to know what’s going on or raise concerns.” Staff told us they had not had an annual appraisal but had participated in 1-2-1 discussions with nurse leaders in the interim.

The hospital recognised the concern relating to nursing leadership absence. As mitigation senior nursing leadership in the hospital worked in the department. This provided managerial and clinical oversight that had been missing. Staff reported this support was welcome and helped to raise awareness of outpatients within the wider hospital.

Despite the challenges, managers and leaders at the service had the relevant skills and abilities to manage the services effectively. They understood the risks to services and had oversight on safety, governance and performance issues through daily involvement and quality monitoring.

Staff reported a more open and transparent culture with direct oversight from the director of clinical services. They reported clearer expectations around safe practice and stronger oversight of consultant activity.

Staff said they felt confident raising concerns and trusted issues would be acted on. Regular team meetings had paused due to the leadership challenges, however the service ensured information was shared consistently through other routes.

The department promoted an inclusive and supportive culture. Staff described strong teamwork and said they felt safe to speak up or challenge concerns respectfully. Leaders were flexible when staff needed adjustments following sickness and were approachable when workload or rota issues arose.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The organisation promoted a strong Freedom to Speak Up culture. There were appointed Freedom to Speak Up Guardians (FTSUG) and Ambassadors who were visible and accessible to staff.

The service had a culture where staff said they could speak up; there were freedom to speak up posters in the clinical areas. Staff knew who the FTSUG was, and they said they would be confident speaking up to senior staff.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service promoted an inclusive and fair culture for its workforce. The team was diverse, with a variety of nationalities represented. Staff said they felt valued and treated equitably.

Leaders supported staff to observe important religious days and celebrations, and flexible working arrangements or reasonable adjustments were made where possible to accommodate personal circumstances.

Staff described the department as welcoming and inclusive, with a culture that encouraged open discussion about individual needs. Equality, diversity and inclusion were promoted across the team, and there were visible sources of support.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a clear governance structure with an ongoing audit programme. Audit results were shared and acted on by the department and managers with action plans in place. The hospital had a comprehensive dashboard for performance indicators which was updated quarterly and shared with the team, this was benchmarked against other Spire hospitals.

Risk management processes were well established. Risks were clearly identified, recorded on risk registers and regularly reviewed to ensure oversight and mitigation. Risk registers and management reports included analysis of trends over time and associated action plans. Staff acted on information relating to risks, performance and outcomes and shared this appropriately to support service improvement and patient safety.

Information governance systems supported confidentiality, secure handling of patient records and compliance with national standards. Managers had access to timely data on performance, staffing and incidents, and this information was used to inform decision‑making and identify areas requiring improvement. Governance processes ensured data collection was routine but not burdensome for clinical teams.

The outpatients and physiotherapy manager both attended the heads of department and governance meetings which gave them oversight of risk at a corporate and departmental level. We saw senior staff receiving information from the daily hospital huddle where any daily risks and actions were shared.

There was regular communication and oversight from Spire Healthcare. The senior management team and departmental leads told us how they reported governance, performance and risks to the provider. Senior and departmental managers participated in regular peer meetings to share learning and benchmarking with the provider’s other hospitals across the region and nationally.

Consultants worked under practising privileges. Practising privileges were reviewed and authorised by the director of clinical services and were also reviewed at the Medical Advisory Committee. These arrangements provided assurance that clinicians had undergone he required checks and were authorised to undertake only those procedures and treatments for which they were qualified, experienced and competent, thereby supporting safe patient care.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service understood their duty to collaborate. They worked in partnership with the local system including the Integrated Care Board (ICB) and NHS trust. This enabled them to respond to the needs of the local health population.

Leaders worked closely with partner hospitals to verify practising privileges and confirm clinicians’ suitability quickly and safely. These discussions supported sharing of information about qualifications, scope of practice and performance.

Leaders held regular meetings with local NHS and independent sector partners. The capacity and utilisation team worked with the local NHS trust to identify patients who could be safely treated at the hospital. The aim was to support the trust to shorten waiting times for NHS patients. This helped ensure that any issues affecting patient care or service delivery were identified early and addressed collaboratively. The capacity and utilisation team maintained a tracker system which provided oversight of waiting times and was used when they liaised with the local trust. Patients waiting longer had tended to have more complex needs and had been referred to other teams during the pathway. This ensured patients received the right care from the right clinician.

Leaders engaged with system partners through the Integrated Care Board assurance programme, which included compliance monitoring and onsite visits.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders demonstrated a strong commitment to continuous learning and improvement. Staff were supported to develop ideas for service changes. Leaders encouraged innovation where it could improve patient experience or outcomes.

Leaders and teams continued to adapt processes based on learning from audits, incidents and patient feedback, demonstrating a culture of continual improvement and forward‑looking practice.

Spire group had a quality improvement strategy, which included the outpatients department collaboration with the inpatient team on patient discharge.

The physiotherapy team had developed the service through access to extended education programmes.