Spire Portsmouth 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

At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant patient’s outcomes were consistently good, and patients' 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 assessed patient communication needs in pre-operative assessment (POA) and planned for assistance if required. Throughout our visit, staff told us their goal was to ensure that everything they did was centred around patient need. We heard how staff in POA always asked about additional needs or if there was anything the service should be aware of. Staff in POA ensured appointments were planned to meet the needs of patients. We saw records were updated after each appointment to ensure any discussions between the patient and staff were recorded and any actions that had been agreed were all logged.

Shift changes and handovers included all necessary key information to keep patients safe. We saw staff sharing key information to keep patients safe when handing over their care to others.

The service was able to support the needs of patient with dementia effectively. Patients with dementia were allocated to a designated room on the ward, located next to the nursing station which enabled enhanced clear observation for staff. This could be easily adapted with `dementia friendly' signage and a coloured toilet seat, adaptive cutlery, plates and bowls, and visual menus. This is because patients with dementia can have reduced depth perception and the contrast of colour helps with memory recall.

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. Pain relief medicines were timed for maximum effect before painful procedures or to allow the patient to sleep at night. Patients’ pain was addressed before they left the operating theatre. There was support available from the anaesthetist when a patient had complex pain needs. When patients required additional support, there were adapted pain scoring tools to ensure all needs were met.

Patients praised the support staff gave them. On wards and in theatres, we saw patients were generally calm, staff spoke with patients to reassure them and understand their needs.

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. Policies and processes reflected changes to the Royal College and National Institute for Health and Care and Excellence (NICE) guidelines.

There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards throughout the service displaying relevant guidance to staff.

Patient care and treatment was assessed using a range of tools to ensure their needs were reflected and understood. The service had a wide range of clinical assessment tools that were up to date and person centred. We reviewed care plan documentation used for 3 pathways within the service. This included patient care records that were specific to their pathway. We found the documents to be clear and well presented, with clear instructions for use and links to relevant supporting policies.

All care plans contained relevant risk assessments such as Venous Thromboembolism (VTE), pregnancy status, mobility, and airway management. These were reviewed, where relevant, throughout all stages of care from recovery to post discharge follow up. The service monitored compliance with VTE risk assessments. We reviewed these which showed they were above target at 95% for the previous month and on average 97% for the past 3 months.

We reviewed 10 sets of patient care records across 2 wards to assess the completion of care plans and risk assessments. All records were fully completed. We saw patient care needs were addressed in line with guidance. 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. Patients requiring special diets for clinical reasons were assessed and advice was given. A wide range of food options were available to ensure all patients were able to access nutrition that was in line with their medical needs. This included options suitable for people with coeliac disease and those requiring low-sugar diets.

The service submitted data to the Private Healthcare Information Network (PHIN). Intelligence reports were reviewed by service leaders. These reports included information on key PHIN performance indicators. This included patient activity volumes, length of stay, never events, Patient Reported Outcome Measures (PROMs), infection rates, data submission levels and complaints data from private insurers.

The service worked well across teams and services to support patients. Staff made sure patient only needed to tell their story once by sharing their assessment of needs when patient 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. This was also supported by patient feedback which highlighted teamwork as a strength throughout. We spoke to a patient who told us ‘‘I have had multiple life changing operations at Spire Portsmouth. The outstanding sense when I come to is the compatible teamwork’

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. Throughout our inspection we observed how staff interacted with kindness and mutual respect with colleagues.

Teams worked effectively to ensure discharge planning considered people’s individual needs, and expected outcomes. Patient needs were assessed prior to admission so that information relevant to discharge was planned for in advance. We reviewed the patient paperwork used for the Preoperative assessment (POA) risk pathway and saw it contained a wide range of considerations such as alcohol dependency, frailty and mental capacity. We saw patient care needs being discussed in planning meetings. This meant information was known at an early stage to ensure patients were safe and had equipment ready and appropriate for their needs. Staff worked across health care disciplines and with other agencies when required to care for patients. Information was shared between teams and services to ensure continuity of care.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care. Patient records showed there was input from a range of clinicians, and they shared information to ensure a consistent approach to care and treatment pathways. We saw evidence of advance neurological observations being requested by nursing staff and this being completed by the clinician.

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.

Staff spoke with patients in preoperative assessments about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health. The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control.

Staff supported patients to live healthier lives and where possible, reduce their future needs for care and support. We saw posters regarding lifestyle changes and support throughout the service for healthier lives, such as losing weight and smoking cessation. There was also information and resources for wellbeing support such as domestic abuse support and signposting for mental health resources.

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.

Outcomes for patients were positive, consistent, and met expectations, such as national standards. The service monitored clinical outcomes through a comprehensive dashboard of safety and performance indicators. We saw evidence the service collected and monitored patient-reported outcome measures (PROMs) and quality of life outcomes across a range of surgical procedures. Data demonstrated consistently positive outcomes for patients undergoing hip and knee replacement, with between 94% and 100% of patients reporting improvement, and 100% of hip replacement patients reporting improved health scores. Quality reported outcome measures (QPROMS) for augmentation mammoplasty and blepharoplasty indicated that 100% of patients reported improvement. Outcomes for cataract surgery showed 85.7% of patients experienced improvement. This was in line with expected benchmarks. The service submitted PROMs data to the Private Healthcare Information Network (PHIN), demonstrating an established approach to monitoring effectiveness. This meant a significant proportion of patients felt their treatment had improved their overall health.

The POA service had implemented WatchPAT investigations to improve patient outcomes and reduce delay. WatchPAT is a portable, home-based sleep diagnostic device used to assess patients for Obstructive Sleep Apnoea (OSA) and other sleep-related breathing disorders. It allows patients to undergo testing in their own home rather than waiting for a hospital-based sleep study. This enabled patients at risk of obstructive sleep apnoea to receive timely assessment, significantly reducing diagnostic waiting

The service benchmarked its outcomes against other services within the provider network. We reviewed this data and saw it showed no significant upward or downward trends across multiple safety measures. This meant the service demonstrated a low risk of complications for elective care. The National Joint registry awarded the service its highest level of accreditation, a Gold Award, in recognition of excellent data quality and patient safety standards.

Patient feedback supported positive outcomes, with patients choosing the service repeatedly for their care. One patient told us, ‘I have attended other independent health hospitals, and this is by far the best’ and ‘I have been coming here many years and standards are always very good’.

Staff monitored the effectiveness of care and treatment through audit and benchmarking against similar services. Findings were used to drive improvements and achieve good patient outcomes. We reviewed the previous 12 months of "Pause for Prosthesis" audits, a mandatory surgical safety check undertaken before implant insertion to confirm the correct prosthesis details and prevent errors. Audit results demonstrated 100% compliance in both Ophthalmology and Non-Ophthalmology services. The service participated in relevant national and provider led clinical audits, including Joint Advisory Group on GI Endoscopy (JAG) accreditation, the recognised "gold standard" for gastrointestinal endoscopy services in the UK. We also saw the service had accreditation for key activities, including the disinfection, assembly, packing, and moist heat sterilisation of theatre trays, procedure packs, and supplementary instruments.

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.

The service had a thorough consent process for patients undergoing cosmetic surgery. Records showed patients were given information about the proposed procedure, risks and alternatives, and were provided with a minimum 14-day cooling-off period before proceeding with surgery. This allowed patients time to reflect on their decision before providing final consent and was in line with The Royal College of Surgeons' standards.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. 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. Consent for surgery included a 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. We observed staff seeking verbal consent before providing care or treatment. People were involved in decision making at all levels. Interpreters were used to support patients to give informed consent, including for British Sign Language (BSL) and face to face interpreting when necessary

Patients said they were involved in decision making about their care and treatment. They could describe the risks and benefits of their surgery, which had been discussed with them beforehand. Staff sought permission before sharing patient information with family or friends. Relatives said they were kept informed about the care and treatment of their family member when they lacked capacity to consent to surgery.

Where specific requests had been made by patients, for a same sex health care professional or theatre team, this was discussed and provided whenever possible. Chaperones were provided if requested.