Spire Portsmouth Hospital

On this page

• 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

At our last assessment we rated this key question requires improvement. At this assessment the rating is now good. This meant patients 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 service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

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.

We looked at the digital system for managing incidents and reviewed incidents reported in surgery for 12 months prior to our assessment. We found incidents had been categorised in accordance with NHS England (NHSE) guidance. Incidents were analysed to identify trends or themes and potential links to individual practitioners. Managers investigated incidents and shared lessons learned with the whole team and wider provider services.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation when things went wrong. Managers used changes in national guidance, incidents, safeguarding and appraisals to identify gaps in learning. We saw evidence of feedback from investigation of incidents, both internal and external to the service in rapid review meetings and staff education sessions. This information was recorded and shared with staff to support learning across the service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

There had been no never events in the 12 months prior to our assessment. Never Events are serious, preventable safety incidents which should not occur if the available preventative measures are followed. This includes serious incidents such as wrong site surgery or foreign objects left in a person’s body after an operation.

Staff told us they felt able to identify and report risks, knowing action would be taken. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harm occurring. In the12 months prior to inspection, 211 clinical incidents were recorded, representing 1.21% of all activity, indicating an established reporting culture. The incidence of harm was low, with 3 cases of moderate harm (0.02% of activity) and no reported cases of severe harm, Never Events, or death within 30 days of surgery.

Managers debriefed and supported staff after any serious incident. We reviewed evidence staff were supported following incidents through SWARM meetings. A SWARM meeting is a rapid multidisciplinary discussion held as soon as practicable after a patient safety incident occurs. These meetings provide an opportunity to quickly assess the situation, share diverse expertise, and agree timely, coordinated actions.

We also reviewed a round table discussion where staff worked through the patient’s journey before and during surgery to better understand what had happened. This was due to a skin injury to a patient noted post operatively. The round table discussion helped staff understand the patient’s journey and provided an opportunity to raise and discuss any concerns. Feedback from the patient about the impact of the incident was also included.

Mental Health and Wellbeing Champions were identified at staff meetings to ensure staff had access to support and someone to talk to following any events that may have affected them. Following an incident where a patient had been transferred to an acute NHS trust, the service held a meeting with day and night staff who had been involved in the patient’s care. This provided staff with an opportunity to ask questions and reflect on the event.

Where required, staff reported incidents to the external agencies, such as the CQC and the UK Health Security Agency (UKHSA).

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

Safety and continuity of care were prioritised throughout people's care pathways. Care and support was planned and organised in a coordinated way that promoted continuity, minimised delays and ensured risks were identified and managed throughout the patient's journey. Patients underwent a comprehensive pre-operative assessment before surgery and findings were used to inform care and treatment planning. Where risks or underlying health conditions were identified, surgery was delayed or cancelled to ensure patients could be treated safely. The service operated clear admission criteria and only accepted patients whose needs could be met safely.

The Pre-Operative Assessment (POA) service played a significant role in ensuring patients were clinically optimised before surgery and that risks were identified, escalated and managed at the earliest opportunity. Staff demonstrated a thorough understanding of patient risk factors and described the actions taken to reduce the likelihood of complications, delays and avoidable harm. Patients told us they valued the time taken to identify and manage risks before surgery. A patient told us ‘“due to the care in preoperative assessment, risk factors were identified. I am grateful because had this not been highlighted, the outcome may have been very different.”

The POA service also introduced direct pharmacy referral pathways, blood pressure home-monitoring initiatives and systems for tracking outstanding investigations such as echocardiograms. These processes improved pharmacy medicine reviews, supported safer prescribing decisions and ensured diagnostic results were available before surgery, reducing delays and late cancellations.

The service had driven a number of improvements to strengthen pathway management, patient safety and operational efficiency. Workforce redesign, including hybrid working arrangements and dedicated administrative support, increased assessment capacity and improved the timeliness and organisation of pre-operative documentation. Personalised patient communications were introduced for all patients undergoing assessment, improving patient understanding.

Multidisciplinary working was embedded within the service. We saw MDT planning meetings that enabled risks, actions and patient-specific concerns to be tracked effectively and reducing the likelihood of omissions or duplication. Staff worked collaboratively to ensure patients requiring further tests, investigations or specialist review experienced minimal delays to their pathway. This improved oversight of complex patients and supported timely follow-up of actions.

The service demonstrated a proactive approach to clinical optimisation. Consultant-led anaesthetic clinics provided earlier review of patients with complex or higher-risk conditions, supporting risk stratification and informed decision-making before surgery. Quarterly meetings with consultant anaesthetic representatives supported review of patient outcome data, identification of trends and implementation of service improvements. This collaborative approach strengthened clinical oversight and supported continuous pathway development.

Communication between teams supported safe and coordinated care. Dedicated communication channels enabled rapid discussion between clinicians and routine sharing of anaesthetic assessment outcomes with day-of-surgery anaesthetists improved preparedness for patients with complex needs. The service also developed an integrated 23-hour pathway involving the POA team, pharmacy and physiotherapy services, strengthening multidisciplinary working, improving patient flow and supporting timely discharge planning.

There were effective systems and processes to ensure patients received the correct treatment throughout their journey. We observed patient identification checks, clinical handovers and transfer processes from admission through to theatre. Staff consistently used the World Health Organisation (WHO) Surgical Safety Checklist to reduce the risk of error and improve communication within theatre teams. We also observed completion of the 'Stop Before You Block' safety check prior to local anaesthetic procedures. Staff understood the policy and audit data demonstrated full compliance over the previous 12 months.

Patients were transferred safely between clinical areas with clinical oversight and were monitored throughout their recovery by suitably skilled staff. Patient records were maintained securely in both electronic and paper formats and staff had reliable access to systems required to support safe care delivery. Where responsibility for a patient's care transferred to another provider, including NHS services, information was shared effectively to promote safe and seamless transitions.

Patient transfers due to deterioration, were not a routine occurrence, so this meant staff were given support and reassurance that their actions, in line with policy, had kept the patient and themselves safe and supported. We reviewed instances of deteriorating patients transferred within the past 12 months prior to our assessment. This showed patients were transferred without delay to acute NHS services to access the additional clinical care they required. In all instances there was evidence of shared learning.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. We spoke with staff who gave examples of safeguarding concerns and investigations they had been involved in. Staff were able to explain the rationale for their concerns and said they felt empowered by the service to protect vulnerable people.

Safeguarding training was part of mandatory training for all staff. Training was aligned with staff roles and staff completed the training assigned to them. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

There were current safeguarding policies, and these reflected the national guidance for adults and children, including visitors. Staff followed procedures to ensure visitors could access wards safely, and patients we spoke with told us they felt safe.

Safeguarding leads had specific defined roles and responsibilities for protection of children and vulnerable adults. The Hospital Director and Deputy Director of Clinical Services were the hospital’s safeguarding leads and had completed Level 4 safeguarding training.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Safeguarding concerns were considered following incidents, and referrals were made for specialist advice where required. Expert safeguarding advice was always available to support staff from duty and on call leaders. Staff knew how to contact them, and we saw clear posters and policies in both wards and theatres with these details. There were links to external agencies and staff knew what happened when they raised concerns.

The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patient’s needs which was safe, supportive and enabled patient to do the things that mattered to them.

The service worked with patients to understand and manage risks. Treatment and care met patients' needs in a way which was safe and supportive and enabled them to do the things that mattered to them. We spoke with 13 patients who told us they felt listened to, understood the risks associated with their care and treatment, and were involved in decisions about their care. One patient told us ‘My plan for care was explained carefully and questions were all answered fully. I have felt safe and looked after throughout.’

Patients completed a pre-admission medical questionnaire before surgery to help identify any risks. Staff followed up with patients who had not completed the questionnaire to ensure all relevant information was available before their appointment. The preoperative team reported having good communication with relevant teams. There were dedicated clinics to perform any required preoperative testing, with a nurse led clinic if patients had more complex health conditions and required and advanced review and planning.

MDT discussions informed pathway planning to manage risks to patients undergoing surgery. We attended a planning meeting where staff reviewed upcoming patient admissions and discussed any risks or additional support needs. The meeting followed a clear structure to cover patients at booking, preoperative assessment, and those scheduled to attend in the coming days and weeks. Risks such as allergies, comorbidities and social issues were discussed for each case. Allied healthcare professionals formed an integral part of the patient care and treatment pathway and promoted recovery and rehabilitation. This meant staff had a good understanding of potential risks and enabled them to plan care in advance.

Ward admission times were staggered to align with morning, afternoon and evening operating lists. This helped to improve patient flow and ensure fasting times were kept to a minimum. In theatre, scheduling was planned based on the complexity of a procedure, the patient’s condition, whether they were staying overnight or returning home the same day, and the type of anaesthetic required. This meant known risks were considered in advance. There was oversight of medicines and ward-based support for staff from a pharmacist.

Systems were effective in capturing information about surgical implants ad equipment to manage risk. Prosthesis and implant details were recorded on a digital system within patient records. Implant data relating to joint replacements was submitted to the National Joint Registry (NJR) which collects and analyses data on hip, knee, ankle, elbow, and shoulder joint replacement surgery. Data on breast implants was submitted to the Breast and Cosmetic Implant Registry. This meant implants could be quickly identified and traced if there was a product recall, in line with national guidance.

In theatres, all staff we spoke with were able to explain the National Safety Standards for Invasive Procedures (NatSSIPs 2) and the World Health Organisation (WHO) key steps for safer surgery. We reviewed audit results from the previous 3 months, which showed 98% compliance with Steps to Safer Surgery observational audits and 100% compliance with WHO checklist audits for cataract procedures.

We also saw evidence the sepsis care bundle had been implemented in the service. A sepsis care bundle is a set of time-sensitive, evidence-based clinical interventions designed to rapidly diagnose and treat sepsis and septic shock. However, there had been no patients with confirmed or suspected sepsis in the 3 months prior to our assessment, therefore, compliance with the bundle could not be monitored during that period.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff carried out daily safety checks of specialist equipment. There was ready access to resuscitation equipment on wards and in theatres. There was suitable equipment provided and used correctly, such as oxygen within patient rooms.

The environment of the wards and other areas used for patient care reduced the risk of patient harm, and included, for example, safe flooring, handrails and window restrictors. Patients could reach call bells. Call bells were positioned by patient beds, and staff showed patients how to use them to summon help. We saw call bells were responded to swiftly and the noise level from unanswered call bells was minimal.

Staff working areas, such as nurse’s stations, were positioned at the entrance of wards to monitor people entering the ward. Patients reported lighting was reduced at night and noise levels were minimised. The service had suitable facilities to meet the needs of patients’ families, when necessary, such as adequate seating. Staff told us arrangements could be made for carers to stay overnight. Staff also said patients who required additional support or reassurance could be allocated a room close to the nursing station.

We saw emergency equipment and oxygen outlets on wards were tested daily to ensure they were safe to use. In theatres emergency equipment was well located and daily checking had been completed in full for the previous 3 months. We observed emergency equipment being used in the event of patient deterioration. Staff worked together calmly and cooperatively to use it, they were able to locate all equipment necessary and without delay. This meant that in the case of an emergency there would be no delay to response.

The theatre environment followed national guidance. Separate areas were used for clean equipment, preparation, and the handling of used equipment and waste. There was storage for equipment including sterile packs, uniforms and linen. We saw there was enough space to prepare theatre equipment safely. There was testing of water outlets and air exchange systems in theatres in line with national guidance.

Where required,access was restricted to secure areas such as theatres and utility rooms. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction. There were audits undertaken in health and safety and fire safety. These had identified areas for improvement in fire safety process across wards and theatres, and an action plan was ongoing to improve compliance.

Specialist equipment used in the operating theatres was used in accordance with national guidance and regulatory requirements. We saw evidence showing that changes to equipment were risk assessed to ensure they were safe and suitable for use. All relevant staff were involved in this process.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair of replacement of broken or missing equipment. Staff told us faulty or broken equipment was reported through the incident reporting system. We saw evidence of staff reporting equipment and action taken.

Control of Substances Hazardous to Health (COSHH) were mostly stored safely and information about products was available to staff. However, in 1 ward and theatre corridor, some COSHH items were stored in a way that was not in line with manufacturer guidance. These concerns were highlighted to leaders and immediately resolved on the day of inspection. We found no evidence to suggest prior storage arrangements had resulted in harm to patients or staff.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

The service had enough nurses, allied health professionals and support staff with the skills, training and experience needed to provide safe care and treatment.

Managers reviewed the number and grade of clinical staff, healthcare assistants and other key roles needed for each shift in accordance with national guidance. The service matched staffing levels to patient activity, with around 80% of shifts covered by permanent staff and 20% by bank staffing. Managers could adjust staffing levels daily according to the needs of patients. Theatre and recovery staffing was planned based on expected activity and the skills needed. We saw evidence in both theatres and wards that showed the service used a clear workforce planning model linked to demand.

Staff were made aware of their shifts in advance and could make requests, although most staff worked set hours, so this was not often needed. Staffing gaps were safely mitigated using the service’s own bank staff, with minimal agency usage. Staff vacancy rates were low. Staff told us they felt staffing levels were safe and allowed them to take regular breaks during their shifts.

All staff told us there was a stable workforce This was observed throughout our inspection as the majority of staff we spoke with had worked for the service for a considerable amount of time. The service had sickness rates of 4.3% in theatres and 4% in ward areas, these were low in comparison to the national average of between 5% and 5.5%. There was also active recruitment in progress. Sickness rates were below both hospital and provider average. The service had enough allied health professional (AHP) staff to keep patients safe and meet their needs. An AHP is a clinically registered, degree-level healthcare practitioner who is distinct from doctors and nurses. AHPs focus on assessing, diagnosing, treating, and rehabilitating patients.

There were safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. New staff, including those working in bank and agency posts, received a full induction tailored to their role and a corporate induction before they started work. Staff received regular supervision and could only carry out clinical skills and procedures once they had completed the required competency assessments. An employee handbook was available for staff which contained relevant information such as company values, essential knowledge and information.

The service supported the learning and development needs of staff and made sure they received any specialist training for their role. Managers supported staff development through annual appraisals, 6 monthly interim reviews, and constructive clinical supervision of their work. Compliance with mandatory training was monitored during annual appraisals. Managers identified staff training needs and provided the time and opportunities needed to develop their skills and knowledge. Staff told us that any learning or development opportunities they identified would always be supported.

Consultant surgeons and anaesthetists were subject to a full assessment through the practice privilege process. Practicing privileges by the Hospital Director, informed by the Medical Advisory Committee. They ensure that consultant surgeons, anaesthetists etc only carry out procedures that they are skilled, competent and experienced to perform. Staff working under practicing privileges were required to provide evidence of appraisal, re-validation and were expected to present evidence of completed mandatory training. Evidence showed 100% of consultant surgeons and anaesthetists had completed mandatory training including safeguarding and had completed yearly and 6 monthly appraisals.

Staff told us the admitting consultant reviewed their patients regularly. The service had formal arrangements for a resident medical officer (RMO) to be on site when patients were receiving treatment and care. We saw evidence that showed there were no gaps in resident medical cover. The RMOs told us they enjoyed working for the service and were well supported. We also saw evidence that overnight and weekend staffing levels were in line with national guidance. This included access to the admitting consultant for advice or attendance when required.

Managers made sure staff attended team meetings or had access to the information shared, when they could not attend. We saw notes from team meetings and other general information was shared on notice boards and within staff emails and newsletters.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates. All staff received training that aligned to their roles and kept up to date with their mandatory training. All staff had completed training on recognising and responding to the needs of patients with mental health conditions, learning disabilities and dementia. However, mandatory training for the service was below the overall target of 95% compliance at 93% for qualified staff, and 91% for clinical staff.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.

Staff used equipment and control measures to protect patients, themselves, and others from infection. Theatres and ward areas were visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. Patients also commented positively on the cleanliness of the hospital, who told us, ‘The hospital felt safe, clean and hygienic’ and ‘Cleanliness of the room was excellent’.

Staff supported infection prevention and control measures by following the uniform policy. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination. We saw staff in all areas following national guidance in handwashing. Hand hygiene audits achieved the full compliance for the past 3 months.

We saw equipment was cleaned after patient contact and labelled to show when it was last cleaned. Staff understood the process for managing spillage of body fluids both on the wards and in theatres and there were dedicated kits for this task.

There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections. The service managed infection risks well and used systems to identify and prevent surgical site infections (SSI). There was evidence that infection incidents were reviewed through governance arrangements to identify themes, learning, and opportunities for service improvement.

Leaders monitored SSI data to help ensure patient safety and quality of care. Data from the previous 12 months showed very low rates of infection for orthopaedic procedures. Mandatory surveillance data showed SSI rates of 0.2% for both hip and knee arthroplasty procedures, with no recorded spinal SSIs. Rates were significantly lower than commonly reported national benchmarks and compared favourably with data seen across NHS and independent sector providers.

There was a provider level infection and prevention and control (IPC) policy and supporting policies in relevant areas such as reducing SSIs. These were easy for staff to access. The providers guidelines reflected National Institute for Health and Care Excellence (NICE) guidance regarding surgical site infection and the Royal College of Surgeons. Staff had access to expertise in infection control from a dedicated IPC nurse. There was also a consultant microbiologist employed by the service who attended relevant IPC oversight groups such as antimicrobial stewardship, water safety and IPC.

Theatre practice minimised the risk of cross infection and we saw staff following best practise regarding the treatment and care of their patients. There was a provider level policy which detailed the process for the decontamination of surgical instruments. The guidance was clear and available to all staff. The service provided evidence of audits undertaken to monitor compliance with decontamination and environmental standards for endoscopy procedures which showed 100% compliance.

There was a wide range of infection and prevention and control audits undertaken in both theatres and wards. We reviewed audit outcomes which showed all IPC audits on wards were compliant, with 6 of the 10 audits being 100% compliant. In theatres, 4 of the 7 audits had 100% compliance. Theatre audits in cannula and catheter care had identified areas for improvement which related to documentation completeness. Action pans were ongoing to drive improvement. This included discussions with relevant teams, random spot checking, and ongoing audits to monitor improvement.

Staff managed clinical and sharps waste in accordance with the provider policy and national guidance. Clean and dirty sluice areas were secure and well maintained and clinical waste was disposed of safely.

The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences. Staff involved patient in planning, including when changes happened.

The service used systems and processes to safely prescribe, administer, record and store medicines. In theatres, medicines were only prepared when required and were not drawn up in advance of operating lists.

There were facilities and systems in place for patients who wished to manage their own medicines. Preoperative assessment staff told us if they identified patients taking CDs, patients were advised not to bring them into the hospital as the service could supply them. For patients who were able and wished to manage their own medicines, they were encouraged to do so, and these would be stored securely in bedside lockers.

The service had clear provider level guidance for staff on safe use of medicines. This included the management of Venous Thromboembolism (VTE) prevention. A VTE (Venous Thromboembolism) is an umbrella term for dangerous blood clots that form in a patient’s veins, this is a known risk of undergoing a surgical procedure as a patient may have periods of limited movement.

There were systems and policies in place for medicines optimisation strategy. This included introducing a pharmacy follow up call when patients were discharged out of hours and actions to improve patient satisfaction.

There was clear guidance for medicines reconciliation. Medication reconciliation is the formal process of creating the most accurate, complete list of a patient's current medications and comparing it to what they are newly prescribed or taking. Staff told us a pharmacist or qualified pharmacy technician performed medicines reconciliation for all inpatients within 24 hours of admission. When patients were discharged, electronic communication was sent to a patient’s GP or care home provider detailing any changes in medications. Internal audits for medicines reconciliation showed 100% compliance with policy.

Staff completed medicines records accurately and there were governance systems in place. There were accurate records of medicines administered in the operating theatre and recovery. CD audits for the service were completed to monitor oversight. We reviewed these which showed 98% compliance for audits in storage and security. CD register audits on wards were 98% compliant and in theatres 97%. All CD records we reviewed across theatres and wards were completed accurately and in full. There was access to medicines needed in an emergency or at short notice at night and at the weekend.

There was a medicines management committee (MMC) which met quarterly. We reviewed the minutes from the most recent MMC meeting in April 2026, and saw they followed a clear agenda. We also saw evidence of changes in prescription policy being discussed following an area for improvement highlighted through auditing.

All medicines incidents were reviewed and shared daily in safety huddles, which were attended by representatives from all departments including pharmacy. This ensured information was widely shared and supported immediate discussion of risks and themes. The pharmacy team told us they also had their own daily huddle where recent medicines incidents and safety alerts were discussed.

There were policies to support the safe prescription of antibiotics (Antimicrobial Stewardship), to ensure antibiotic prescribing was evidence-based and consistent with current regional practice. The service told us staff could access advice from a microbiologist 24 hours a day for complex or routine infections. Recent antimicrobial stewardship audits were below compliance targets at 92%.

However, not all staff had completed mandatory training in controlled drugs in theatres, wards and surgery. This training had been completed by 100% of staff in assessment and pharmacy. The target for completion was 95%, the lowest compliance with this training was in theatres at 66%.