Spire London East 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.

At our last assessment we rated this key question as good. At this assessment, the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Patients’ needs were assessed and reviewed, care was planned in line with best available evidence, and staff worked together to support coordinated care across the surgical pathway. Patients were given information to support recovery and staff followed clear consent processes. However, some pre-operative planning, escalation and documentation processes were not always consistent, and health promotion opportunities were not fully embedded.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed a total of 10 surgical care records during the assessment, across 2 record review exercises. This included a mix of day-case and inpatient pathways across different specialties. The records reviewed showed that staff completed comprehensive health assessments for patients.

Staff developed care plans that reflected the needs identified during assessment. Care documentation consistently included risk assessments such as co-morbidities, venous thromboembolism (VTE) risk and relevant investigations. Screening tools, including VTE assessments and nutrition screening where applicable, were completed and used to inform care delivery. This demonstrated that staff used assessment findings to guide treatment and reduce avoidable risks.

Care plans were personalised and holistic. Staff understood and applied the policy on meeting the information and communication needs of patients with a disability or sensory loss. Patient records showed that care planning reflected the full surgical pathway, including pre-operative, intra-operative and post-operative stages. Documentation included MDT input, such as anaesthetic reviews where required, and evidenced that consent processes were clearly recorded, supporting patient involvement in decisions about their care.

However, staff feedback and record review evidence identified variation in pre-operative planning. Pre-assessment processes did not always fully address ongoing issues on a consistent basis, with examples where concerns such as pain or social support needs required further escalation or clearer planning. In addition, variation in documentation, including clarity of clinician identification, meant leaders could not consistently evidence accountability, oversight and follow-through. While records showed identified concerns were generally recognised, these findings highlighted opportunities to strengthen the consistency of pre-operative review, escalation and documentation.

The service planned and delivered care in line with current evidence-based guidance and national standards.

Staff followed up-to-date policies informed by National Institute for Health and Care Excellence (NICE) and Royal College guidance, and changes were communicated through meetings and management updates. Care was supported by structured pathways, multidisciplinary team input and recognised assessment tools, which promoted consistency in clinical decision-making. However, some reliance on local practice meant leaders could not fully demonstrate that all pathways were standardised, consistently overseen and implemented in line with current guidance.

Spire London East Hospital held multiple accreditations and certifications, reflecting its commitment to patient safety, data quality and best practice standards in surgery and endoscopy. These included recognition from respected bodies such as the National Joint Registry (NJR), Joint Advisory Group on Gastrointestinal Endoscopy (JAG) and SGS, covering both clinical and operational aspects of the service.

Staff assessed and met patients’ nutrition and hydration needs in line with best practice. Patients received clear fasting instructions during POA, including when to stop eating and drinking before surgery, to support safety and reduce anaesthetic risks. Processes were in place to minimise nil by mouth times and allow fluids where clinically appropriate, and staff confirmed fasting status when patients arrived in theatre. Patients were offered food choices that met dietary, cultural and clinical needs, including allergies and intolerances post-surgery. Inpatient menus included clear allergen labelling, which supported safe and informed choices. Food and fluid charts were completed where required to monitor intake and inform care planning, supporting recovery and good health outcomes after surgery.

The service had a strong approach to clinical audit. Staff participated in a comprehensive audit programme covering key areas such as IPC, medicines management, surgical safety and POA. Audits were completed at regular intervals, including weekly, monthly, quarterly and annually. Findings were used to improve care and were discussed through governance processes, including rapid response meetings and safety and quality committees. Learning was shared through team discussions, informal teaching and scenario-based learning.

The service usually worked well across teams and services to support people. Staff shared information within teams to provide care.

Evidence showed effective MDT working across recovery, theatres and ward teams, with strong day-to-day collaboration. Recovery staff reported working “very well” with theatre teams and anaesthetists, and there was evidence of MDT involvement to support clinical decision-making and patient flow. This supported continuity of care across the surgical pathway.

Staff shared information about patients through daily handovers, MDT meetings and huddles. These included a daily MDT team safety meeting on the surgery ward and theatres at 8:00am, followed by a hospital-wide daily huddle at 10am. These meetings were used to discuss patients, share key clinical information, highlight risks and support improvements in care. During the assessment, we attended both the MDT safety meeting and hospital-wide huddle and observed active participation from staff across disciplines. These arrangements supported the timely sharing of clinical information, risk identification and coordinated decision-making across patient pathways, including transfers between theatre, recovery and ward areas.

However, evidence from staff feedback identified pressures that affected team working in some areas. Staffing constraints, workload pressures and concerns relating to staff wellbeing, engagement and culture created challenges for teams managing competing demands. Staff also reported that escalation of clinical concerns, including documentation queries and treatment decisions, was not always communicated back to relevant teams and clinicians. This reduced assurance that information was consistently shared, actions were clearly communicated and care was coordinated across teams.

The service provided patients with practical advice and support to help them maintain their health, prepare for surgery and recover well after treatment. Staff assessed patients’ individual needs on admission and gave relevant advice to support recovery, wellbeing and healthier lifestyle choices.

Patients received information about their condition, treatment and how to prepare for surgery. This included guidance on maintaining their health before and after the procedure, activity levels, recovery expectations and general wellbeing. Staff from different disciplines reinforced this advice, which supported continuity of care and helped patients understand how to manage their recovery at home.

Patients were provided with written and verbal information about post-discharge care, including how to recognise signs of deterioration and when to seek further advice or treatment. They were advised how to contact the ward, pharmacy team or other relevant services if concerns arose after discharge. These arrangements supported access to advice and information following discharge and helped promote continuity of care.

However, health promotion was not fully embedded within the surgical pathway. Although patients received advice to support recovery and general wellbeing, there was limited evidence of structured initiatives, such as smoking cessation support or wider screening programmes, being consistently offered. This limited assurance that opportunities to support longer-term health and wellbeing were consistently identified and acted upon.

The service monitored care, treatment and outcomes through accreditation schemes, audits, governance processes and performance data. However, variation in how improvement actions were recorded and followed through reduced assurance that learning and changes were consistently embedded.

Staff used recognised tools and systems to identify and respond to clinical deterioration. Monitoring and risk assessment processes were in place across the surgical pathway, with structured escalation routes and defined responsibilities for responding to deteriorating patients. Strengthened triage processes and verification checks supported earlier identification and escalation of risk.

Outcomes were monitored through national and local audits, governance meetings and theatre audit programmes. Staff participated in audits relevant to surgery, which supported benchmarking against expected standards and helped identify areas for improvement. Audit findings were reviewed through governance processes and used to inform changes to practice.

The service also reviewed wider outcome and activity data, including returns to theatre, transfers, clinical indicators and surgical volumes by specialty. This helped the service understand demand, plan capacity and maintain oversight where national comparisons were limited.

Learning from outcomes was shared through mortality and morbidity meetings, incident reviews, audit discussions and governance forums. These processes helped identify themes, agree improvement actions and share learning with staff and consultants to support ongoing improvement in practice.

Technology supported monitoring and clinical decision-making. Electronic systems were used to record and analyse incident data, monitor performance and support patient flow. Staff also had access to point-of-care testing and monitoring systems, which enabled timely access to clinical information, including test results.

However, evidence showed that some monitoring and escalation processes relied on individual knowledge rather than consistently applied systems. Records did not always clearly show accountability or confirm that improvement actions had been completed. This reduced assurance that concerns were consistently escalated, actions were followed through and learning was embedded across the service.

The service had effective processes to support informed consent, with patients receiving the information they needed to make informed decisions and staff checking consent at key stages of their care and treatment.

Staff understood and applied the principles of the MCA and DoLS. Where there were concerns about a patient’s ability to consent, staff completed and recorded decision-specific capacity assessments, particularly for significant decisions such as surgery. Staff adapted communication to help patients make their own decisions wherever possible, including involving family members, using clear language and providing information in a way patients could understand.

When patients lacked capacity, staff made decisions in their best interests. These decisions were supported by MDT discussions and involvement of relatives or people close to the patient. Staff considered the patient’s wishes, feelings, beliefs and history, and systems were in place to ensure best interest decisions were documented and followed legal frameworks.

Staff were knowledgeable about consent, mental capacity and associated legislation. They understood how to support patients experiencing mental ill health and how to access further advice where needed. Patients could also access additional support, including advocacy services, to help them take part in decisions about their care and treatment.