Spire London East Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question as good. At this assessment, the rating has remained good. This meant people’s needs were met through good organisation and delivery.

Patients were generally involved in planning their care and supported through coordinated pathways from referral to discharge. Staff provided information in accessible formats, used interpreter and translation services where needed, and gathered feedback through surveys, complaints, patient forums and quick response codes. However, people’s experience was not always consistent. Some patients experienced delays, cancellations, limited appointment flexibility and difficulty accessing digital information. The service also had limited oversight of some access and discharge data, which reduced assurance that barriers and delays were always identified and addressed.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices, and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. Patients were usually involved in decisions about their care, and staff generally considered their individual needs, preferences and circumstances.

Patients described feeling listened to, supported and treated with respect by staff throughout their care. Staff adapted their approach when patients were anxious or in pain, responded appropriately, and provided reassurance. Patients said staff communicated clearly, explained care in a way they could understand, and gave them information before and after treatment to support their individual recovery.

Staff supported shared decision-making by giving patients time to ask questions and be involved in decisions about their care and treatment. Staff explained risks, benefits and recovery clearly, which helped patients make informed choices. Patients understood what would happen next and knew who to contact after discharge. This supported independence and confidence in managing their care. In many cases, patients were also able to choose appointment times that suited their personal circumstances, which showed flexibility and respect for individual preferences.

The service supported a holistic approach to person-centred care. MDT and allied health professionals contributed to care planning across the patient pathway, helping staff respond to patients’ individual needs. Staff also considered patients’ dietary and wellbeing needs as part of their care.

The service adjusted support for children and young people (CYP). The recovery area included a designated bed space for younger patients, which helped separate them from older patients and supported their privacy and comfort. The paediatric recovery space was also decorated to create a more age-appropriate and welcoming environment.

However, patients did not always experience care that was responsive to their individual circumstances and preferences. Some patients experienced limited choice in appointment scheduling and repeated cancellations, which reduced their ability to plan care around their personal circumstances. Some patients reported delays in receiving assistance when unwell and felt their immediate needs were not always prioritised because of staffing pressures.

The service understood patients’ diverse health and care needs and generally provided joined-up, flexible care that supported continuity across the patient pathway.

The service worked effectively with a range of MDT professionals to meet patients’ needs. Patients had access to doctors, nurses, pharmacists and allied health professionals, including physiotherapists and other specialists who provided support seven days a week. Medical cover arrangements included a resident medical officer on site and consultant oversight throughout the patient pathway. This supported coordinated, holistic care, although some arrangements were based on established practice rather than fully standardised protocols.

Care was organised to support patients from referral through to discharge and follow-up. The booking and referral process was structured and coordinated. Consultants or medical secretaries submitted booking forms, which were reviewed for completeness and progressed according to the patient’s funding route. Specialist teams managed approvals and financial arrangements. Once confirmed, patients were scheduled for surgery and moved through pre-assessment pathways. Pre-operative assessment (POA), including digital questionnaires and clinical review by the POA team, supported clinical decision-making and helped ensure patients were prepared before admission.

Electronic systems supported coordination and communication between teams and specialties. These systems enabled staff to share information as patients moved through different stages of care. This reduced the need for patients to repeat information and supported continuity across theatre, recovery and ward areas. Staff also worked collaboratively through MDT handovers and safety huddles, where they shared key information, identified risks and supported patient flow. This helped ensure patients experienced a coordinated pathway across services.

The service worked with external healthcare providers to maintain continuity beyond the hospital setting. Arrangements were in place to share information with primary care and community services. Discharge planning processes included follow-up arrangements and advice to support patients after leaving hospital. Patients were told who to contact if they had concerns following discharge, which supported ongoing care and recovery.

The service had business continuity arrangements to support continued care during disruption. The plan covered theatres, sterile services and endoscopy, and identified risks that could affect care provision, including loss of utilities, medical gases, information technology systems and staffing disruption. It set out response arrangements in and out of hours, priority timescales, minimum staffing requirements and recovery actions. This supported the service to maintain essential pathways and restore services safely following disruption.

However, oversight of patient access and engagement was not fully assured. While the service monitored attendance and non-attendance rates and had a Did Not Attend (DNA) policy in place, it was unable to provide DNA data specific to the surgical department when requested. This limited assurance that leaders had effective oversight of attendance trends, barriers to access and the impact of non-attendance within the service.

The service generally ensured that patients were provided with accurate and up to date information to help them understand their care, treatment options and any changes to their treatment plans.

Patients had access to a range of information leaflets covering topics such as their rights, care processes and post-operative recovery. Staff took time to answer patients’ questions and checked their understanding, which helped support informed involvement in care decisions. The service also supported patients with communication needs by providing access to independent interpreters and translation services, including British Sign Language support. Information was displayed in multiple languages explaining how to access these services, and patients were asked to notify the service in advance if they required an interpreter, which supported safe and effective communication.

However, one patient reported difficulty accessing documents through the patient portal. While this was a limited example and did not evidence a wider pattern, it provided some evidence that access to digitally shared information was not always effective for every patient.

The service generally listened to people and involved them in decisions about their care. Patients had accessible routes to give feedback, raise concerns and receive support, and the service used feedback and complaints to inform improvements.

Patients could provide feedback through accessible routes, including surveys and quick response (QR) codes, which enabled them to share views simply and promptly. The service also had a clear complaints process aligned with the Independent Sector Complaints Adjudication Service (ISCAS) Code and relevant ombudsman standards. Complaints were managed through this process and used to inform improvements in communication, documentation and patient experience.

Concerns raised through the “talk to us” system were reviewed, triaged as clinical or non-clinical, and discussed in operational meetings to support oversight. Complaints, including those about cancellations, were investigated to identify root causes and learning. At the time of the assessment, the service was managing 6 open complaints and 9 concerns. A dedicated patient experience leads coordinated responses and usually contacted patients, sometimes within 24 to 48 hours. This supported a responsive approach and helped reduce the likelihood of further escalation.

There was evidence that patient feedback led to meaningful changes in practice. Following a complaint about a last-minute surgery cancellation caused by an administrative error, the service strengthened its process, so consultant leave had to be clearly documented before cancellations were approved. In another case, where a patient with a known allergy was discharged with inappropriate medication, the service introduced additional checks. These included senior clinician authorisation for changes to discharge letters, reminders for staff to double-check medicines, and guidance to seek advice when unsure. These actions showed that patient feedback was used to improve safety, communication, and care processes.

The service also supported patients to be involved in decisions about their care. The patient experience lead and advocacy services were available for patients who needed additional support, helping them take part in discussions and decisions about their treatment. The service held patient forums twice yearly and used FFT responses to gather feedback. Results were displayed within the service, which supported transparency and showed patients how feedback was being used to influence improvements in care quality.

The service ensured patients had equitable access to care and treatment, with clear processes in place to support fair and clinically led decision-making.

Staff told us there was no difference in the clinical services or expertise provided to NHS and private patients, and we found no evidence to suggest disparity. At the time of inspection, approximately 95% of activity related to NHS patients and 5% to private patients. In April, there were 512 admissions against a target of 518, which showed activity levels were broadly in line with expectations and did not impact equitable access or prioritisation.

All patients underwent a POA to ensure suitability for surgery and to identify any additional needs. This included assessment by appropriately trained staff, with higher-risk patients discussed through an MDT process to support safe and appropriate pathways. This approach ensured that decisions about access to surgery were based on clinical need and supported consistency across patient groups. Where patients were not suitable for treatment at the hospital, there were clear arrangements to redirect them safely to NHS services based on clinical criteria.

The service made reasonable adjustments to meet individual needs. Staff provided equipment such as walking aids and shower chairs for patients with mobility issues, and improvements such as clearer signage and dementia friendly features had been introduced following patient feedback. Children and young people and their guardians were supported through dedicated pathways, including pre admission visits to paediatric areas to reduce anxiety. Patients aged 16 to 17 years were individually risk assessed to determine whether care should be provided in paediatric or adult environments, ensuring care was appropriate to their needs.

There was adequate medical cover in place, with doctors’ available day and night and able to attend the ward quickly in an emergency. Discharge planning was embedded in the patient pathway and usually began at pre assessment. Staff worked with care managers and coordinators to plan safe discharges, particularly for patients with complex needs. Discharges were not delayed for non clinical reasons, and MDT working supported continuity of care. The service monitored activity and discharge processes to manage patient flow and demand.

The hospital had the facilities and capacity to meet a range of patient needs, including 24 inpatient beds, 3 high observation beds, 15 short stay rooms and a separate paediatric area. Surgical facilities included 4 operating theatres (3 in use due to operational constraints), 6 recovery bays including 1 dedicated to CYP, and additional treatment and consulting areas. These arrangements supported delivery of care across a range of patient groups.

The service monitored activity data, including surgical volumes and theatre use, to align capacity with patient need. Systems such as pre assessment and ongoing clinical review supported safe access to care and helped reduce avoidable risks for patients undergoing surgery.

However, there were some operational challenges that affected the consistency of access. Although most theatre lists ran on time, delays occurred on some days, affecting between 14% and 60% of lists, mainly due to overruns and late arrival of consultants or anaesthetists. In addition, 134 elective procedures (2.4% of scheduled surgery) were cancelled on the day, most commonly because patients were unwell or not fit to proceed due to failure of the POA process. These issues did not indicate inequitable access but meant some patients experienced delays to treatment.

On-the-day changes to theatre lists were discussed within teams but were not formally recorded, which limited the service’s ability to analyse causes, identify themes and evidence learning from delays. There were also occasional impacts on patient flow, for example where limited physiotherapy provision delayed discharge in some cases. The service did not consistently hold comprehensive data on delayed discharges or affected wards, which limited oversight of trends, impact and opportunities for improvement.

The service gathered patient feedback through surveys, patient experience meetings and accessible feedback routes, and there was evidence that feedback was used to make improvements. However, the service did not always demonstrate that information affecting people’s experience and outcomes was consistently identified, analysed or acted on across all areas.

Evidence showed that concerns about patient pathways, staffing and pre-operative planning were not always heard, recorded or followed through. This limited leaders’ ability to demonstrate that variation in people’s experience and outcomes was consistently identified and addressed.

The service could not demonstrate that mandatory equality, diversity and inclusion (EDI) and human rights training was consistently completed across all staff groups. Compliance was below the 95% target in several areas: wards 94.7%, theatres 69.7%, POA 50.0% and pharmacy 80.0%, although physiotherapy achieved 100%. This reduced assurance that staff consistently had the training intended to support inclusive practice, equality and human rights in care delivery.

Operational issues also affected consistency of patient experience. Theatre delays occurred on some days, affecting 14% to 60% of lists, and 134 procedures (2.4%) were cancelled on the day. On-the-day list changes were not formally recorded, and gaps in data on delayed discharges and ward impact reduced leaders’ ability to oversee trends, understand the impact on different patient groups and identify where action was needed to improve consistency of outcomes.

However, the service gathered patient feedback through patient experience meetings and surveys and used this to improve services. Changes included improved signage, disability friendly facilities, dementia friendly adaptations and the sunflower scheme. Patients could also raise concerns through accessible systems including QR codes and advocacy support.

The service supported patients to plan for their care, treatment and recovery. Patients received information and time to understand their options, prepare for surgery and make informed decisions about their future care.

Individual assessment and MDT involvement supported personalised care planning. POA identified clinical risks and individual needs, and staff liaised with GP’s or referred patients to specialists where this was needed before surgery. During POA and consultation, patients received information about their surgery and had opportunities to discuss treatment options with doctors. This supported patient-centred planning and helped patients prepare for surgical treatment.

Recovery and discharge planning supported continuity of care. Patients received tailored advice on pain management and wound care and were given contact details for relevant healthcare professionals and services if concerns arose after discharge. These arrangements supported safe recovery and ongoing access to advice.

Patients with complex needs were supported through coordinated care planning. POA processes and governance arrangements helped ensure consultants, nurses, and allied health professionals were involved in planning and delivering care where required.

The service also used feedback and complaints to inform future planning and improvement. The service complaints framework set out how concerns were managed, how learning was identified and how improvements were embedded through governance systems. Learning from complaints was shared across teams to support service improvement.

Despite these positive practices, some strategic plans to improve the surgical environment and capacity remained delayed. One operating theatre remained closed due to operational budget constraints and was being used for storage at the time of inspection. Senior leaders had not provided a clear timescale for reopening or using the theatre. Although this had not affected current service delivery, reopening the theatre could increase capacity and improve patient access to surgical care.