Spire Southampton Hospital

On this page

• 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people's care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. The service completed assessments and followed patient pathways which were nationally recognised, and evidence based. They followed national guidance to gain patients' consent.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people's outcomes were consistently positive, the service strived to improve patient outcomes in a range of ways and people's feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service always made sure people's care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Patients were given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally. This was provided in a variety of ways, prior to surgery. Staff ensured patients were involved in the assessment of their needs, and support was provided where needed to maximise their involvement.

Staff assessed patient communication needs in pre-operative assessment (POA) and planned for assistance if required. Throughout our visit, we heard from staff that the 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. If during a pre assessment, staff were alerted that a patient was taking Controlled Drugs the patient was advised not to bring them in as the hospital could supply these.

We saw examples of adaptations made for patients with learning disabilities to support them in attending, this included visits to see the department prior to admission, this reduced anxiety. There was also a `Neurodiversity' (ND) box available to all patients. This contained equipment staff could offer to support ND patients, which included noise cancelling headphones, fidget items, and wellbeing tools. 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 coloured toilet seat. This is because patients with dementia can have reduced depth perception and the contrast of colour aides with memory recall. Staff had access to a dementia resource box available to all patients. The box contained items such as adaptive cutlery, plates and bowls, visual menus and adapted pain scoring tools to ensure all needs were met.

The service told us that should a patient who has complex needs require additional physical support such as a service dog or person of support to be in, this would always be accommodated. The hospital also had temporary beds available which they would place in the patients' room.

For patients who attended the service for NHS treatment, and may not have POA at the service, they used the patients existing hospital passports. These were reviewed in full prior to patient admission to ensure all adaptations were incorporated into the patient's personalised pathway.

Staff completed risk assessments for each patient on at pre-operative assessment, on admission and reviewed this regularly during admission. The pre-operative assessment team met with the anaesthetist weekly basis to ensure all patients were suitable for surgery at the hospital. There were standardised patient pathways which prompted staff to update risk assessments daily following surgery. Nursing staff used nationally recognised tools to assess patient's risk of developing pressure malnutrition, falls, pressure sores, as well as risks associated with moving and handling. Patients identified at risk were placed on care plans and were monitored more frequently by staff to reduce the risk of harm. We observed theatre staff explaining pain relief to a patient following surgery using simple and straightforward language to ensure this was understood by the patient. We reviewed 4 sets of notes and found all risk assessments had been completed and reviewed regularly.

Theatres and the ward audited patient records to sure they contained essential information in line with policy. The target compliance for all audits was 95%. Where audits outcomes did not meet this action plans were made to improve compliance. We reviewed action plans which showed clear improvement targets and saw these audits were discussed in safety meetings to ensure oversight.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They 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. Staff used surgical pathways which were in line with national guidance. This included in the provider policy, ‘Five steps to Safer Surgery’ which was complaint to NatSSIPS. NatSSIPS provide a framework to produce Local Safety Standards for Invasive Procedures (LocSSIPs). We reviewed service guidelines including managing sepsis and preoperative testing, these were in date and reflected NICE guidelines. Policies were stored on an online system which all staff had access to. The service used NICE guidelines to ensure care was evidence-based. Policies, processes, and other supporting documentation were based upon national guidance and standards. The provider employed a NICE guidance lead who oversaw policy updates and review to ensure consistent compliance throughout service locations. All best practice guideline updates were reviewed by a clear process to determine if updates to provider policy was required. When this was required a clear process was followed to implement this in a consistent manner.

Patient care and treatment was assessed using a range of tools to ensure their needs were reflected and understood. The services had a wide range of clinical assessment tools that were up to date and person centred. We reviewed care plan documentation used for three pathways within the service. This included the Major Orthopaedic Care Pathway, Intermediate Shoulder Care Pathway, and the Minor Orthopaedic Surgery Care Pathway. We saw that these documents were clear and well laid out and included guidance for use and links to relevant supporting policies. All care plans contained relevant risk assessments such as VTE, pregnancy status, mobility, and airway. These were reviewed, where relevant, through all stages of care from recovery to post discharge follow up.

Where policies were updated, this was communicated in team meetings, safety huddles and staff email. Staff were required to electronically acknowledge they had reviewed updates to policies, and this was followed up by managers.

Staff followed guidance regarding management and reporting of medical implants, such as for hip replacement surgery. The service reported mandatory information to national implant registers including, the National Joint Registry (NJR), Breast and Cosmetic Implant Registry (BCIR), National Institute for Cardiovascular Outcomes Research (NICOR) and the British Spine Registry (BSR). Patients signed a consent form agreeing they were satisfied for their details to be stored by the service which complied with GDPR data sharing regulations. Cardiac implants such as pacemakers and valves were captured on The National Institute for Cardiovascular Outcomes Research within 2 weeks of surgery. The primary reason for using these registries is to improve patient care, enhance device design, and facilitate informed decision-making by clinicians and patients.

The evidence showed a good standard. The service always worked well across teams and services to support people. Staff shared thorough assessments of people's needs when they moved between different services, so people only needed to tell their story once.

The service had policies and processes in place to support the transfer of patient information. All patient transfers were reviewed through the incident reporting process. Incidences of internal and external transfer, were reviewed by a multidisciplinary group. This process included feedback from staff involved in the transfer including, resident doctors and consultant surgeons and anaesthetists. This ensured a complete end to end review of the transfer process including handover documentation and that the transfers are timely and appropriate. Patient, family, and staff feedback at the receiving hospital were also included in this review. All patients that required transfer were followed up after a transfer to both NHS hospitals and the services own critical care unit to communicate any issues or concerns between staff.

The Hospital Director, Director of Care Services and Critical Care lead met with senior consultants in General intensive care unit (GICU) at the local NHS trust twice a year. This allowed an opportunity to audit and review any patients transferred. The service told us they have also recently invited a GICU consultant to join the medical advisory committee at the service.

The service did not employ a speech and language therapist (SLT) however those identified requiring these services would be referred directly to NHS services or private providers. This ensured treatment from SLT could be maintained following discharge for ongoing long-term support. The services told us they recognised the benefits of early interventions for SLT. Due to their collaboration with the local NHS trust they were hoping to explore opportunities for more integrated speech and language involvement to further improve patient care and long-term outcomes. Discharge communication was sent to patient GPs or care home facility to highlight any changes in medication.

The evidence showed an exceptional standard. The service always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Patients attended pre-operative assessment appointments (POAA) where their suitability for surgery was checked. This included the completion of a pre surgical assessment and an opportunity for staff to provide advice or refer patients on to other appropriate services if they required these services. Staff assessed each patient's overall health and provided support and advice to help patients lead healthier lives. This included screening for alcohol dependence, nutrition, mobility requirements requiring physiotherapy input, and obstructive sleep apnoea. The service told us that staff would provide health education to patients who may require support with reduction of alcohol units consumed, and being more active. Staff spoke at POAA to patients who were active smokers about the risks associated with smoking and surgery, for example, increased risk of VTE and infection. Patients were also able to independently access advice about smoking cessation and could self-referral to programmes via a QR code tool.

The service undertook audit to monitor compliance with clinical risk assessments, in the 12 months prior to inspection the service had 98% completion which exceeded the clinical target of 95%.

We saw posters and information in outpatient and ward areas that related to mental health services, support groups, heathier food choices, and smoking cessation. The service also supplied additional images of posters throughout the service that supported patients to live healthier lives.

In addition to pre-operative assessment, patients undergoing some knee or hip surgeries were offered a place to participate in the pre-operative education session formally known as `Joint School'. These sessions were run on alternate weeks for hip or knee replacement surgery patients. The service told us that on average 3-4 patients are seen per session which involved advice and education on pre-operative exercises, optimising home set up including any relevant equipment that may be required. Patients are also instructed on what to bring to hospital, what to expect on admission and what they would be expected to achieve for safe discharge. For patients unable to attend this advice was also given via telephone. All other patients received this same information when they were an inpatient before surgery.

On discharge patients were given surgery specific information sheets regarding physiotherapy advice and lifestyle management. These would be tailored to fit patients' individual needs or if there was deviation from standard post operative instructions. For patients undergoing bariatric surgery there was an online support group where patients could share their experiences and support each other in their weight loss journeys.

All patients undergoing surgery at the service, regardless of private or NHS funded were directly referred for follow up physiotherapy to the services' outpatient physiotherapy centre. NHS patients were not charged for this service. Patients who lived out of area or who privately funded treatment were also given guidance for arranging follow up rehab and physiotherapy. The service also held details of NHS and private physiotherapy providers in Hampshire and the surrounding area to support onward referral.

The evidence showed a good standard. The service monitored all people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service participated in all national audits that were available for private providers this included the National Joint Registry, Breast and Cosmetic Implant Registry, National Cardiac Audit Programme, and the Patient Reported Outcome Measures (PROMs) programme for knee and hip replacements. Consultants submitted information to the British Spine Registry. The service also submitted data to the Private Healthcare Information Network (PHIN).

The service completed a wide range of over 100 audits monthly to monitor whether staff followed best practice guidelines. These audits were allocated to the hospital areas they covered such as cardiac catheter team, endoscopy suite and orthopaedic ward. These covered areas such as infection prevention and control, health and safety and safety checklists. Staff were observed to undertake the World Health Organisation safety checklist effectively.

Leaders told us that in September 2024 the hospital was informed by the Society for Cardiothoracic Surgery in Great Britain and Ireland that the NICOR data submitted for the period of April 2021 to March 2024 provided some of the best clinical outcomes and survival rates for cardiac patients. The service consistently outperformed expectations for 9 consecutive years, compared to national data and was one of the services with better than expected outcomes for cardiac surgery in the UK. In June 2023, Spire Southampton was awarded a Certificate of Accreditation by The College of Clinical Perfusion Scientists of Great Britain and Ireland, as an Accredited Perfusion Centre for five years.

The service had a dedicated dietetic service for those requiring dietetic support post-surgery. The majority of these patients were cared for by the bariatric service, oncology or general surgery. However, the service told us that the cardiac ward had also sent referrals for cardiac patients for education on diet and diabetes management. We heard that patients would be referred to the dietetic service at POA should it be identified this would be beneficial.

The service held a bronze award for the NJR for commitment to patient safety through the registry. We reviewed the past 24 months of evidence of compliance and revision compliance with the NJR. The National Joint Registry records, monitors, analyses and reports on performance outcomes in joint replacement surgery in a continuous drive to improve service quality and enable research, to ultimately improve patient outcomes. The service performed well in time taken to enter data, which the service averaged within 5 days, against the national expectation of 30. The service also achieved a compliance with consent rate of 98% for data collection in the year 2022-2023. This was the most recent year of validated data.

The majority of procedures reported to NJR were knee replacement procedures. The 90 day mortality rate for all knee replacement operations was within expected limits. However, patients were more likely than the national average to need any knee replacement surgery revised between 2018 and 2023.In 2023 the service had been identified by the NJR as being an outlier in this area, the service had identified this performance outlier in advance of this and in response completed an internal review of the Knee Arthroplasty service, led by the hospital's NJR Clinical Liaison Lead. This was undertaken in conjunction with an ongoing review the local NHS trust, as well as individual data review for relevant surgeons. This review identified a likely cause of the increase in revisions, this was then subject to an Elective Care Review by the British Orthopaedic Association (BOA) in January 2024. This review acknowledged the findings and identified areas of good practice, but made further recommendations with respect to the cause of increased rates. In response to this the service developed a 25 point improvement plan with an aim to complete this by Q2 of 2025. At the time of inspection 9 of the action points had been completed, with a further 3 awaiting closure approval. The service told us an update with this plan was being provided to the Provider led Operational Safety, Quality and Risk Committee every two months until the action plan was closed. Progress with the action plan was also being monitored by the Medical Professional Standards Committee.

The evidence showed a good standard. The service always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Patients were given information about their proposed treatment both verbally and written, to enable them to make an informed decision about their procedure. Each patient file contained a consent form which showed staff had discussed the risks and benefits of treatment with patients prior to any procedures being undertaken. Staff clearly recorded consent in the patients' records. There was also a checklist within the pathway to ensure the consent form was checked prior to surgery going ahead; this was completed in all notes we checked. We also observed a patient being taken to theatre and they were asked about their consent form prior to leaving the ward and then again in the anaesthetic room. We looked at 5 sets of patient notes and saw consent was recorded in all these records. Staff were given the appropriate skills and knowledge to seek verbal and written informed consent before providing care and treatment to their patients.

There was a consent policy in place to support decision making. There was also a policy to support consent for cosmetic surgery, stating that patients requesting cosmetic surgery should be required to attend two appointments at least a week apart with 2 weeks following this to `cool off'. This was in line with the Royal College of Surgeons best practice guidance.

The service had a robust inclusion criterion which meant that patients detained under the Mental Health Act did not receive treatment at the location. The service did however provided care and treatment for some patients who may have dementia or learning disabilities. When patients could not give informed consent, staff made decisions in their best interest, considering patients' wishes, culture and traditions. They would involve the patient's representative and other healthcare professionals. Staff told us most patients admitted had the capacity to make their own decisions. Patients who lacked capacity were identified during the pre-operative assessment process, where it was determined whether they could be admitted for treatment at the hospital.

Staff were aware of the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberties Safeguards (DoLS). Staff we spoke to understood their role in supporting patients who came under the MCA and DoLS. We reviewed training data that showed that 100% of non-registered staff on wards had completed training in MCA. However, only 89.9% of registered ward staff and 93.4% of registered theatre staff had completed this training. The service target was 95% by April 2025 so at inspection this was below the target, leaders told us staff were expected to achieve this.