Spire Southampton Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant that leaders recognised where improvement was required and were taking actions to address this.

This service scored 75 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service vision and strategy was to ‘make a positive difference to people's lives though outstanding personalised care'. It was evident throughout our inspection that staff were focused on this purpose. Staff took time and visible action to ensure care aligned with individual patient needs. They were focused on the needs of patients receiving treatment and worked well together to ensure they achieved good outcomes for patients. This was reflected in the amount of proactive engagement the service had with the community to ensure their strategy achieved the planned vision.

Staff were proud to work in the organisation and spoke of how everything they did was for the benefit of the patient. The culture was centred on the needs and experience of people who used services. The most recent staff survey said that 70% of staff who responded were proud to work for the service.

We heard how the values of the service were part of annual staff appraisals and interim reviews to support and promote a positive working culture. Staff were encouraged to review the values and reflect on how they could use their strength to achieve them or develop areas they felt they could be improved. Most staff agreed, to some degree, that their health and wellbeing was a focus at the hospital.

The evidence showed a good standard. The service had leaders at who understood the context in which they delivered care, treatment and support with the organisation. The service recognised that work was needed to improve culture across the workforce so they fully embodied the service values.

The senior leadership team consisted of the hospital director, director of clinical services, finance director and operations director. Each head of department reported into a senior manager and there was a monthly heads of department meeting. We saw that ward and theatre staff worked together effectively.

Staff mostly felt respected, supported, and valued. The hospital director had come into post recently and acknowledged there was work to be done to improve the service's culture to ensure staff felt leaders were visible and responsive. Some staff did not feel there was a two-way flow of information between leaders and teams and that concerns were not always escalated.

Senior leaders told us work was underway to improve relationships with staff and to ensure they felt heard. There had been a staff `pulse' survey to determine areas of focus for improving staff relationships with leaders. This highlighted the need for improvement in senior leadership visibility and for staff to better understand the roles they played. This was also raised in a previous staff survey. Senior leaders had since increased their visibility in the service and ensured they always attended staff huddles. There had also been an increase in planned staff forums and this had been welcomed with increased staff attendance. The hospital director undertook these staff forums, to provide a 2 way dialogue with staff. These meetings included dissemination of information and provided staff with an opportunity to pose questions and have them answered directly. The most recent staff forums were held in the week we inspected. These forums covered a range of dates in order to accommodate colleague working patterns. The hospital director told us that attendance at these forums had increased with over 300 colleagues. There had also implemented increased opportunities for staff praise and monthly staff newsletters on updates within the service.

We were told managers were approachable at the majority of levels and were mostly helpful. In theatres there had also been a recent change in leadership with an interim theatre manager leading the area. Some staff felt that their mental health had suffered previously due to poor morale and staff conflicts. Staff told us they had also previously felt unable to speak up, but leaders had worked to improve this. A freedom to speak up ambassador had been recruited in the theatre team, with more being recruited. Most theatre staff now described the culture in surgery as being positive and friendly.

We also heard consistent staff feedback from one area, where staff had raised concerns about poor manager behaviour to senior leaders, and these had not been addressed. Staff in this area also highlighted concerns around blame culture and a lack of confidentiality regarding personal staff information. Following our inspection, and in line with the ongoing work to improve oversight, changes had been made to ward leadership. This involved creating a dedicated cardiac ward and move to more generalised surgery in other areas. A single leadership team would then oversee the generalised surgery wards.

There was a clear management structure with clear lines of responsibility and accountability. There was a leadership structure in place for the service. The service had processes in place to ensure staff were recruited fairly and for roles they were competent in. Where new leaders were recruited, there were processes in place to ensure they were supported. There was a process for leaders to meet and discuss issues and cascade information back down to the staff in the service. Minutes from the governance meetings showed leaders were knowledgeable about their issues and priorities in their services.

The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

\"Freedom to Speak Up\" (FTSU) refers to the right of individuals to voice concerns, suggestions, and criticisms without fear of reprisal or retribution, especially in a workplace. It encourages an open and honest culture where everyone feels safe and confident to speak up about issues that may impact patient safety, worker well-being, or organisational effectiveness.

From April 2023 to March 24 a total of 381 cases were brought to FTSU guardians for this provider. When compared with similar organisations by size the provider has the highest number of cases raised in this period. Data is reported at provider level, however, this data does reflect that the FTSU process is well utilised by staff in the organisation.

There was a freedom to speak up policy and a whistleblowing policy and staff were aware of this. The service had an appointed FTSU lead and also FTSU guardians through departments within the service. Staff could also report concerns anonymously via the hospital incident reporting system and use FTSU as the type of concern. There was also a dedicated phone number for the provider for FTSU reporting. FTSU concerns were reviewed by the FTSU lead or, where appropriate, the provider concerns team. We also saw FTSU information posters in staff areas.

We undertook an anonymous staff survey in addition to our onsite inspection. This was to enable staff to provide feedback directly to the inspection team. Some staff told us they were not confident to speak up due to fear of repercussions when concerns were related to those they were directly managed by. Staff were asked if they knew how to raise a concern through the `freedom to speak up' process and the majority (92.8%) said `yes'. Over 70% of staff told us the hospital encouraged staff to report concerns. However only 60% of staff were confident their line manager would take action to address concerns. The most recent internal staff survey stated that only 64% of staff felt able to speak up without fear of consequences.

In the anonymous CQC survey only 51% of staff said they felt safe to report concerns. Additionally, 52.3% of staff also said that they did not know how to use the hospital's whistle-blowing policy, although out of this 9% said that they would know where to find it. Leaders told us they hoped the wider work to engage with colleagues and improve visibility would improve speaking up culture.

Staff were encouraged to raise concerns with their line managers in the first instance. Some staff said they had previously raised concerns following a provider led strategy to reduce staffing levels. They told us this increased stress and anxiety in some staff. Senior theatre staff raised this directly with leaders and told us they felt able to `stand their ground' with no fear of repercussions. We heard from staff that a FTSU guardian in theatres had been appointed and this `felt like an improvement' in response to previous concerns.

Following this inspection the service advised that additional actions had been taken to further support a speaking up culture within the service. This included issuing formal guidance to local leaders on how to support staff when speaking up, in addition to the mandatory training they already undertake. The service had appointed of additional FTSU representatives. There were also provider led `focussed training and engagement sessions' planned at the service with a range of leaders including SLT, and FTSU team. A session was also planned with Head of Departments which would cover `Receiving Concerns/Breaking Down Barriers'. The service hoped that this would help foster improved FTSU confidence among staff.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and processes in place to ensure the service were inclusive and fair in the way they operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

The service promoted equality and diversity in daily work and provided opportunities for career development. Equality and Diversity training was part of the mandatory training programme; 99% of staff had completed this. Leaders told us they monitored pay gaps relating to gender as part of corporate governance. The service undertook work in 2024, where all staff were aligned to the correct role and had their pay mapped accordingly.

We reviewed provider level reporting to identify Workforce Race Equality Metrics from August 2023. This was used by the provider alongside its equality, diversity and inclusion strategy to support an inclusive culture. Measures to improve inclusivity included allyship to help staff feel supported in their role and improve ‘speaking up’. There was also an active Race Equality Network that aimed to give better representation to staff from minority ethnic groups. The service told us they encouraged potential and existing staff to identify reasonable adjustments so these could be considered for implementation.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear management structure. Leaders monitored quality and operational processes and had systems to identify where action should be taken. There were a range of other systems which supported the delivery of safe and high-quality care. These included daily management huddles and daily walk arounds by leadership team to most clinical areas. The service had a clear governance structure with various committees. We reviewed the minute of these meetings which showed clear discussions and scrutiny of issues.

Staff told us there were governance, management, and accountability arrangements in place, and that they understood their role and responsibilities, what they were accountable for, and to whom. The hospital's governance framework was supported by a medical advisory committee (MAC) meeting and a clinical quality and safety meeting. They held risk forum meetings which fed into these meetings such as clinical heads of department monthly meeting, infection prevention and control, medical devices and medicines management. We saw standard agenda items for discussion included clinical incidents, complaints, audits and risks. There was evidence of action taken to address compliance within the surgical service. Staff told us they received feedback from meetings. There was an ongoing theatre action log from their team meetings.

We reviewed monthly ward and theatre team meeting minutes which kept staff informed. They followed a standing agenda to ensure the most important updates were always provided.

The surgical division had departmental risk registers, which highlighted the main risks for each area. The departmental risk registers were incorporated into the hospital risk register to allow oversight at all levels. Risk registers were reviewed regularly and updated quarterly with clear actions documented.

The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

The service worked closely with their local NHS trust to improve partnership working. This included providing commissioned patient services to support waiting times and improve patient outcomes. The director of clinical services provided quarterly reports to their local integrated care board. These reports included relevant clinical information such as clinical incident reporting, IPC statistics, complaints and patient feedback scores, and medication incidents. Unplanned patient transfers were reviewed at biannual meetings with the local NHS trust. Senior leaders also had annual engagement meetings to review against clinical patient outcomes.

The service was a charity partner with a cancer charity that supported people with a cancer diagnosis and their families. There were fundraising events within the service. Patients and those caring for them were able to use the service for holistic needs. We saw a certificate and letter of gratitude from the charity on display in the service.

There was an online support group for patients who received bariatric surgery. We saw evidence of the service promoting fundraising events for local charities. The service also hosted coffee morning support services that had an open invitation to the community.

Students studying nursing at 4 local universities were supported to undertake placements at the service. Feedback from the students was also gained to improve learning journeys. We spoke with staff who had undertaken student placement at the service and then taken up post graduate roles. There was also an ongoing offer of training from a university to provide clinical updates and training to staff.

Consultants from the service provided training updates to healthcare staff in other services such as GPs, physiotherapists and optometrists. The service told us the aim of this was to improve patient diagnosis and treatment. We saw that consultants had run over 90 training sessions in a wide range of topics. We heard how the area of training focus was determined by the requests from the local medical community.

There were free educational sessions for people in the local community, covering a range of health topics such as aches and pains and cardiac concerns. Feedback also shaped the topic covered at these sessions.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They actively contribute to safe, effective practice and research.

All staff were committed to continually learning and improving services. They had a good understanding of how to make improvements happen. Leaders encouraged staff to speak up with ideas for improvement and actively invested time to listen and engage.

Staff also had regular meetings to discuss service improvement. For staff unable to attend, due to working patterns these were to feedback to staff. Leaders told us staff could submit feedback anonymously and discuss wellbeing ideas in staff forums.

We heard from the perfusion team they had recently raised maintenance and repair concerns regarding the Heater-Cooler Units (HCUs) used by the team. HCUs are essential medical devices used during cardiac surgery procedures to maintain a patient's body temperature. The equipment manufacturer was no longer manufacturing the equipment and this raised concerns regarding servicing and maintenance. Staff were able to research a replacement HCU and after a trial to assess suitability and a business case had been approved for a replacement unit in March 2025.

Anaesthetists recognised the need for a pre-operative anaemia clinic (POAC) at the service. It had been identified that some patients were not receiving active treatment or management of anaemia symptoms at their local GP service. These patients were at a higher risk of reduced iron levels in their blood due to surgery, requiring additional medical support and a risk of delayed discharge. Pre-operative anaemia, is a common surgical complication associated with an increased risk of peri-operative blood transfusion and adverse post-operative outcomes. It is important to diagnose and manage anaemia preoperatively to improve patient outcomes and reduce the need for transfusions. A review was undertaken to identify patients that could benefit from iron infusions to improve who would benefit from treatment for anaemia. A treatment protocol for treatment was developed and approved and training was delivered to staff who would deliver the treatment. The service had started running the POAC in late 2024 and planned to undertake a quality improvement review over the course of 2025.

The service hosted 3 patient forums per year to further understand patient issues and make patient centred improvement. Discussion at these groups was shaped from patient feedback to give areas of focus. The forum group consisted of 12 patients of the service who were randomly selected at provider level, the hospital director, director of clinical services and patient clinical coordinator. We reviewed the topic of discussion for the past 3 meetings and saw it contained a wider range of topics such as ease of communication, appointment times and delays, in room facilities, & post discharge information.

Patient and their families were invited to undertake the Patient-Led Assessments of the Care Environment (PLACE) audit. Patient-led assessments of the care environment (PLACE) help organisations understand how well they are meeting the needs of their patients, and identify where improvements can be made.