Spire Washington 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 generally positive, the service strived to improve patient outcomes in a range of ways and people's feedback confirmed this.

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. 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 at the pre-operative assessment and planned for assistance if required. Staff knew how to access interpretation services for those whose first language was not English or had other accessibility needs. Throughout our visit, we heard from staff that the goal was to ensure that everything they did was centred around patient need.

Adaptions were made for patients with learning disabilities to support them in attending the hospital. Staff had access to a dementia resource box. The box contained items such as adaptive cutlery, plates and bowls, visual menus and adapted pain scoring tools. Department visits were optional for patients who might have anxiety before admission. Families and carers of patients were involved as much as possible. They were able to stay for the entirety of admission if needed and the service had open visiting hours.

Patient records were up to date and showed comprehensive assessments undertaken leading to effective ongoing care.

Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

There was a comprehensive programme of clinical audits to monitor quality and effectiveness and to drive improvement. We reviewed audits in IPC and saw that they were completed in line with policy. Where these audits identified areas of improvement with a score of less than 95%, action plans were made with clear actions.

Staff followed up-to-date policies and procedures. Surgical pathways were aligned with national guidance including compliance with National Safety Standards for Invasive Procedures (NatSSIPs) and Local Safety Standards for Invasive Procedures (LocSSIPs).

The service followed national guidance for the management and reporting of medical implants and submitted mandatory data to national registers, including the National Joint Registry, the Breast and Cosmetic Implant Registry and the British Spine Registry. We reviewed care plan documentation used for pathways within the service. 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.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service had policies and processes 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. In the 12 months prior to inspection, only 5 patients had been transferred to other providers. Incident investigation showed that 4 of these patients had experienced no physical harm and 1 had experienced low physical harm.

There was a daily huddle for all heads of departments and the senior management team to share any risks with their service. The teams worked together to prepare patients for what to expect post-operatively and when they returned home.

There were structured processes to support safe transfer of patient information. Internal and external transfers were reviewed through the incident reporting system.

A daily senior management and heads of department huddle took place to share information, manage risk and support coordination of care.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Patients attended pre-operative assessments where lifestyle advice and onward referrals were provided when appropriate.

Information was displayed throughout the service promoting mental health support, healthy lifestyles and smoking cessation.

On discharge, patients received surgery-specific and tailored advice, including physiotherapy guidance.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Managers and staff carried out a programme of repeated audits to monitor improvements over time. Managers used the audit findings to improve care and treatment, and ensured staff understood the outcomes and any required actions.

Staff followed current policies to plan and deliver high‑quality care in line with best practice and national guidance. They used surgical pathways aligned to national standards, including the provider’s Five Steps to Safer Surgery policy, which complied with the National Safety Standards for Invasive Procedures (NatSSIPs). NatSSIPs provide the framework for developing Local Safety Standards for Invasive Procedures (LocSSIPs).

We reviewed service guidelines, including those for managing sepsis and preoperative testing. These were current and aligned with NICE (National Institute for Health and Care Excellence) recommendations. Policies were stored on an online system accessible to all staff.

The provider employed a NICE guidance lead who oversaw policy updates and reviews to ensure consistent compliance across service locations. All guideline updates were reviewed through a defined process to determine whether changes to the provider’s policies were required. Where updates were needed, a clear and consistent implementation process was followed.

Staff followed relevant guidance on the management and reporting of medical implants, including those used in hip replacement surgery. The service submitted mandatory data to national implant registries such as the National Joint Registry (NJR). The provider participated in all national audits that were available for private providers including the Patient Reported Outcome Measures (PROMs) programme for knee and hip replacements. The service also submitted data to the Private Healthcare Information Network (PHIN).

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.

People felt supported by staff, who took time to explain treatment and decisions. Staff were sensitive and knowledgeable when giving updates to families.

Staff obtained consent for care and treatment, ensuring informed decisions. They made sure patients consented to treatment based on all the information available. Staff understood how to assess a patient’s capacity to make decisions. 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

Staff received Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training. They understood relevant consent and decision-making requirements. Staff knew how to access policy and advice on these topics.