Spire Washington Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff were open, transparent, and honest about reporting incidents. Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses in line with the organisation’s policy. Staff felt safe to speak up about issues without fear of blame and told us that they would intervene to prevent harm should they identify risk. Staff said that the senior leadership team had an open-door policy and they were approachable to discuss concerns they might have. Safety huddles were held in each clinical department daily. Daily hospital wide safety huddles afforded colleagues the opportunity to raise any departmental issues and any other business they had,

The service had corporate policies and processes for staff to follow when reporting incidents. These explained how to report, categorise, and investigate incidents.

There had been 632 incidents reported across all specialities pertaining to surgery between 1st October 2024 and 30th September 2025. Incidents were categorised into no harm, low, moderate harm, or death. The most common trends included surgical complications and clinical deterioration. 97.5% of incidents were classified as no or low harm.

The duty of candour policy was adhered to, and staff demonstrated a good understanding of its importance. Incident records confirmed that patients, or their representatives, were offered a sincere apology, appropriate support, and a clear and honest explanation of events in a timely manner.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

The service used a variety of patient pathways, dependent on their procedure. Each care pathway outlined its aims from pre-assessment to admission to discharge using tailored checklists and care record documents.

Staff held regular and effective multidisciplinary meetings to discuss all patients and improve their care.

A standard operating procedure clearly set out the process for staff to follow if a patient needed to be transferred to the local NHS trust in the event of an emergency. Resident doctors were able to attend all deteriorating patients without delay due to their proximity to wards. There was also an on-call theatre team to support rapid return to theatres.

Patients discharged following surgery were provided with contact details for a 24 hour phone number should they feel unwell or have additional questions. Patients were given information about their prescribed medicines, when to call for help, and advised to contact the service if they were admitted to another hospital within 31 days of surgery. In the 12 months prior to inspection, there were 57 unplanned readmissions following surgery, the majority of these patients were readmitted at a Spire Hospital. The readmission rate was less than 1% of patients who underwent surgery.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Staff demonstrated a strong understanding of safeguarding and the actions required to protect patients at risk of, or experiencing, harm. They understood how to escalate safeguarding concerns and worked effectively with external agencies where required.

Safeguarding policies and procedures were clear, accessible, and aligned with current best practice. At the time of inspection, all staff had completed level 2 adult safeguarding training and 99% had completed advanced safeguarding children training. For level 3 adult safeguarding, all ward staff had completed the training, and in theatres, all support staff and 98.9% of registered staff had done so. All staff required to complete level 4 safeguarding training were fully compliant.

There was a designated safeguarding lead for the location who supported departments in raising safeguarding alerts, providing a consistent and coordinated approach to reporting and oversight.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were clear and well defined inclusion criteria for patients undergoing surgery at the hospital. This ensured patients received treatment in a setting appropriate to their individual needs. We reviewed risk assessments in patient care plans that were completed and managed in line with guidance. Staff completed risk assessments for each patient at pre-operative assessment, on admission and reviewed this regularly during admission. The pre-operative assessment team met with the anaesthetist on a weekly basis to ensure all patients were suitable for surgery at the hospital.
Staff used the nationally recognised National Early Warning Score 2 (NEWS2) to identify patients at risk of clinical deterioration and escalated concerns appropriately. There was a clear policy to guide staff on managing deteriorating patients within the service. 100% of clinical staff were trained in immediate life support and 4 others including the resident doctor were trained in advance life support.
All theatre staff took part in a theatre huddle at the beginning of each morning to discuss the patient list for that day, any ongoing investigations and any recently reported incidents. In addition to this, each operating theatre team performed their own team brief before starting each operating list. The WHO (World Health Organisation) surgical checklists were undertaken with each procedure. WHO checklist audits showed compliance of between 99% and 100% for the 4 months leading to inspection.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, and facilities supported the delivery of safe care.

The design of the environment followed national guidance. The service had enough suitable equipment to help them to safely care for patients. In theatres we reviewed equipment servicing history and saw all equipment was in date. All equipment we checked onsite contained evidence of in date electrical safety testing and servicing.

Theatres were well stocked with equipment and supplies. Advanced planning of schedules meant staff could ensure equipment was readily available. There was a dedicated team that undertook maintenance and oversight of equipment faults. Where indicated, external providers were contracted to undertake servicing.

Each theatre had its own scrub area, anaesthetic room, and prep area. All anaesthetic rooms were set up the same. This meant that staff knew where equipment was even when allocated to different theatres. Staff were trained to use specialist equipment safely and had annual updates. Staff disposed of clinical waste safely.

Resuscitation trolleys were available on both wards and within the theatre suite. These were secured using anti‑tamper tags to provide assurance that equipment had not been accessed inappropriately. Staff completed daily checks of the resuscitation equipment located on top of the trolleys, with full monthly checks of trolley contents. These checks were documented consistently.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

The service had enough nursing and medical staff with the right qualifications, skills, training, and experience to provide the right care and treatment. The theatres were staffed in accordance with the Association for Perioperative Practice guidelines. Staff undertook a wide variety of training relevant to their roles and responsibilities such as medical device training, NEWS2, and infection prevention and control. Mangers monitored staff training to ensure this was completed. The service goal was 95% completion of all mandatory training by April 2026. Most departments had reached or exceeded this goal.

A resident doctor rota provided 24-hour cover and a doctor was available at all times for emergencies. Consultants were not directly employed but had practising privileges at the hospital and would make arrangements individually to review their patients when they were on the ward. These practising privileges (PPs) were outlined in the Spire Practicing Privileges and Appraisal Policy. This policy and other related policies documented eligibility for privileges, roles and responsibilities, scope of practice and how their work was reviewed. The Medical Advisory Committee (MAC) authorized the formal granting of practicing privileges and this was documented in staff files. The MAC also reviewed PPs in terms of scope of practice and competence. Where issues arose about practice, leaders took action to address them that included engaging with external partners and the local NHS trust.

Staff undertook performance reviews know as ‘Enabling Excellence’ which had 3 stages that gave staff the opportunity to plan and set objectives, review these mid-year and conclude with an end of year review. In 2024, 95.6% of staff had completed their performance review. 2025 figures showed that at the time of inspection, 93.6% were in train for completion by the end of the year.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service took action to address any shortfalls

The service had a clear Infection prevention and control (IPC) policy, this reflected current guidance. Staff followed infection control principles including the use of personal protective equipment (PPE). Staff had access to PPE including aprons, masks and gloves in a variety of sizes. Staff cleaned their hands before, during and after patient contact

Theatre areas were noted to be visibly clean and well-organised. All staff during our inspection were `bare below the elbows' and dressed in line with the service's policy. We saw staff cleaning equipment appropriately following theatre cases. There were cleaning records available in each area in theatre and we saw these were completed in full. Ward areas were also clean, well-organised and had suitable furnishings

Policies relating to surgical site infection reflected NICE guidance NG125 and CG74. The service had processes to reduce the risk of surgical site infections and to monitor for signs of infection. Patients who met the service’s criteria were screened for methicillin‑resistant Staphylococcus aureus during pre‑assessment. The service completed surgical site infection surveillance at 30 days post‑surgery for all patients who underwent hip or knee replacement surgery. Data showed that infection rates were low with only one occurrence of clostridium difficile captured via Private Healthcare Information Network (PHIN) in the reporting period.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. Doctors prescribed medicines on a paper-based chart. This was stored within patients’ nursing record. Pharmacy teams ensured the best use of medicines through interventions and regular ward visits. Pharmacy staff visited wards throughout the day, carrying out medicines reconciliation and checking drug charts.

Medicines were always stored safely in line with recommended practice. Medicines storage and security checks were undertaken and recorded regularly. Controlled drugs (CDs) were stored safely and securely with access restricted to authorised staff. Checks were undertaken daily and recorded by registered staff in their respective areas such as wards and theatres.