St Anthony's 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 patients and communities had the best possible outcomes because their needs were assessed. We checked that patients’ care, support and treatment reflected these needs and any protected equality characteristics, ensuring patients 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.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant patients’ outcomes were consistently good, and patients’ 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 usually made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

Staff with appropriate seniority discussed and documented patients' wishes and preferences should their condition deteriorate. Care decisions took account of the wishes of patients and, where appropriate, their families.

Staff assessed patients’ pain and used recognised tools to do so. Staff gave pain relief in line with individual needs and best practice and assessed how effective this was. Patients’ pain was addressed before they left the operating theatre to ensure it was controlled before transfer to the ward.

Pain relief medicines were timed for maximum effect before painful procedures or to allow the patient to sleep at night. Patients told us they received pain relief soon after requesting it. They felt their pain was well managed. Staff achieved 98.1% in the pain audit against the 90% target.

We saw patients were generally calm, their faces appeared relaxed, and they were moving around comfortably, suggesting that they were not in significant pain. There was support available from the anaesthetist when a patient had complex pain needs.

The service usually planned and delivered patient’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.

Staff followed up-to-date policies and guidelines to plan and deliver high quality care according to best practice and national guidance. The service 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). The policies, guidelines and processes also took account of changes to the Royal Colleges guidelines and National Institute for Health and Care and Excellence (NICE) guidelines.

All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance to staff.

Polices and processes took account of changes to the Royal Colleges guidelines and National Institute for Health and Care and Excellence (NICE) guidelines.

Most patients undergoing cosmetic surgery waited a minimum of two weeks between consultation and procedure. This ‘cooling off’ period was in line with national recommendations (Royal College of Surgeons (RCS) Professional Standards for Cosmetic Surgery (April 2016)).

The service followed the Royal College of Surgeons guidelines for robotic assisted surgery, particularly in relation to governance, training, and audits.

We looked particularly at the pathway for people who were admitted for elective orthopaedic surgery and anything else done on the NHS choices route, as well as self-pay/insured patients having other surgical procedures. The service supported the reduction of national waiting times for surgery by meeting its target number of patients within the agreed timeframe. All self-pay and insured patients were able to access surgery in line with their preferred timescales.

We reviewed 5 care records for evidence of completion of care plans and risks assessment of patients and found all patients had an appropriate risk assessment. Patients waiting to have surgery were not left nil by mouth for longer than necessary. Intravenous fluids were used to ensure pre-operative optimisation for emergency surgery, when necessary.

Staff fully and accurately completed patients’ fluid and nutrition charts where needed. The information was used to inform care planning and delivery.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition and used this to inform care planning and delivery. Patients requiring special diets for clinical reasons, were assessed and advice given.

The service reported information to the Private Healthcare Information Network (PHIN). This information allowed the provider to benchmark itself against similar independent providers using a range of performance measures, including; patient activity volumes, length of stay, never events, patient reported outcome measures (PROMs), infections and data submission levels. This data demonstrated the provider performed well in areas measured.

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

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff reported healthy working relations across staff groups including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care. Daily hospital safety huddle clinical planning meetings and multidisciplinary meetings were attended by all heads of department, representatives from different units, and the senior management team to share and review service risks, and to take timely action on matters such as staffing and facilities issues. Daily huddles were used to review high-risk cases and included a resuscitation huddle, where specific staff responsibilities were agreed in advance to support a prompt and effective response in the event of an emergency.

Shift changes and handovers included all necessary key information to keep patients safe. During the assessment we attended staff handovers and found all the key information needed to keep people safe was shared. The handover shared information using a format which described the situation, background, assessment, recommendation (SBAR) for each person.

Information was shared between teams and services to ensure continuity of care. Regular multidisciplinary team (MDT) reviews, clinical planning meetings and ward rounds were held for some specialities such as cardiothoracic surgery.

Plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Discharges were planned at an early stage to ensure they were safe and appropriate for the person’s needs.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, patients that needed rehabilitation following surgery.

Peoples’ records showed there was input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways.

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

Staff provided advice and supported patients to live healthier lives and reduce future health risks. For example, staff supported and signposted patients to other services in the community for smoking cessation and substance misuse support.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health.

Staff provided relevant information promoting healthy lifestyles and support to patients on an individual basis. This included individualised postoperative verbal and written advice following surgery.

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

Staff monitored the effectiveness of care and treatment through audit and benchmarking to compare with other similar services. The service used the findings to make improvements and achieved good outcomes for patients. The service participated in relevant national and provider led clinical audits, including National Joint Registry (NJR). Audit findings were reviewed and monitored at various governance meetings and the Medical Advisory Committee (MAC) to drive improvement and learning.

The service had a low number of readmissions of 0.2% for patients having elective care and the return to theatre rate was 0.3%. The unplanned transfer to an NHS hospital was low (0.2%) in the previous 12 months.

The overall surgical site infection rate was 0.41% and below the national average.

The service had an audit programme covering areas such as venous thromboembolism (VTE), falls, pain, hydration, fasting, and NEWS documentation and trigger audit. Audit results were shared with staff and supported by action plans to drive improvement.

The service had been accredited under relevant clinical accreditation schemes. Such as being an accredited perfusion centre and achieving a bronze quality data provider award in the National joint registry for their commitment to patient safety through the registry.

The provider considered health inequalities and took steps to ensure that outcomes for people with protected characteristics were in line with the wider community.

The service monitored and reacted to avoidable deaths and harms. Mortality and morbidity meetings were held regularly as part of the safety, quality and risk governance meeting.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the services policies related to consent, mental capacity, deprivation of liberty and restrictive practice, as relevant.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Consent for surgery was sought by the most appropriate doctor and included discussion about the benefits, potential complications, the risks and alternative options. Patient consent was checked at various points before they went to the operating room and immediately prior to surgery. There were consent audits completed and outcomes shared with staff, and these demonstrated good compliance. Staff achieved 99% compliance in the consent audit.

Patients said they were involved in decision making about their care and treatment. They could describe the risks and benefits they were told about prior to surgery.

Staff sought permission before sharing patient information with family or friends. Staff told us that relatives were kept informed about the care and treatment of their family member when they lacked capacity to consent to surgery.

We observed staff seeking verbal consent before providing care or treatment. People were involved in decision making at all levels. Housekeeping staff asked patients what they wanted to eat and drink.

Where specific requests had been made by patients for a same sex health care professional or theatre team, this was discussed and provided whenever possible. Chaperones were provided if requested.

Interpreters were used to support patients to give informed consent, including for British Sign Language (BSL) and face to face interpreting when necessary. These were arranged in advance of admission for surgery, which ensured they were in place when required.