Three Shires 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

The service provided evidence-based, effective care and treatment, delivered by highly trained, professional staff who undertook specialist development. Managers monitored the effectiveness of the service and made sure staff were competent. Multidisciplinary teams worked well together for the benefit of patients, advised them on how to lead healthier lives, and used feedback and data to evidence outcomes. Key services were available flexibly and staff continually sought opportunities to pilot and adapt care practices at the leading edge of the sector

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a culture of joint learning and education between different clinical teams within the hospital to ensure the service fully and holistically assessed individual’s needs. For example, a clinical educator worked across nursing and physiotherapy teams to support joint working and promote accurate patient assessments. This meant better safety and recovery support for each patient. This included pain management and wound care training for physiotherapists and rehabilitation training for nurses.

Staff used a wide range of recognised tools and assessments to deliver care and treatment. These were based on each patient’s individual needs and conditions which aligned with international standards, such as the American Spinal Injury Association (ASIA) Impairment Scale. Staff used continuous measurements, for safety and comfort, while patients were admitted, ensuring safe rehabilitation and discharge.

Staff used effective tools to monitor and address pain. Physiotherapists audited pain scores and reported an average pain score reduction from 4.2 before surgery to 1.1 at the point of discharge, using the numerical pain rating scale. The results were supported by the provider’s quarterly pain relief audit, which found 95% compliance with expected standards in the last quarter. This score met the provider’s target and reflected 4 months of sustained improvement.

The service had focused on improving pre-operative assessment and had appointed a new lead nurse and anaesthetist who were managing this process. Staff audited the effectiveness of this stage of care and since April 2024 the team achieved 99% compliance with the provider’s assessment pathway, reflecting a significant improvement.

All staff completed Mental Capacity Act and dementia care training. The service had adapted the “This is me” tool from the Royal College of Nursing and Alzheimer’s Society to reflect the specific nature of care in the hospital. Staff completed training in the effective use of the tool and the dementia lead coordinated assessments with the pre-operative and surgery teams.

Staff delivered care and treatment in line with best practice guidance and evidence based practice.

Surgery was accredited by the Association for Perioperative Practice (AfPP) in recognition of evidence-based practice and risk management in theatres. Staff followed a range of good practice guidelines to underpin care with the most up to date practice, such as British Dietetic Association (BDA) guidelines to manage post-operative nutrition and hydration.

Staff were focused on continuous improvement and had training and new programmes to develop evidence-based care. Some staff were undertaking a heart and lung course to provide enhanced pre-assessment care. The pharmacy team carried out training for staff in each department and offered coaching. The pre-assessment team led monthly lunchtime microteaching sessions to help improve knowledge of their work.

The hospital achieved gold accreditation status with the Joint Registry Service in November 2024 after demonstrating high standards of data quality for joint replacement surgery.

Staff followed up-to-date policies to plan and deliver high quality care according to national guidance, including that issued by the National Institute of Health and Care Excellence (NICE), the Chartered Society of Physiotherapy, and the Royal Pharmaceutical Society. They carried out a rolling programme of 62 clinical audits, ranging from monthly to annually, to benchmark care and assess compliance. The hospital performed consistently well across the provider’s network.

The audit programme reflected a genuine curiosity in the team to exploring the effectiveness of care and their drive to be innovative.

Multidisciplinary working was embedded in all aspects of the service and staff proactively looked for opportunities to improve care. They secured specialist input to help coordinate care for patients with complex needs and comorbidities.

A representative from each department joined a daily huddle to review pressures and discuss incidents or complaints received in the previous 24 hours. Staff used a RAG (red, amber, green) rating to indicate the status of their department, such as if they had unplanned staff shortages or other challenges. We observed the process and saw multidisciplinary staff worked well together to coordinate the service. For example, theatre staff had logged 2 incidents the previous day. The quality manager shared these with the huddle to promote group learning and strengthen collaboration between clinical and non-clinical teams. Teamworking processes in theatres provided assurance of patient safety. Each member of the team was empowered to intervene and stop treatment if they felt unsafe. This included junior members of staff and meant everyone worked in teams and environments in which they made contributions to safety.

Patient’s records demonstrated how staff built a detailed picture of the individual’s social past to help inform effective treatment. For example, ward nurses secured the support of a physiotherapist with specialist training to support a patient with a history of pain and worked with social care professionals to ensure a vulnerable patient had the necessary support in place at home.

The IPC lead operating department practitioner worked in theatres 1 day per week as part of their other role as surgical safety guardian to observe and support practice.

Nurses and physiotherapists worked closely together to deliver multidisciplinary rehabilitation and recovery care to patients.

Staff continuously sought opportunities to help patients improve their health and holistic wellbeing. Nurses discussed smoking cessation and alcohol reduction with patients during pre-assessment and physiotherapists arranged weight loss counselling and empowerment sessions post-operatively. A dietician provided individual support to patients at each stage of care and helped them improve their recovery and long-term health.

Physiotherapists had developed a ‘pathway to recovery’ programme that encouraged patients to begin recovery exercises 2 weeks before surgery. The team facilitated access to exercise classes at other sites in the provider’s network as part of the pathway and provided education on safe and effective exercise. Supported by consistently good patient-reported outcome measures (PROMS) data, this approach contributed to a reduced length of stay in the hospital and faster recovery. The team’s work had been recognised nationally by the provider and was reflected in the shortest post-operative length of stay in the provider’s network in the region.

In addition to the health promotion work staff undertook individually with each patient, they worked with colleagues to support and promote the provider’s national work designed to improve people's health. For example, they participated in breast cancer awareness events, National Eye Health Week, and facilitated community events for each.

Staff were clearly committed to supporting patients to obtain outcomes important to them. For example, through post-operative musculoskeletal therapy, the physiotherapy team shared evidence of care that resulted in significant improvements to patients’ life after intervention.

The service participated in a national benchmarking audit in 2024 to assess PROMS for hip and knee surgery. The audit included outcomes data for private and NHS care, which reflected the patients of this hospital. For hip surgery, 99% of patients reported expected or better outcomes, which was better than the national average. For knee surgery, 91% of patients reported expected outcomes, which was similar to the national average.

In response to the findings of a quality improvement project, staff introduced a focused daily patient hour. This involved multidisciplinary staff spending time with patients to review care and discuss progress towards their preferred outcomes.

Physiotherapists were committed to improving quality of life and patient mobility through a constant drive for excellence. The team used a peer review programme to improve care and ensure patients achieved their goals. Peer reviews took place during rehabilitation sessions with patients and involved constructive challenge to support continuous improvement while recognising good practice. The review process included records and notes as part of a comprehensive overview of care decisions in relation to each patient’s desired outcomes.

Physiotherapists measured patient outcomes using a series of recognised tools. Results reflected consistent good practice. In the previous 12 months, 99% of patients reported improvement in their health using the global rate of change scale. The team had implemented a specific measure for patients undergoing treatment for pelvic conditions. The patient specific functional scale (PSFS) showed an improvement in function from 2 at pre-assessment to 8 after rehabilitation, where 10 is the maximum score.

Staff had a deep understanding of the meaning and importance of consent and embedded it in each stage of care and in pre-assessment and educational activities.

Patients gave consent at each stage of treatment, including at their pre-operative assessment and on the day of surgery when they met the anaesthetist. The process ensured patients were aware of the planned treatment outcomes as well as potential risks and action staff would take if things went wrong. Patients we spoke with said they felt well informed and clear on the potential benefits and risks of their planned procedure.

We observed staff carry out a consent process with a patient who did not speak English using a telephone translation service. The nurse leading the process was thorough and methodical and asked the translator to ask the patient several questions about what they understood about their planned treatment, recovery plan, and associated risks. The nurse leading this process had a clear focus on assurance that no detail was lost in translation and used a series of checks to achieve this.

Physiotherapists had produced a video to help patients prepare for surgery and recovery. This included an anaesthetist-led discussion of sedation, which an overview of the consent process. This helped patients to engage with the consent process and enabled them to prepare questions for the clinical team in advance.

Staff audited consent processes and found consistently good standards of practice that exceeded the provider’s targets. In the previous 12 months audits demonstrated over 99% compliance.

The service offered a 14-day cooling off period for surgery in line with national standards.

Staff had implemented a new pre-assessment process for patients on a neurosurgery waiting list and subject to an enduring power of attorney. Designed to reduce cancellations caused by disagreements amongst family members, the process promoted access for patients in challenging circumstances.

Staff worked within exclusion criteria to make sure care and treatment plans were in the patient's best interest and did not create unacceptable risk. For example, the pre-assessment team used a mental health scoring tool to ensure patients understood their planned treatment and could give consent. The team arranged for a mental health review before proceeding with a treatment plan where this reduced individual risk.