Spire Fylde Coast Hospital

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• 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

At our last assessment we rated this key question as good. At this assessment, the rating has remained good.  

This meant people’s outcomes were consistently good, 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 provider made sure people’s 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 had discussions about the patients’ preferences and wishes if their condition deteriorated. Decisions about care were made with consideration of wishes of the patient and/or their family. 

Care pathways and risk assessments were in place to support safe and effective care. Patients with complex needs were appropriately assessed and supported during admission, with the anaesthetist involved in final decision making to ensure patients were suitable for surgery. Patients were supported with nutrition and hydration before theatre using “fit to sip” guidance, and pain was regularly assessed and well managed throughout their care.

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.  

Pain relief medicines were timed for maximum effect before painful procedures or to allow the patient to sleep at night. Alternatives to pain relief medicines were considered and patients advised how to manage pain. For example, 3 Patients told us they received pain relief soon after requesting it. They felt their pain was well managed.  

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.  

Staff assessed and met patients’ communication needs effectively. Mobility was assessed in person to ensure safe care planning, and additional support was available for patients living with dementia, including access to a dedicated dementia-friendly room.

Patient risk assessments and audits were in place, including venous thromboembolism (VTE) risk assessments for all patients, as well as falls risk assessments. Staff used the National Early Warning Score (NEWS2), which is a tool used to monitor a patient’s condition, and understood how to escalate concerns appropriately. Staff also had training in dementia care and were aware of Martha’s Rule, which supports patients and families to request urgent reviews if they are worried about deterioration. There were safe arrangements in place for escalation of care, including for blood transfusion where needed.

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

Staff followed up-to-date policies to plan and deliver high-quality care according to best practice and national guidance. 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.  

We reviewed 7 care records for evidence of completion of care plans and risks assessment of patients and found The service followed National Institute for Health and Care Excellence (NICE) guidance and incorporated evidence-based practice into the delivery of patient care. Staff demonstrated a good understanding of current clinical guidance and were aware of specialist pain management approaches and Public Health England (PHE) surveillance systems. Clinical pathways and protocols were in place to support consistent, safe care, including pathways for venous thromboembolism (VTE) prevention through the use of anti-embolism measures. 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). Intelligence reports were reviewed by service leaders. These reports contained data on PHIN’s existing performance measures, including; patient activity volumes, length of stay, never events, Patient Reported Outcome Measures (PROMs), infections and data submission levels. In addition, it also includes complaints data that we receive from private insurers.  

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

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. For example, staff worked well together to plan care around patients’ individual circumstances and needs. A patient’s home environment was not suitable following damage to the property. As the procedure was elective and not life-threatening, staff advised the patient to delay surgery until appropriate arrangements were in place at home.

Staff also managed patient expectations by clearly explaining what to expect after surgery, including likely levels of pain and recovery time. They worked together to plan care safely, including managing risks such as bleeding and the use of medicines like enoxaparin, which is used to reduce the risk of blood clots.

Information was shared between teams and services to ensure continuity of care. Multidisciplinary reviews and meetings were held for some specialities, for example orthopaedics.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, managing patient expectations by clearly explaining what to expect after surgery, including likely levels of pain and recovery time. They worked together to plan care safely, including managing risks such as bleeding and the use of medicines like enoxaparin, which is used to reduce the risk of blood clots

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.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care.

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

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

The service supported people to live healthier lives by planning care around their individual circumstances and promoting recovery. Health promotion was an important part of care, with advice provided during pre-assessment on areas such as smoking cessation, alcohol reduction and good nutrition. Leaflets were also available throughout the site to support these messages and encourage patients to make healthier lifestyle choices. Records were complete, clear and up to date, showing the full patient journey and taking account of people’s holistic needs.

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.

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 the surgical WHO checklist, Reducing Surgical Site Infections Audit , the Oxford Hip Score (hip replacement), Oxford Knee Score (knee replacement) and the Oswestry Disability Index (Lumbar Spinal Surgery).

The service had a low number of readmissions to theatre, and the rate was 1 patient per 1000 discharges. The surgical site infection rate over the last 12 months was 0.0% for Hip Arthroplasty and 0.35% for Knee Arthroplasty. Audit findings and recommendations of Venous Thromboembolism Prophylaxis Prescribing post-operatively; a project undertaken by the pharmacist team meant the audit achieved the target compliance with a percentage of 96%. In addition the hospital has achieved VTE Exemplar Status, recognising excellence in venous thromboembolism (VTE) prevention and patient care.

Improvements had been made as a result of patient feedback Surveys in relation to discharge medication.

Following feedback from a patient attending a patient forum an accompanying sheet was sent home with the patient’s medical details on so they could record when they had taken their discharge medication.

The pharmacist would go through the details with the patient when giving them their medication to go home with so that they could use the sheet at home and any queries could be discussed with the pharmacist before going home. The sheet also contains contact numbers for the patient in case they needed any further advice or support once they were home.

The provider considered health inequalities and took steps to ensure that outcomes across 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 every quarter. Learning from these meetings was shared with the aim of making improvements

The service told people 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.

Where possible, 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 was consent audits completed and outcomes shared with staff.

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. Relatives said they 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 BSL and face to face interpreting when necessary.

Staff sought permission before sharing patient information with family or friends.

Consent was recorded both verbally and in writing, and patients were given time and opportunities to ask questions so they could make informed decisions about their care. Staff interactions were polite, respectful and proactive, helping patients feel comfortable and supported throughout their journey. Chaperone procedures were followed, with staff offering chaperones appropriately to maintain dignity and reassurance.

The Consent audit achieved the target compliance percentage and scored 100% In the last 12 months.