Orthopaedics and Spine Specialist 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

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses appropriately. Managers investigated incidents and shared lessons learned with the team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. The service had up-to-date policies for safeguarding and consent. Staff understood how to protect patients from abuse, had training on how to recognise and report abuse and knew how to apply it. The service had appropriate processes for identifying escalating a deteriorating patient. Patients benefited from staff completing preoperative assessments and post operative follow up to manage any ongoing risks and signpost patients to appropriate services for any additional support. The service had processes in place to maintain facilities, equipment, and technology. However, during our on-site assessment we identified concerns regarding the service recording and reporting faults and repairs. We have requested an action plan from the service to give us assurances on the actions it will take to ensure staff compliance with reporting faults and repairs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us safety within the service was a top priority and they wanted to encourage a culture of safety and learning. Incident reports we reviewed showed that investigations were based on openness, transparency and learning, feedback was shared, including actions to prevent any future events. Staff we spoke with told us that leaders encouraged people and staff to raise concerns, and they felt confident that they would be treated fairly and would not be blamed, or treated negatively if they did so. Information we reviewed during our assessment showed staff and leaders reported incidents willingly and used these as an opportunity to put things right, learn and improve the service.

The service had an up-to-date incident reporting policy, including near misses. Information we reviewed on site showed that incidents and near misses were appropriately investigated and reported to external bodies where appropriate. Lessons learned from safety incidents or complaints were shared with staff, resulting in changes that improved care for others. The service had an up-to-date duty of candour policy. Information we reviewed showed that leaders and staff understood the process of duty of candour, apologised when things went wrong and offered the opportunity to put things right. At the time of our inspection, duty of candour letters was not on a standard template, however, the service was developing this as part of its quality standards. In January 2024, the service reviewed how they respond to incidents with the aim of creating a common culture of putting the patient first, creating an open and compassionate culture of caring, listening to patients, families, and carers, and supporting and encouraging staff to provide compassionate care. As part of the review, the service highlighted areas of good practice and areas for improvement.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff we spoke with knew how to report concerns and understood safeguarding and how to take appropriate action. Staff gave good examples of them escalating concerns, and explained they had received feedback, and that there had been positive impact on the people involved. Leaders had appropriate training and knew how to access additional support and advice from external stakeholders and commissioners if they had any safeguarding concerns.

Staff and leaders had received the appropriate levels of safeguarding training and the service had up-to-date safeguarding polices and processes in place. The service had appropriate consent and chaperone processes and staff completed training in mental capacity to ensure they were supporting people in line with their wishes and best interest. Policies and practices were reviewed regularly, reflected best practice, and referred to appropriate external guidance to protect and promote people’s rights.

Staff provided information and guidance to people using the service pre-operatively regarding any risks and how to keep themselves safe. Staff ensured risks relating to the patient’s procedure were explored and explained to the patient. Staff gave patients contact information for the post-operative period they could access for ongoing guidance and support.

The service had a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. Leaders and staff understood risks within the service and managed these in a positive way to support patients and achieve positive outcomes. Staff we spoke with explained that risks for patients were managed well. For example, staff explained that patients were screened for any mental health concerns, any social or background issues and obesity to help protect the safety and wellbeing of all patients and people using services.

The service had effective risk management processes. These were person-centred, proportionate, and regularly reviewed with the person, where possible. The service had a process to ensure patients were eligible to access services to minimise risks and ensure staff could meet the needs of the patient. Leaders had up-to-date policies and processes for managing risks and responding to emergencies. The service had an up-to-date process to escalate deteriorating patients and a dedicated transfer out policy to provide after care at a local NHS trust.

Patient feedback regarding the services environment and support services was routinely positive.

Leaders we spoke with explained the service’s processes to maintain facilities, equipment, and technology. Equipment and facilities service records provided by the leadership team were up-to- date and the service had an up-to-date planned preventative maintenance schedule with an associated action plan to address any remedial works.

During our on-site assessment we identified concerns regarding staff reporting faults and repairs within the service. For example, we observed some fire doors were not closed and the magnetic fire door retainers were broken. Following our inspection, we received assurances both by the service and the fire officers that these had been repaired. We have requested an action plan from the service to give us assurances on the actions it will take to ensure staff compliance with reporting faults and repairs.

The service had processes in place to maintain facilities, equipment, and technology. Equipment and facilities service records we reviewed were up-to-date and the service had an up-to-date planned preventative maintenance schedule with an associated action plan to address any remedial works. However, during our on-site assessment we identified concerns regarding the service recording and reporting faults and repairs. We have requested an action plan from the service to give us assurances on the actions it will take to ensure staff compliance with reporting faults and repairs.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.