Spire Clare Park 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

We assessed a total of 3 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found people received care, treatment and support that was in line with legislation and current evidence-based good practice and standards. Staff worked well across teams and services to support patients. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients told us they understood the procedure they were having and relevant risks had been discussed with them. Patient experience results from March 2023 to February 2024 showed the majority of patients (96%) felt fully informed at all times with their care and treatment.

Staff told us multidisciplinary teams were involved in clinical reviews and medical committees to make sure patients were receiving the right care at the right time and care and treatment was safe and effective. Staff told us patients received food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods. The service made adjustments for patients’ religious, cultural and other needs.

The service had up-to-date policies and procedures to ensure care and treatment was delivered in line with national guidance and best practice. Policies we reviewed referenced national guidance. The hospital had policies and processes in place to ensure that the planned care met the needs of the patient and appropriate staffing was in place based on the level of care delivered at the hospital. Patients were assessed preoperatively using the American Society of Anaesthesiologist (ASA) grading system for pre-operative health of surgical patients. This is a system to record the overall health status of a patient prior to surgery. The system, with other factors, enabled staff and anaesthetists to plan specific post-operative care for patients as required. Spire Healthcare did not use audit to monitor ASA grading against patient outcome. Updates to policies, due to change in guidance and tracking of policy review dates, were carried out at a corporate level and cascaded to the hospital for implementation. Changes to policies was a standing agenda item at the hospital’s quarterly clinical governance meeting. Changes in working practice was the responsibility of the head of department to execute and staff were required to sign to say they had read the update to the policy. Changes to policies and procedures was also a standing agenda on the medical advisory committee (MAC) meeting. Staff could access policy documents on the hospital’s database. These measures ensured staff working in the service were following up-to-date practices and providing safe care to patients. The hospital completed a range of audits throughout the year to ensure healthcare was provided in line with their policies, national guidance and standards. This included the Spire Healthcare audit programme, a rolling programme of set audits and hospital specific audits. The hospital shared audit results and post audit action plans with us to evidence standard of care and treatment at the hospital.

Patients told us they felt involved in the planning of their care. They had received information explaining about their surgical procedures and what to expect throughout their hospital visits, including the different teams involved in their care and treatment. They could tell us about the care and support offered pre-operative, following the procedure and when discharged. Patient experience results from March 2023 to February 2024 showed the majority of patients (97%) felt they care and treatment at the hospital had been effortless and 99% of patients felt they had really been cared for/looked after.

Staff explained how they worked as a one team to support patients and services. This included an inclusive culture and multidisciplinary team meetings. An example given to us was the daily huddle, which took place every morning and was attended by the senior management team and a representative from each department and stuff to a set agenda. All staff contributed to provide an overview of the hospital’s activity and to mitigate any issues arising. Relevant information was taken back to each department and cascaded to the team. Management and staff described the meeting as supportive and an effective way to share information as one team.

Staff told us they had good working relationships with their local NHS trusts. The hospital participated in the NHS e-Referral service for certain procedures. Through this service, NHS patients who required an outpatient appointment or surgical procedure were able to choose both the hospital they attended and the time and date of their treatment. The hospital would use the services of the local NHS if the hospital did not have the facilities for care and treatment. This could be for contractual reasons, the hospital had no CT scanner on site or for enhanced care that the hospital could not provide itself.

During our inspection we observed effective multidisciplinary working between different teams involved in patient care and treatment in the surgery service. There was clear communication between staff and we observed safe and effective handovers of care, between the ward, theatre and recovery staff. We observed physiotherapists gave support to patients and clinical staff pre and post operatively.

The hospital used care pathways. Patient’s notes were prepared according to these pathways. They were multidisciplinary, meaning each clinical team wrote in the same set of notes which provided a clear picture of the care and treatment each patient received from their initial contact through to discharge and post discharge care. This meant it was easy for staff to share information between teams and services to ensure continuity of care.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients told us consultants went through the risks and benefits of surgery. They were given information about their procedure both verbally and in writing by the consultants and nursing staff to make an informed decision about their procedure. Patients said doctors fully explained their treatment and additional information could be provided if required. They explained the consent process, where they consented to the procedure and consented again on the day of surgery when they were seen by the consultant.

Staff followed their internal process for seeking consent from patients when providing care and treatment in line with legislation and guidance and this was clearly recorded. We observed staff asking patients’ verbal consent prior to examinations, observations and delivery of care. Staff told us the majority of admitted patients had the capacity to make their own decisions. Patients who lacked capacity were identified during the pre-operative assessment process to determine whether they could be admitted for treatment at the hospital. Patients were risk assessed on an individual basis and adjustments put in place to deliver safe care to the patient if needed.

The hospital had an in-date consent policy. Consent training was provided to all patient facing staff as a core thread throughout mandatory training, core competencies and workshop delivery. The hospital had a different consent form if a patient lacked capacity to sign their own consent. The person with a lasting power of attorney for health would sign on the behalf of the patient. The hospital had processes in place to ensure decisions on care and treatment were in the best interest of the patient.