13. 9% reduction in blood use - this has fallen year-on-year and now stands at half the rate it did when our transfusion programme began in 2006. in-patient surgical mortality down 30% on last year (and 60% on 2008)In addition, hospitals achieved an all-time high in terms of compliance with our record keeping standards, resulting in ever better communication between clinicians and nursing teams.Spire Healthcare's indicators of reliable care processes - returns to theatre (0.22%), transfers out (0.07%), readmissions (0.28%) - demonstrate continuing strong performance associated with 'high reliability' organisations. This is especially important as we continue to treat patients with increasingly complex health needs, oftenOur ability to consistently deliver high-quality clinical care, results from the willingness of clinical teams to work collaboratively with consultants and Medical Advisory Committees to enable modern and safe practice to flourish. We set great store by the availability of relevant, accurate and timely management information to help us monitor, analyse and, most importantly, act upon insights that drive up our standards of care. Spire's frontline staff provide hands-on care with dignity and compassion, as well as being clinically effective. Our established and strong systems for clinical governance support our teams with the information they need to help keep patients safe, to make them better again and to provide great care. This is why we believe Spire hospitals continue to grow their reputation for high clinical quality.Over this past year we successfully transferred the registration of all Spire services with the Care Quality Commission under section 10 of the Health and Social Care Act 2008 (in line with the planned transfer of registration for independent sector providers), as well as meeting all requirements for registration with the Human Tissue Authority (10 registrations), the Human Fertilisation and Embryology Authority (two registrations), the Healthcare Inspectorate Wales and the Scottish Care Commission (now Healthcare Improvement Scotland).Against a background of successfully improving our operating flexibility, I am pleased to report that hospitals have once again raised the bar in terms of clinical performance. Among the more notable highlights are:. 20% reduction in surgical site infection following hip and knee replacements, despite extending our surveillance periodIndependent sector average0.30%*Spire0.22%Independent sector average0.20%*Spire0.07%Independent sector average0.50%*Spire0.28%* Independent Healthcare Advisory Services (IHAS) Credentials Document (England); 2007.Returns to theatreReadmissionsUnplanned transfersService quality

14Spire Healthcare Annual Review 2010requiring the services of one of our five intensive care or 30 high dependency units.In 2010 Spire hospitals added 13 clinical research projects to the Spire research register, and we undertook a further 12 health technology assessments, underlining our commitment to safely introduce innovative treatments for the benefit of our patients.Our results demonstrate that not only have Spire hospitals achieved considerable gains on last year, but also that we have been able to sustain our hard-won improvements from previous years. This marks Spire Healthcare as a sophisticated organisation with the maturity to learn when things do not go to plan, and to take prompt action to effect lasting change for the better.We continue to share a broad range of performance indicators and will again this year publish a Quality Account that complies fully with the requirements set out by the NHS.Finally, we were pleased to win the coveted Laing & Buisson Independent Healthcare Award for 'Nursing Practice' for the second year in a row. This reflects our focus on attracting, developing and retaining nurses and allied health professionals of the highest calibre. Nevertheless, we remain alert to any sense of complacency, and we will continue to challenge ourselves to continuously improve the services we provide for the benefit of our patients and those who care for them.Dr Jean-Jacques de Gorter, Director of Clinical ServicesDirector of Clinical Services' statement continued Service qualityConsultant Neurosurgeon, Mr David Porter, at Spire Bristol Hospital has increased his case complexity rate in the last year as a direct result of the high-quality critical care provision."In the last few years there has been increasing investment in the ITU and critical care provision at Spire Bristol Hospital, with consultants being brought in as part of an outreach team to facilitate nurse training, increase the skill-mix and help develop the ITU as a resource. As a result of this, my confidence in the critical care function has greatly increased to the point that I have grown the number of complex surgery cases that I perform at the hospital in the last year. The high-quality care provided is mirrored by the fact that I have had no returns to theatre, zero complication rates and no need to transfer patients. In fact, all of my patients have been able to return to work and some have even progressed in their careers. I am looking forward to increasing the number of cases that I perform at the hospital."