Fulwood Hall 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 looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patients were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant patient’s outcomes were consistently good, and patient’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 service made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed records for 10 patients and found them to be completed appropriately. Records included holistic assessment of needs, care plans that were up-to-date, clear goals and objectives, nutrition and hydration needs and pain management plans. The electronic record system had a clear section to document patients’ additional needs that required any reasonable adjustments.

The provider used a mixture of electronic and paper-based records, which included written consent.

Weekly capacity meetings, multi-disciplinary team meetings, and daily team meetings identified patients with additional needs and planned how best to meet their needs. We observed that patients were appropriately identified including if at risk of falls or a diagnosis of dementia were highlighted and individualised care plans were put in place.

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.

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

The service was part of a larger organisation that delivered care and treatment nationally. Policies and procedures were standardised across the services for staff to follow locally. These covered a range of healthcare needs to support care delivery.

Leaders told us that the service participated in a range of internal audits that were benchmarked within the organisation with learning shared across the locations. These audits focused on patient risks and ensured treatment was in line with best practice.

The service participated in the ‘Getting it Right First Time’ (GIRFT) programme. Which is a nationally recognised initiative to standardise care of specific orthopaedic and spinal surgical procedures.

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

Information was shared between teams and services to ensure continuity of care. Multidisciplinary reviews and meetings were held weekly with colleagues of all levels across the surgical departments to discuss the needs of patients being admitted. Staff identified and discussed patients’ specific needs in review meetings and planned how these needs would be met.

Multidisciplinary review meetings with specialists were held for example, an anaesthetic review meeting was held with the pre-operative assessment team prior to admission for surgery for patients who had additional health conditions.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, we heard examples of where staff had identified patients with complex social care needs and had planned their care with consultation with the external agencies involved.

The service had Service Level Agreements (SLA) with outside organisations to support service delivery. There was an SLA with the local NHS trust for the provision of an emergency backup laboratory service for haematology including blood transfusion.

The provider worked with system partners to follow the standard operating procedure which covered arrangements for the emergency transfer of critically ill patients from independent hospitals to NHS acute hospitals in the local area.

We requested information about ward meetings for staff. The information provided showed that ward department meetings take place and ward communication is disseminated. However, these do not follow a unified format, and they had not taken place consistently.

The service 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 hosted consultant-led education events for the public on topics such as managing renal stones. The service also used social media to share health focused content about nutrition.

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. When modifiable risk factors are identified at the pre-operative assessment the patient is given an explanation about why the risk factors matter to anaesthetic and surgical outcomes and given information to take away that can be acted upon.

The service did not always monitor patient’s care and treatment to continuously improve it. Staff did not always ensure outcomes were positive and consistent, or that 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 British Spine Registry, National Patient Reported Outcome Measures (PROMS), and the National Joint Registry.

The Patient Reported Outcome Measures for the 12 months prior to the inspection showed overall good outcomes such as, 8 out of 10 patients reported improvements following cataract surgery, 9 out of 10 patients reported improvement following knee surgery, and 9 out of 10 patients reported improvement following hip surgery.

The service had a readmission rate of 0.25% of all patients operated on being readmitted with a reoperation rate of 0.13% between December 2024 and November 2025. While the service was an outlier for re-admissions within the wider organisation it was not an outlier for reoperation rates.

The surgical site infection rate was low for the procedures between December 2024 and November 2025. The surgical site infection rate for total hip replacements was 0.23% of 440 procedures performed, total knee replacement was 1.16% of 518 procedures and 0.1% for all other 9772 surgical procedures performed.

Improvements had been made as a result of the WHO (World Health Organisation) and NaTSSIPs (National Safety Standards for invasive procedures) audits, which resulted in the implementation of formal mandatory training for staff members acting as List Safety Officers in theatres.

The leaders told us that they carried out audits. These included National Early Warning Score 2 (NEWS2) which is the standard clinical measurement to detect the deteriorating patient, venous thromboembolism (VTE) risk assessment, blood transfusion compliance, and patient journey including transfer from the ward to theatre, intra-operative observation and recovery observation. However, the service did not provide data to show the outcomes of the audits.

The outcomes recorded for the ‘Getting it Right First Time’ (GIRFT) programme indicated over 80% of cemented hybrid hip surgery in patients aged over 70 years old was found to be in line with national standards.

The service had been achieved gold standard accreditation with the National Joint Registry.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

There was a consent for assessment, care and treatment policy for the provider. There was an additional policy to support patients regarding the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

We observed staff asking patients for verbal consent such as when carrying out clinical observations. We were told that staff obtained the patient’s written consent both at initial outpatient appointment and then observed second consent prior to the surgery. These were recorded in the patient record.

All the patients that we spoke with during the inspection told us that they had been given information about their care and treatment and had been asked for consent throughout their journey of care.

The service ensured that those with additional support needs can access appropriate ways to provide informed consent for their care and treatment. For example, patients with a visual impairment could be provided with information about their care in Braille, and documented consent can be obtained witnessed by a family member or nurse.

The service completed consent audits. The last audit which was carried out in April 2025 had an overall compliance rate of 99%.