Fulwood Hall Hospital

On this page

• 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

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first time this key question has been rated. At this assessment, we have rated the key question good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The service planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. The service worked well across teams and services to support people and ensured that outcomes met both clinical expectations and the expectations of people themselves. Patients gave informed consent prior to treatment, and the consent process was thorough.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

As part of the pre-operative assessment (POA) triage process, patients were supported to complete patient health questionnaires during their outpatient appointment. Documents were scanned within 24 hours or completed electronically. This enabled early identification of significant co-morbidities and supported timely clinical decision-making and appropriate patient referrals.

The outpatient department reported high completion rates for patient health questionnaires being completed following a decision to treat. Initial consultations and documentation were comprehensive, covering medical, psychological, emotional, and social needs providing personalised care planning.

Physiotherapists played an active role in pre-operative planning. Patients were triaged according to risk and need. Low-risk patients received written information and access to a pre-operative educational video. Patients with identified concerns received telephone assessment, while more complex patients were invited for face-to-face reviews.

Staff assessed patients' mobility and equipment requirements prior to surgery. Equipment such as walking frames, toilet frames and chair raisers could be prescribed where appropriate. When social needs were identified, referrals could be made to social services.

Daily bed meetings reviewed patients scheduled for admission over the next 7 and 14 days. Staff discussed mobility issues, communication needs, disabilities, mental health needs and any reasonable adjustments required.

Staff considered protected characteristics such as disability, neurodivergence, and cultural needs. Patients were provided with a contact number if they had queries or concerns after appointments and patients we spoke with said they felt able to ask questions or raise concerns with staff.

Clear referral and booking criteria were in place, and triage systems helped allocate the right consultant and intervention pathway. Private patients had the opportunity to choose their consultant when booking.

We spoke with an outpatient consultant who spoke positively about the service. They told us that healthcare assistants routinely acted as chaperones during clinical examinations, which they felt provided a better experience for patients and supported good clinical practice. The consultant also spoke positively about the support available from outpatient and booking staff, stating that clinics were well managed and appropriately populated.

The consultant explained that weekly multidisciplinary team (MDT) meetings were effective and cases from the previous 2 weeks were reviewed as part of a quality assurance process. They also told us that the pre-operative assessment service had improved significantly and was effective at identifying exclusion criteria before surgery, helping to reduce the number of cancellations.

The hospital had a policy on mental capacity and deprivation of liberty safeguards (DoLS). Due to nature of the service there had been no DoLS applications in the last 12 months prior to our assessment.

We scored the service as 3. The evidence showed a good standard. The service 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 could access corporate group policies that followed nationally recognised recommendations such as the National Institute for Health and Care Excellence (NICE) guidance. Staff could also access policies and standard operating procedures which were in line with NHS guidance. This included an outpatient initial consultation appointment policy, a patient journey policy and a patient-initiated follow-up policy which allowed patients to request follow-up appointments when needed. This promoted self-management and shared decision-making.

The policies we reviewed were easy for staff to access, up to date and referenced national guidance. Staff told us how they accessed relevant policies and procedures via the intranet for reference. We saw evidence that updates to legislation and policies had been actioned and discussed at relevant meetings and shared with appropriate leads and teams.

The service ensured staff were kept up to date with national legislation, evidence-based good practice and required standards. Staff told us there was a process for signing to confirm they had reviewed new or revised policies.

The service used corporate policies and procedures that were regularly monitored through monthly head of department meetings. Leaders reported that all policies were up to date, and we saw evidence of this in the policies we reviewed.

Patients' nutrition and hydration needs were met while attending the outpatient department. Refreshments, including drinking water, tea and coffee, were available for patients and visitors within waiting areas. Staff told us additional refreshments could be provided when required, particularly for patients who were attending longer appointments or undergoing investigations. Patients we spoke with confirmed they had access to refreshments during their visit and felt their comfort and wellbeing needs were considered whilst attending the department.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they need to appropriately assess, plan and deliver patients care, treatment and support.

The hospital used a multidisciplinary patient activity planning meeting to proactively review upcoming admissions and identify opportunities to improve patient pathways. Outpatient staff worked closely with diagnostics, theatres and inpatient teams to ensure patients were appropriately prepared for treatment and that essential clinical information and investigations were complete before admission. The outpatient team undertook pre-admission telephone calls between 48 hours and one week before surgery to confirm patients understood pre-operative instructions, identify any changes in their health status and escalate concerns where required.

Staff told us this approach helped reduce on-the-day cancellations, improve patient preparedness and support safer, more efficient care pathways.

During our assessment we attended a multidisciplinary meeting and observed good teamworking and best practice. The outpatient department was represented at multidisciplinary team (MDT) huddles that took place every morning and included staff from departments across the hospital. The huddle outlined the key support roles available across the hospital, including the speak up for safety lead, mental health first aider, safeguarding lead, senior leader and resident doctor on call. This meant that staff knew who to contact for support or escalation when required. The outpatient department had no issues to escalate in the meeting we observed.

Staff described well-established systems for managing referrals, appointment bookings and waiting lists. There were designated leads responsible for managing NHS referrals and private referrals, triaging referrals, monitoring clinic capacity and scheduling outpatient clinics.

Designated leads managed NHS and private referrals and worked closely with staff for triaging referrals, monitoring clinic capacity and scheduling outpatient clinics. They worked closely with consultants to establish new clinics, fill appointment gaps and manage clinic cancellations. Staff told us consultants were expected to provide 6 weeks' notice of cancellations where possible, and replacement or additional clinics were arranged to minimise the impact on patients.

Staff told us they there were good lines of communication from management and within the outpatient department. They described effective communication with consultants, secretaries, GPs and patients to support timely access to care and ensure services ran smoothly.

Staff shared examples of good collaboration between the outpatient and radiology team to support patient care. Staff had worked flexibly and communicated effectively to coordinate access to imaging and follow-up consultations within a limited timeframe. The joint approach helped avoid a repeat scan and ensured a timely review by the consultant. The patient had expressed high satisfaction with the service and the team’s willingness to go above and beyond to meet their needs.

Managers described strong MDT working throughout the hospital and attended various meetings including daily and weekly bed management meetings, orthopaedic MDT meetings, and enhanced recovery meetings.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people to reflect on their own health goals and recovery journeys as part of treatment planning.

Patients were asked about smoking and alcohol consumption as part of their pre-operative assessment. Patients who were deemed to be at risk of alcohol or smoking related complications were given advice leaflets. We saw health promotion, falls prevention and sight loss leaflets available in patient areas.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes met both clinical expectations and the expectations of people themselves.

The outpatient service participated in the hospital wide clinical audit programme. Audit data from the previous 12 months showed the outpatient service performed highly across most of their audits. This included National Safety Standards for Invasive Procedures (NatSSIPS) instruments (100%) and histology (100%). Medical records - pre-operative assessments (87%) and medical records – plastic and reconstructive surgery (100%). Department governance audit data from April 2026 was 95% and had increased from 72% in November 2025.

National Joint Registry (NJR) data showed strong compliance over the previous 12 months. Staff told us that the outpatient department initiated the NJR process by ensuring the required forms were completed before surgery. Performance data demonstrated compliance rates that were above national expectations, including 96.47% for recording valid NHS numbers, 95.9% for overall consent compliance and 95.9% for elective consent compliance. The service also performed better than expected in the timeliness of data submission, with data entered within four days.

Patient Reported Outcome Measures (PROMs) data demonstrated positive patient outcomes across several specialties supported by the outpatient department. Patients undergoing cataract, carpal tunnel, breast, hip, knee and shoulder procedures reported outcomes that were in line with or better than national averages.

Physiotherapy staff used a range of outcome measures to monitor patient progress and evaluate the effectiveness of treatment. Visual Analogue Scale (VAS) pain scores were recorded to assess patients' pain levels, with scores collected at the initial appointment and, where appropriate, at subsequent appointments to monitor improvement over time.

They also used condition-specific outcome measures, including the Oxford Shoulder Score, which assessed pain and the impact of symptoms on daily activities. These measures were collected before treatment and again following treatment or discharge to assess outcomes.

Staff told us they regularly reviewed patient progress and adapted support accordingly and nurses completed follow up calls with patients. For example, PROMs data was reviewed and where patients reported poorer outcomes than expected, alerts were generated for the physiotherapy team. Staff told us they would contact patients to discuss any concerns and determine whether further support or intervention was required.

Patients we spoke with said that someone from the service called them after their treatment to check on their progress and that staff checked their recovery at follow up outpatient appointments.

Physiotherapy staff told us they reviewed patients' records on their initial presentation before treatment. They also asked patients to assess their initial perception of their current abilities prior to surgery and compared this to their patient outcome forms at the end of their treatment. Staff told us patients were often pleased with the progress they had made.

Performance reported outcomes measures (PROMs) data was reported at hospital level.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Patients gave informed consent prior to treatment, and the consent process was thorough and included details of the risks associated with the procedure. We reviewed 5 patient records and found that all patients had signed consent forms and there was documentation that risks, benefits and alternatives were discussed.

Informed consent was supported by Essential Information in Decision and Outcome (EIDO) procedure-specific leaflets. The leaflets helped patients understand their condition, proposed treatment or procedure, benefits of treatment, risks and complications, alternative treatment options and what to expect during recovery. We saw that EIDO leaflets had been recorded as being provided to patients.

Staff understood how to assess whether a patient had the capacity to make decisions about their care and when this was appropriate. Where patients did not understand information given or asked about care and treatment, or they demonstrated reduced capacity to consent, staff carried out a capacity assessment. Where relevant, best interests’ decisions were clearly recorded within patient care records and staff gave examples of meetings they had been involved in.

Medical records consent audits were completed twice a year and showed that compliance was 99% in April 2025, 79% in January 2026 and had improved to 98% in April 2026. We observed that issues identified during the consent audits were recorded and monitored to ensure they were resolved and to identify any recurring concerns.

We saw evidence from audits that the outpatient department was 100% compliant in consent governance and 98% compliant in the consent process.

Outpatient staff were 100% compliant with consent training and mental capacity act training.