Fulwood Hall Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people’s needs were met through good organisation and responsive delivery.

Care was person centred and the service understood the diverse health and care needs of people and their local communities. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. The service made sure that people could access the care, support and treatment they needed when they needed it. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff described a personalised approach to care and worked with other departments to ensure adjustments were in place before admission.

Staff told us that advance notification reports and electronic alerts were used to identify patients who required additional support. They gave examples of reasonable adjustments such as arranging face-to-face assessments for patients living with dementia and providing additional physiotherapy support during assessments.

We saw evidence that initial appointments and future care plans were shaped in partnership with patients and their relatives and carers. Staff were able to provide examples of how care was tailored to meet individual patient needs. For example, longer appointment slots were arranged for patients with mental health needs or those receiving end-of-life care, allowing sufficient time for discussions, questions and emotional support.

Outpatient department appointments identified patients living with dementia or a learning disability. Staff told us teams escalated any dementia-related admissions and created individualised care plans. Staff from all specialities, including physiotherapists, doctors, and nurses, attended daily multidisciplinary team (MDT) meetings to discuss patient needs and preferences.

Compliance with dementia awareness training was 96%.

Staff had access to a corporate policy on supporting adults and children with learning disabilities and autism and received mandatory training in learning disability and autism. Training data showed compliance was 100% for all staff groups across the outpatient department.

Consultants who held practising privileges at the hospital were required to complete this training at their substantive posts within NHS hospitals. Compliance for the e-learning element was 45.47%. The training also included a mandatory face-to-face module for staff in clinical or leadership roles. At the time of our assessment, the face-to-face sessions had not yet been delivered locally due to the recent introduction of the programme, and this was being monitored by management.

Accessible toilets were available in all departments and were equipped with nurse call buzzers and emergency pull cords.

Staff described effective arrangements for supporting patients whose first language was not English. They spoke positively about the Language Line interpreting service and told us interpreters could be accessed when required. Staff explained that interpreter details were recorded within consent documentation to ensure accurate records were maintained.

They also described how patients requiring additional support, including family involvement or adjustments related to anxiety, were identified and communicated to the clinical team before appointments where possible.

Patient information leaflets were also available in Braille and in multiple languages on request. Where patients had visual impairments, information relating to cataract surgery was printed on yellow paper to improve accessibility. Staff described providing information in alternative formats when required, including supporting patients with dyslexia.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The outpatient’s department operated 6 days a week, Monday to Saturday. Staff told us outpatient activity on Saturdays was limited to mornings. Patients requiring urgent advice or support outside of these hours were diverted to the inpatient ward.

Physiotherapy services were available Monday to Friday. Clinics operated from 8am to 8pm on Mondays and Wednesdays, until 6pm on Tuesdays and Thursdays, and until 4pm on Fridays. Staff told us physiotherapy cover was available throughout the week, with service hours varying according to demand.

Patients’ care and treatment was delivered in a way that met their needs from services that were co-ordinated and responsive.

The hospital routinely monitored conversion rates from outpatient consultations to surgery to assess referral appropriateness and pathway effectiveness. Analysis of this data was used to identify areas where patients may be more appropriately managed in alternative services and to inform discussions with GPs, referral management services and the Integrated Care Board. For example, a review had highlighted a low conversion rate of gynaecological surgery services and how some patients would be better managed within the community. The service helped direct suitable patients to community-based services, which helped to improve patient pathways and reduce unnecessary delays.

Staff across all specialities could also access the information they needed to deliver safe and coordinated care. For example, physiotherapists had access to all scans, imaging, nursing and medical notes.

The service provided consultant-led outpatient and allied health services across a range of clinical specialties. Activity includes initial consultations, follow-up reviews, post-operative rehabilitation, diagnostics, minor procedures, and discharge planning.

Services were delivered to NHS, private medical insurance (PMI), and self-pay patients. Activity included initial consultations, follow-up care, post-operative rehabilitation, diagnostics, minor procedures, and discharge planning.

Over the previous 12-month period, the service had delivered 54,299 appointments (including 3257 minor procedures) across NHS, private medical insurance (PMI), and self-pay pathways. The majority of activity was NHS-funded, accounting for 44,908 appointments (83%), while 5,439 appointments (10%) were delivered to PMI patients and 3,952 (7%) to self-pay patients.

The service managed outpatient clinics using structured templates within the electronic patient record system. This process aligned capacity with demand and consultant availability. Appointment types were clearly defined as initial, follow-up, and post-operative follow-up, so that patients could be seen at the right time by the correct clinician.

The outpatient department was represented at the weekly hospital wide operational bed meetings. The meetings reviewed capacity, patient flow, staffing, and operational risks across departments to ensure services could be delivered safely and efficiently. The outpatient department contributed to the meeting by providing updates on clinic capacity, confirming whether additional clinics could be accommodated, reviewing clinic utilisation, monitoring completion of pre-operative telephone calls, and providing assurance regarding staffing levels.

The meeting also provided an opportunity for the outpatient team to escalate any operational concerns that could affect patient care or service delivery.

Staff described positive working relationships between outpatient, pre-operative assessment and booking teams, which supported effective communication and coordination of patient care.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. The service had processes in place to ensure that patients received information that met their communication needs and was compliant with the AIS standards.

For example, during the first contact with the service patients are asked about their communication requirements such as large print, easy read, interpreters, visual or hearing impairment. Staff could flag patient communication needs on the electronic patient record system and when patients were transferred to another provider, staff shared their communication needs as part of the referral process.

Information leaflets were available to support patients in understanding their care and treatment. Staff told us that information could be requested in a range of languages to meet the needs of the local population and ensure patients could access information in a format they understood. Staff were able to identify the most commonly requested languages and described the process for obtaining translated materials when required.

Information governance systems included confidentiality of patient records. Staff kept detailed records of patients’ care and treatment. The majority of record keeping was made electronically.

The service had acted on feedback from patients who had reported feeling anxious due to a lack of information and the urgency associated with urine flow tests. Patients were now provided with clear written information at their initial consultation explaining what to expect and how to prepare. Staff were also briefed to ensure consistent communication prior to booking.

Staff accessed information guides on the intranet for a range of different surgeries to share with patients prior to the procedure. The guides were detailed and explained what the operation involved, medication, preparation, alternatives to surgery, complications and recovery.

The patient records we reviewed were up to date and clearly written with a focus on patient outcomes. The electronic system was secure, and care records, including emails, were encrypted with only authorised staff able to access the system.

There was a corporate health records’ management policy and a process for the management of health records. Both documents were in date and had a review date.

Patients were provided with clear and transparent information that follows consumer rights best practice, including contracts and charges. We observed leaflets for patients with clear information about the cost of private treatments, options for private and self-funded patients and payment options.

We observed an ophthalmology consultation where staff provided clear, detailed and patient-centred explanations throughout the appointment. The clinician carefully explained the patient's condition and discussed the proposed cataract surgery, including what the procedure would involve. The patient was given clear advice about preparing for surgery, including continuing their regular medications unless otherwise advised. Staff also explained what would happen following discharge, including follow-up appointments, post-operative care requirements and what activities to avoid. Information was provided both verbally and in writing, supporting them to make informed decisions and plan for their future care and treatment.

In the previous 12 months, the outpatient department had reported 1 data security breach, and staff had taken immediate action to manage the incident, investigate the cause, and implement measures to prevent a recurrence.

There have been no data breaches meeting the threshold for notification to the Information Commissioner’s Office (ICO) within the outpatient department during the past 12 months.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients participated in PLACE (Patient‑Led Assessments of the Care Environment) assessments. This meant that patients were involved in giving feedback on the environment and facilities. An associated action plan was in place that showed most actions had been completed in response to patients’ views. For example, improvements to access and car parking had been completed, including the introduction of clearly marked patient drop-off zones. A covered external waiting area with seating near the main entrance had also been installed to improve comfort for patients.

Patients we spoke with knew how to give feedback about their experiences of care. We saw posters and leaflets displayed in patient areas on how to give feedback.

The service had a complaints policy that set out the required procedures, including offering patients a face-to-face meeting to discuss their concerns if they wished. The policy stated that complaints should be acknowledged within 3 days and a full response provided within 20 working days, or within 20 days of a face-to-face meeting. The complaints policy included the process to follow for unresolved complaints and signposted to external organisations such as the Independent Sector Complaints Adjudication Service (ISCAS) for private funded patients and the Parliamentary and Health Service Ombudsman (PHSO) for NHS patients. During our assessment, we observed that complaint information leaflets containing this guidance were readily available for patients.

The outpatient department had received 3 complaints in the previous 12 months. The main theme had been communication, and actions had been taken to reduce recurrence of issues. Compliance with response times was monitored, and data provided by the service showed that the majority of complaints were responded to within the required timeframe. Staff told us that delays were managed and communicated clearly to complainants with extension letters sent if required.

Patients and their families could give feedback on the service and their treatment, and staff supported them to do this. There were several surveys that patients could complete including Friends and Family Test (FFT), Private Healthcare Information Network (PHIN) and a patient experience survey.

Patients also had the opportunity to share their experiences and provide valuable feedback through engagement activities, including participation in PLACE (Patient‑Led Assessments of the Care Environment) inspections. Patient experience and themes were presented to the patient experience group meeting with a focus on improvements being patient led.

The service had identified FFT response rates within the outpatient department and recognised the need to increase patient feedback to support service improvement. The patient experience group had taken actions such as attaching FFT leaflets to patient registration forms and health questionnaires. They had encouraged staff including reception staff to actively request feedback. Progress and the impact of these actions were scheduled for review at the next patient experience group meetings.

We reviewed outpatients FTT data from 1 March 2026 to 1 April 2026, which was based on 99 responses. The average satisfaction score for that month was 9.8 out of 10 and 94% of patients had reported a ‘very good’ experience. This was the same as the reported NHS average mean score and slightly lower than the private average score of 10.

Learning from feedback was seen as an opportunity for improvement and staff gave examples of how learning was incorporated into daily practice. This included improvements in how they delivered urine flow tests. A planned clinic model was introduced, with improved facilities, flexible patient booking, and streamlined processes for faster result review and escalation. This had led to improved patient flow and waiting times had reduced from up to 5 months to 14 days. There was also less delays reported and a reduction in repeat tests.

At the time of our assessment, the hospital was developing a patient experience strategy, which was in draft form.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Managers monitored waiting times and made sure most patients could access services when needed and received treatment within agreed timeframes and national targets. Patient appointments were booked by the administrative team, who assessed patients’ individual needs and scheduled an appointment with adequate time.

Patients told us they were seen with very little waiting time. One patient told us, “I was seen very quickly and chose this hospital due to the lower waiting list, and it was closer to home”.

Staff told us patients frequently praised the short waiting times for appointments and surgery and described the service as efficient and responsive. Staff also explained that appointment lengths could be adjusted to meet individual patient needs where required.

The service helped minimise delays to treatment by supporting patients on site to complete the patient health questionnaire so it could be scanned within 24 hours or completed electronically.

Staff training compliance for equality and diversity training was 100%. Staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support. One patient told us, “I felt respected and equal given that I am 80 years old, this was not the same experience when my husband was seen at another hospital”.

Patients on open pathways (including those waiting for outpatient appointments or who have had a decision to treat) were reviewed weekly using data from waiting list and tracking systems to ensure they were managed appropriately. The information was collated and shared with heads of departments and used within a weekly activity meeting. Referral to Treatment (RTT) performance was reviewed to support timely patient care and to identify consultants with high demand and limited capacity. This enabled patients to be offered greater choice, including the option to transfer to alternative consultants within the same specialty where clinically appropriate.

The service provided the most recent data for outpatients RTT performance. This was monitored against the national standard of treating 92% of patients within 18 weeks of referral. At the time of our assessment, for outpatient specialties at the hospital, performance for this standard was 70.24%. This was better than the benchmark average for the provider’s other hospitals (63.57%) and the national average (62% last reported October 2025).

The outpatient specialities at the hospital had a low number of patients waiting over 52 weeks for treatment (0.39%). Additionally, there were no patients waiting over 65 weeks. This performance was also better than the benchmark average for the provider’s other hospitals and national average.

Staff monitored clinic utilisation through scheduling and cancellation spreadsheets and used a rolling scheduling programme to ensure clinic capacity met demand across a range of specialties, including ophthalmology, spinal surgery, gynaecology, respiratory medicine, pain management, cardiology, plastics, trauma and orthopaedics, urology and physiotherapy.

The service had effective capacity utilisation and access controls which supported timely access to care and reducing non-attendance. Data for March 2026 showed 100% utilisation of NHS appointment slots across all specialties each week.

The service provided data on the number of cancellations and patients that did not attend appointments (DNAs) over the previous 12 months. There had been 3,171 appointments cancelled and 2,546 DNAs.

The outpatient manager reported that DNA rates were low (less than 5%) and that patients received text message appointment reminders to help reduce missed appointments. Where patients did not attend, the non-attendance was recorded on the electronic patient record system and reviewed by the consultant. Patients were routinely offered another appointment and sent a new appointment letter where appropriate.

Cancellations were primarily attributed to clinical and care-related factors, accounting for 2,082 cancellations (72%), including consultant or health care professional availability, changes in clinical priority, unavailable results, and cases where treatment was no longer required. Non-clinical and operational factors accounted for 782 cancellations (27%), including session cancellations, staffing issues, and scheduling processes. A total of 307 cancellations (9%) occurred on the same day, and mainly due to consultant sickness, late pathway decisions, outstanding diagnostics, or duplicate bookings.

From a total capacity of 54,299 outpatient appointments, the overall cancellation rate was 5.84%, with same-day cancellations representing 0.56% of activity. A standard operating procedure was in place to ensure patients were rebooked promptly, minimising disruption and supporting continuity of care. We spoke with a patient who said that their missed appointment was quickly resolved through a phone call and another appointment was arranged promptly.

Staff told us that mitigation measures were in place to reduce lost capacity and data was reported monthly to the lead Integrated Care Board (ICB) through governance reporting.

Actions were taken to reduce cancellations including timely patient contact and rebooking, including the use of virtual consultations where appropriate. All on-the-day cancellations were reported through the incident reporting system to enable tracking and learning. Learning outcomes included reinforcing expectations with consultants, such as providing a minimum of 6 weeks’ notice for clinic cancellations in line with policy.

Actions taken to reduce DNAs and late cancellations also included the expansion of multi-channel reminders, improving appointment communications, and introducing hybrid mail to speed up correspondence and reduce reliance on physical post. Patients with repeated DNAs were reviewed, and short-notice waitlists were used to maximise clinic capacity.

To improve demand and capacity matching, the service carried out regular specialty-level reviews, monitored follow-up activity to ensure clinical appropriateness, and increased the use of patient-initiated follow-ups. Clinic templates had undergone further standardisation, and trend data was used to refine booking processes and patient communication.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service supported a diverse patient population across NHS, PMI, and self-pay pathways, promoting equitable access through multiple referral routes, including GPs, consultants, and direct access where appropriate. Staff told us that appointment types were aligned to individual clinical need, including initial consultations, follow-ups, post-operative reviews, diagnostic appointments, and discharge consultations.

Staff told us they managed both NHS and private patient pathways in a way that ensured NHS patients were appropriately prioritised whilst maintaining access for private patients. They said they aimed to provide the same standard of care regardless of funding source. Separate appointment slots were reserved for private patients; however, if these were not required they could be released for NHS patients to maximise clinic capacity.

Staff demonstrated a clear understanding of current waiting times across specialties and described actions taken to reduce waits where possible. For example, patients requiring spinal or gynaecology appointments were contacted when earlier appointments became available.

Staff were committed to ensuring equitable access, outcomes, and experiences for all patients, including those with learning disabilities, autism, dementia, and mental health needs.

Patients care, treatment and support promoted equality and removed barriers or delays. For example, staff supported patients to complete the patient health questionnaire at the outpatient appointment following a decision to treat. Performance data for the outpatient department showed that they consistently performed among the top 3 out of 19 provider hospitals for completing pre-operative assessment (POA) triage within 5 working days of patients being listed for surgery. The hospital reported very few patients missing the POA triage KPI. Data also showed that the hospital had relatively few telephone assessments because comprehensive clinical information was collected at the outpatient appointment and supported a more effective triage process.

Staff told us that spinal injection services had reduced following changes to Integrated Care Board (ICB) funding arrangements. As a result, spinal and pain injection procedures were no longer routinely provided through the hospital, with patients being directed through community pathways. However, spinal surgery continued to be undertaken at the hospital. Staff said these changes had been implemented from January 2026 and had significantly reduced pain clinic activity, which was now predominantly provided for private patients.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff supported patients to make decisions about their care and treatment and their future.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs and people were supported to transition to other services or community resources when appropriate.

Patients told us they had been provided with sufficient information about their future care and treatment, which enabled them to make informed decisions.

Staff helped patients plan for the future and access ongoing support should their circumstances or needs change following treatment. Staff told us that patients who may require additional emotional or psychological support were signposted to appropriate services, including the mental health crisis team and the Samaritans.