HealthHero - Fox Talbot House

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 staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last inspection, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Arrangements to manage frequent contacts and standard operating procedures were available to support clinicians. For example, risk assessments were undertaken on each occasion, such as determining repeat prescribing to a person unknown to the clinician with considerations of whether they could be referred back to their in-hours GP.

Administrative and call-handler staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The service had effective systems to identify people with previously undiagnosed conditions.

Information was shared with staff and other healthcare organisations to enable them to deliver care and treatment. Delays in onward referral such as emergency departments were monitored, and audits were carried out to ensure that the patient's own GP had been reliably notified of any urgent primary care actions, such as urgent cancer referrals, in addition to the standard post-event message.

People’s accessibility and communication needs were recorded in their clinical records. Staff were trained in the care-navigation process to ensure people were directed to the most appropriate part of the urgent care service. Staff had access to the future care planning templates on the service clinical records system which incorporated checks for people’s wishes, mental capacity and any treatment escalation planning.

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 service standards. The provider had systems to keep clinicians up to date with current evidence-based practice.

We saw evidence of clinicians assessing needs and delivering care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols. Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to help ensure people’s needs were met. NICE guidance updates, in easy to read format were distributed electronically to all clinical staff via the intranet, monthly newsletters and weekly clinical leadership email updates.

The service had an induction programme for clinical and non-clinical staff which included information for training, appraisal and guidance for providing evidence-based care. Clinical staff had access to local care pathways and prescribing guidelines with the British National Formulary (BNF).

We carried out a review of the service’s clinical records system and noted people were assessed and treated in line with national guidelines, such as people with minor illnesses, long-term conditions and urgent care. A sample of records reviewed showed people and their medicines were reviewed to ensure care was provided in line with evidence-based guidelines. We also noted there were personalised treatment plans for people with diagnosed conditions, within the records we reviewed to inform future care planning. Staff used clinical templates effectively and adapted care for people with complex needs. The service demonstrated an effective system for updating clinical guidelines and protocols.

The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff had access to the information they needed to appropriately assess and plan, people’s care, treatment, and support. The service worked with other healthcare partners to ensure continuity of care, including where clinical tasks were delegated to other services. For example, staff monitored correspondence from external professionals involved in people's care.

The service had implemented its own ‘Care Co-ordination Service’ to work closely with the local ambulance trust to support paramedic crews by taking on cases for people who have been assigned urgent but not immediately life-threatening ambulance dispositions. The service involves coordinating care delivery and managing people’s treatment using a multi-disciplinary team. Developed in 2022, this service had managed over 50,000 cases with only 14% of all 999 calls reviewed by the Care Coordination service resulted in the patient being taken to hospital. This meant 86% of all cases were safely managed without the need for hospital care, using alternative pathways such as clinical responder home visits, community nursing referral or virtual wards. The service worked to ensure people received timely and appropriate care without unnecessary escalation to emergency departments. This is achieved through a combination of remote clinical advice, urgent care appointments, and coordination of community-based interventions.

We saw records that showed all appropriate staff, including those in different teams, were involved in assessing, planning and delivering care and treatment. Each service within the Health Hero’s urgent care pathway worked collaboratively to ensure care was co-ordinated effectively. For example, when people were assessed via the Clinical Assessment Service (CAS) and had their care transitioned to either the clinical responders (home visiting team) or people’s attendance at a GP out of hours site.

There were processes to monitor and manage care when people were moved between services such as after referral to secondary care, or admission to hospital.

During our review of the service’s clinical records systems, examples of effective plans for the movement of people across multiple services were noted. Treatment plans and discharge summaries were managed appropriately and considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. This was managed in a timely manner to inform future care and treatment planning.

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 were consistent and proactive in empowering people and supported them to manage their own health and maximise their independence. The service identified people who may be in need of extra support. For example, people over 80 years old, where increased case complexity is common and known to lead to difficulties for call handlers in completing the NHS Pathways assessment. As these could result in inappropriate referrals to local ambulance trust and then subsequently the local hospital’s emergency department, the ambulance and ED validation process would provide intervention in such cases to provide a more appropriate pathway. Additionally, people over 80 years old and children under the age of 5 on the Clinical Assessment queue would be reviewed by the Clinical Navigator or other senior clinician as a priority, to determine whether they required more urgent intervention than the disposition allocated by the NHS Pathways assessment. These cases could be escalated for more urgent assessment, with a lower threshold for a face-to-face assessment if required due to their higher risk of health deterioration. Where appropriate, staff gave people advice so they could self-care.

The service utilised ‘special patient notes’ processes which enabled them with NHS 111 to have access to tailored support plans, in which clinicians were able to update ReSPECT (Recommended Summary Plan for Emergency Care and Treatment or Treatment Escalation Plans accordingly. This meant if a person became suddenly unwell or loses capacity, clinicians across services could follow a plan that is current, accurate and aligned with the person’s wishes, whilst reducing distress.

Risk factors, where identified, were highlighted to people and their normal care providers so additional support could be given. Where people’s needs could not be met by the service, staff redirected them to appropriate healthcare organisations through the Directory of Services (DoS). The DoS is a national NHS database to identify the most appropriate local service for people based on their clinical needs.

The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service had a programme of quality improvement audit activity and routinely reviewed the effectiveness and appropriateness of the care provided. For example, there was a clear plan for conducting clinical and non-clinical audits. Outcomes and learning were shared with staff to ensure future recommendations were implemented. The provider carried out clinical consultation audits using the clinical guardian software underpinned by the Royal College of General Practitioners (RCGP) toolkit, to support clinician feedback, reflection and multidisciplinary case reviews. Senior leaders reviewed the performance of its services through auditing call recordings and the quality of notes each month.

The provider worked with the local commissioners to evaluate outcomes from it’s High-Intensity user service. The service demonstrated a reduction in avoidable emergency department attendances and emergency service use had been achieved by comparing 3 months prior and 3 months post implementation of the service. The service highlighted a 59% and 41% total reduction in NHS 111 and Integrated Urgent Care cases and 52% and 19% reduction in attendances to 2 local NHS hospitals. This showed the service not only reduce the burden on urgent care resources but also costs across the local healthcare system.

The service had carried out an audit of care and treatment outcomes, in relation to its care coordination service, and determined, between April and June 2025, a total of 4,800 referrals were received. Of these, only 571 people (12%) were delivered onward to local Emergency Departments (ED) and 244 people sent directly to specialist secondary care (such as Stroke or Surgical Assessment), bypassing emergency departments, reflecting the service’s emphasis on out-of-hospital management and triage.

The service had a ‘Clinical Effectiveness Committee’ which ensured staff remained up to date by reviewing and cascading the latest research, guidelines and best practice. Meetings were held monthly and standing agenda items included infection prevention and control (IPC); antimicrobial resistance; medicines management; sepsis; end-of-life care; and clinical pathways. The Senior Clinical Leadership team led on system wide ‘front-door’ events, alongside stakeholders from the urgent care system and NHS England colleagues. These events involved end-to-end multi-professional team, to review a person's journey, to identify and continuously act on improvements.

The service provided additional education sessions for all clinical staff to evaluate the safety and effectiveness of prescribing and risks associated with the patient's condition and current medication when treating them in the urgent care setting. This was to encourage stopping or switching people’s medicines while they were acutely unwell with a view to their own GP reviewing at a later stage when they had recovered.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. People are informed about their rights regarding consent to the care and treatment offered. Systems and processes ensured individuals understood the care and treatment proposed, enabling informed decision-making.

Staff understood the legal requirements around consent. Mental capacity was assessed where appropriate, and consent was recorded accurately in the person’s clinical record. There was evidence of shared decision-making and staff had received training in the Mental Capacity Act. Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) and Treatment Escalation Plans (TEP) records had also been completed, reviewed and adhered to in line with national guidance as required.