HealthHero - Fox Talbot House

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 - We looked for evidence that the service met people’s needs through good organisation and delivery.

At our last inspection, we rated this key question Outstanding. At this assessment, this key question remains rated Outstanding.

This service scored 89 (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 was exceptional at making 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. People consistently received care that was personalised, compassionate and responsive to their individual needs. Staff demonstrated a strong commitment to understanding people’s unique circumstances, preferences and communication needs. The service ensured reasonable adjustments were routinely identified, recorded and implemented. Care plans reflected physical, mental, emotional, and social needs of people including those related to protected characteristics under the Equality Act. Our review of clinical records showed people were supported to understand their condition and were involved in planning for their care needs and in decisions about their care.

The service designed bespoke clinical templates to capture referral information from healthcare professionals contacting the service such as for people who were palliative. This was designed in partnership with the community palliative care clinical team including representatives from each local hospice. The service introduced a dedicated contact number for healthcare professionals and palliative patients directly for urgent or person-centred support. We identified from January 2025 to September 2025, an average of 2642 calls per month via the dedicated healthcare professional line were made to the service. During this period, the service reduced the percentage of cases passed to the ambulance service and local emergency department (ED) to an average of 5% per month. This demonstrated reduced unnecessary ED attendances, quicker support for at‑risk groups by reducing duplicate triage steps through NHS 111 and clinical assessment pathways.

The service demonstrated a proactive approach to tailoring care pathways. For example, clinical flows were redesigned to ensure during under 5s consultations, senior clinical oversight would ensure such cases were escalated for more urgent assessment when necessary and parents could be offered a face-to face appointment, regardless of the NHS Pathways disposition, recognising the rapid deterioration risks in children and reducing anxiety and inappropriate ED attendance. This provided additional safety netting due to an increased risk of deterioration of symptoms presented in children. As a result of audits carried out by the service, clinicians followed up any people who failed to attend an appointment or who were unable to be contacted, to determine whether an alternative appointment or consultation was required. Risk assessments were completed by clinicians of any failure to make contact, including checks on attendance at other healthcare services. If significant risk was identified, welfare checks were arranged and any concerns were communicated with the person’s GP service.

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 service had tailored its provision to meet the diverse needs of its community, for example, building relationships with community groups to promote the uptake of screening programmes. For example, people were signposted to local services such as mental health crisis teams.

The service had made improvements to its ‘Clinical Assessment Service’ operating model to a clinician-led ‘ledger’ way of working. Cases were prioritised based on the NHS Pathways disposition, ensuring that those requiring urgent attention are addressed first. This enabled escalation of cases that required a higher priority response, ensuring that critical needs were met promptly and appropriately. This demonstrated a more focused case management approach to assessing people’s care whilst prioritising a reduction in delays of clinical decision-making. Clinicians conducting telephone consultations were provided with real-time insights into their performance and make data-informed decisions throughout their shifts. People’s needs were fully assessed. This included their clinical needs and their mental and physical wellbeing.

The Clinical Responder home visiting service was integrated with the Clinical Assessment Service, enabling continuity of assessment when people required in‑person clinical review. Operational systems such as clinical queues enabled accurate visibility of people’s care and this enabled seamless handovers between clinicians.

The service implemented ‘the high-intensity user service’ who offered people a range of local health and wellbeing initiatives. This helped to identify any undiagnosed conditions as well as provided collaborative working with the local mental health partnership to support people with additional mental health needs.

There were established mechanisms for engaging with community healthcare providers. Multidisciplinary meetings were held regularly for people with complex needs such as with community district nursing and community mental health services. The service ensured longer appointments were available for those with additional needs. The service took proactive steps to identify and remove barriers so people could access care and support when they found it difficult to use services. For example, the service had effective oversight of system pressures through active participation in ‘Gold System calls’, which enabled them to support local primary care services in system‑wide escalation planning and to provide timely accessible care for people during high-pressured periods.

The service recognised local demographic needs, such as Wiltshire remaining a large military presence and in 2023, committed to achieve Veteran Aware accreditation, signing the Armed Forces Healthcare Covenant. The project delivered several key achievements, including partnerships with military charities, hosting 2025 Remembrance event and the integration of veteran identification processes into care pathways. The service secured the bronze award under the Defence Employer Recognition Scheme and continue to focus on ensuring inclusive care for members of the Armed Forces community across the integrated urgent care service. This scheme recognises UK organisations that demonstrate and advocate support for the armed forces community and align their values with the Armed Forces Covenant. The service demonstrated the veteran‑aware processes led to more timely identification and safer escalation of care for this demographic. For example, 243 same‑day urgent care appointments were offered to veterans in one month, and 77% of veterans received at least one same‑day appointment in the year—39% higher than non‑veteran patients of the same age. Veteran‑friendly training materials were used to improve staff understanding of military‑related mental and physical health needs, and to ensure clinicians understood priority treatment requirements.

The service supplied appropriate, accurate and up-to-date information tailored to individual needs.

Information to promote people’s care and treatment was available in a range of languages. The service made reasonable adjustments to meet individual needs in line with the Accessible Information Standard. People were informed as to how to access their care records. There were arrangements to ensure confidentiality at the GP out of hours sites and within the call centre operated by the clinical assessment service clinicians and administrative team which prevented sensitive information being inappropriately shared or overheard.

Staff used information leaflets to support people’s understanding of their care and treatment. Safety‑netting templates and digital communication tools were used to ensure people understood advice and next steps.

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 The service identified themes from a review of complaints and learning was shared with staff. Staff were able to identify changes in response to feedback and complaints. For example, as a result of administrative and record-keeping errors relating to referrals, automated referral reminder alerts were added to clinical systems which prevented reoccurrence. The service also provided additional training to staff in relation to data security. During our assessment, we reviewed a sample of complaints and noted these were investigated and responded to appropriately in line with service policy. Where appropriate, people were provided with an apology and signposted to the Parliamentary and Health Service Ombudsman.

The service made it easy for people to share feedback and raise concerns. Complaints were rare, with only one complaint per 2,717 consultations, and were handled promptly and transparently. Learning from feedback was embedded into improvement plans and shared widely across teams. People were informed about changes made as a result of their input, reinforcing trust and partnership.

The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The service provided an Integrated urgent care service across the local areas of Bath and North East Somerset, Swindon and Wiltshire. This was delivered twenty-four hours a day, seven days a week by a multidisciplinary clinical team, and supported by a coordination team. The Clinical Assessment Service (CAS) ensured people received the most appropriate care, concluding with advice, a prescription, an appointment or referral for further assessment or treatment. The service also provided a ‘Clinical Responder’ provision which were an extension of the clinical team working with a senior clinician who managed case and care plans once triaged from CAS. These staff members were home visiting clinicians which were made up of both GP’s and Advanced Care Practitioners (ACP).

The service worked closely with the local ambulance trust to support them with providing care and treatment for higher acuity patients (severe, complex, or unstable medical condition requiring monitoring) who are given the disposition of requiring a category 3 ambulance (a category 3 ambulance call refers to an urgent but not immediately life-threatening medical situation, often with a target average response time of around 2 hours to treat at home or transport to hospital). This involved coordinating care delivery and managing people through the healthcare system using a multidisciplinary team. The team demonstrated how they provided equitable access to prevent acute hospital admissions and expedites discharges. We highlighted audits of call recordings and clinical notes each month completed by the service as an additional safety net and to provide wider learning for staff. This service has had a demonstrable impact on system pressures by reducing ambulance conveyance and Emergency Department attendance. As a result, the Care Coordination Project - Ambulance Navigation was awarded the Gold Award at the HSJ Partnership Awards in 2024, for ‘Most Effective Contribution to Integrated Health and Care.

We noted the service worked to enhance clinical responsiveness and patient experience through the ‘Next case = Y’ workflow (a way of working which enabled clinicians to deliver care to the next most urgently prioritised case). This model assigned the next clinically urgent case to clinician’s, regardless of queue order, which supported safer and efficient triage based on clinical urgency. As a result of the service model change, the service demonstrated performance data which showed strong achievement of national Integrated Urgent Care standards. For example, in September 2025, we noted performance was above commissioned targets. In particular, 88% of Clinical Assessment Service (CAS) consultations met disposition timeframes, against the minimum standard of 60%. Whilst, 95% of treatment centre (UTC) and 90% of home visits met disposition timeframes against the 90% target. The service consistently demonstrated performance data which exceeded commissioned targets.

We saw evidence of audits completed in relation to access performance, such as clinician capacity and demand data, triage waiting times and ‘Did Not Attend’ (DNA) rates per GP out of hours site to assess performance. The service had also reviewed audits of telephone access data which included the total number of inbound calls daily; queue waiting times and call abandonments. This helped provide oversight to rota management and staffing arrangements to meet access demand.

As a result of people’s feedback into providing care for those with protected characteristics, the service facilitated improved wheelchair access to the premises of one of the out of hours treatment centres. This included repairs to prevent a threshold drop and changes to the outward opening door. This mitigated the need for additional access assistance and demonstrated an improvement in meeting the needs of people.

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.

Feedback from people using the service was exceptionally positive. People felt involved in any assessment of their needs and felt confident staff understood their individual and cultural needs. Feedback provided by people using the service, via feedback surveys as well as to CQC through ‘Give Feedback on Care’ function, was overall positive. For example, we saw feedback themes which highlighted people were well informed and involved in decisions about their care and staff treated people equally, without discrimination. The service demonstrated oversight of feedback themes and gave examples of actions taken to improve the service. Between April and June 2025, the service received 375 completed survey responses (of which 73% was sourced from telephone consultations) highlighted between 96-99% respondents recommended the service.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to online services. We saw examples of actions taken to improve outcomes for people as a result of feedback. For example, people who were triaged through the Clinical Assessment Service were contacted through dedicated comfort calls when waiting times were extended, in the form of a comfort call, to establish if symptoms had changed, as well as provided an updated on when a clinician would be able to contact them. This aimed to help reduce anxiety, ensured people felt supported and was a measurable method to determine any deterioration in people’s symptoms who may require urgent intervention. Staff described this as a compassionate way to reassure people during busy periods. Feedback consistently reported that this was welcomed to ensure their care needs remained a priority.

We saw numerous examples of co-production and engagement. High Intensity User (HIU) case studies illustrated how the service worked holistically with individuals to improve health, wellbeing, and independence. The service demonstrated equity and inclusion, tailoring care for those with additional needs, such as neurodivergence, language barriers, and physical disabilities. Reasonable adjustments, longer appointments, and use of translation tools ensured accessibility. Initiatives such as Veteran Aware accreditation and support for refugee communities showed a proactive approach to meeting diverse needs.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Our remote clinical care records showed people were supported in their care which considered their wishes for during end-of-life care, including cardiopulmonary resuscitation and existing treatment escalation plans. Care and treatment which took place was shared with other services such as the person’s GP practice when necessary. The service contributed to local frailty and palliative care multi-disciplinary meetings to support healthcare partners, which included frequent users of the out-of-hours service. Clinical staff had completed appropriate training on how to have effective and sensitive conversations with people and their families about their wishes and preferences for emergency care.