The New Foscote 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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people 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.

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

We reviewed 12 electronic patient care records. We saw that staff carried out pre-operative assessments, including medical history, allergies, current medicines, previous anaesthetic history, lifestyle factors, and risks that could affect airway management or recovery.

The theatre booking team collated all relevant diagnostic reports and images and uploaded these to each patient’s record. They contacted every patient to arrange appointments and discuss individual needs. The provider used a booking system with a ‘patient clipboard’ function, where staff recorded any specific needs. Staff also offered dedicated appointments for patients who needed additional support completing online medical questionnaires.

Consultants saw all patients before surgery for a pre-operative assessment. During this appointment, they reviewed medical history, current health and individual needs, and discussed the planned procedure. This allowed staff to plan personalised care for each patient.

There were procedure-specific pathways, such as for hip and knee surgery. We saw records were complete and supported a personalised approach, for example, including identifying patient anxieties to plan appropriate support.

We saw staff maintained clear and up-to-date records throughout the patient journey. They reviewed and updated care plans as needed to ensure care remained safe and appropriate. Staff consistently checked patient identity and recorded physiological observations in line with policy.

There was a communication support, interpreting and translation policy, which set out how staff provided accessible information, obtained informed consent in a way patients could understand, and made reasonable adjustments for communication needs. The service met the Accessible Information Standard, and staff completed training in this as part of mandatory training.

Staff assessed communication needs during pre-assessment and arranged additional support where required. They accessed British Sign Language interpreters, hearing loops, easy-read materials, communication boards and digital translation tools. The service provided interpreting support face-to-face, by telephone and via video. Staff told us they could also provide braille information when needed.

We scored the service as 3. 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.

The service developed and reviewed clinical guidelines and policies to align with national guidance. Staff could access these policies and knew how to find them. There were processes to keep policies up to date, including regular review through service and governance meetings.

Staff delivered care and treatment in line with evidence-based practice. For example, they administered fluids in line with national guidance for patients undergoing surgery and assessed patients for nausea and vomiting to support safe recovery. The service used Patient Reported Outcome Measures (PROMs) to assess patient outcomes and experiences. It also participated in relevant NHS national audits and benchmarking programmes, using the findings to evaluate the effectiveness of care and support continuous improvement in line with evidence-based practice.

In line with national guidance, the service had a comprehensive venous thromboembolism (VTE) policy to support the prevention, identification and management of blood clots. This included the use of anti-embolism stockings, electronic devices to promote blood flow and clear discharge information to help patients recognise symptoms and seek timely advice after leaving hospital. VTE is a serious condition where a blood clot forms in a vein, most commonly in the leg. Audit data showed staff completed VTE risk assessments for 100% of patients, demonstrating consistent compliance with the service's prevention and risk management processes.

A sepsis recognition policy was in place, which, staff undertook training for through workshops and online. Staff also followed an invasive procedures policy that incorporated the National Safety Standards for Invasive Procedures (NatSSIPs) and Local Safety Standards for Invasive Procedures (LocSSIPs). This helps to reduce the risk of avoidable harm during procedures.

The service participated in national audits, including surgical site infection surveillance, and submitted data to national reporting systems such as the Private Healthcare Organisation Network (PHIN) and the National Joint Registry (NJR), alongside internal quality and safety reporting. The governance team reviewed and documented audit and performance data. This supported oversight of care and treatment and helped ensure practice followed current evidence and national guidance.

The service employed a multidisciplinary team, including doctors, nurses and physiotherapists, to meet patient needs. The provider also operated an on-site kitchen, and patients and staff told us the food was of a high quality.

Managers carried out annual appraisals for all staff, identified learning needs and supported staff to develop their skills and knowledge. The service provided an induction for new staff to ensure they were prepared for their roles.

We scored the service as 3. 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.

The service used a dedicated administrative bookings team. Staff arranged surgical lists and collected detailed patient information at the point of booking. They used systems to record and share information with the clinical team, supporting coordinated and effective care planning.

Staff shared care records with patients, uploaded them to the system and sent copies to GPs to support continuity of care. Nurses led patient discharge following consultant review, ensuring clear communication and a smooth transition of care. On the day of inspection, the provider introduced a new system to email discharge letters to GPs. The system automatically populated parts of the letter from the patient’s electronic record, helping to ensure GPs received timely and accurate information.

In the event of a patient requiring transfer to another hospital, staff copied medical records and completed a transfer form, so the receiving team had all relevant information. The provider maintained a service level agreement with a local National Health Service Trust for the transfer of critically ill patients. The service had a transfer of deteriorating patient policy, which set out clear processes to support safe transfer and effective coordination between services.

Staff attended daily multidisciplinary ‘huddles’, where they discussed patient safety, planned the day and identified risks. Staff carried out structured handovers when patients moved through the service, sharing key information about clinical needs and risks. Staff described positive working relationships across teams, including care coordinators and discharge teams.

We scored the service as 3. 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, reduced their future needs for care and support.

Staff gave general pre-operative advice and provided written information to support patients in preparing for surgery, including fasting instructions. The service did not run formal pre-operative optimisation programmes.

In some cases, staff advised patients to lose weight before surgery to improve safety and support better surgical outcomes. The service also provided physiotherapy as part of rehabilitation for patients undergoing joint replacement surgery, supporting recovery and functional improvement. This showed the service considered patients’ health and took steps to support safer preparation for surgery and recovery.

We scored the service as 3. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

A benchmarking and outcomes improvement framework was used to monitor performance, compare outcomes and improve services. Staff collected data from clinical systems, audits, incident reports and patient feedback, and compared results against national standards and peer organisations.

Staff used recognised tools, including the World Health Organisation Surgical Safety Checklist and measures of post-operative complications, to identify risks early and respond to any signs of patient deterioration. This helped staff improve escalation and support safer patient outcomes.

Staff used digital systems to access test results quickly. This supported faster clinical decisions and improved coordination of care.

Governance teams reviewed benchmarking data each month and quarter. Where performance fell below expected standards, staff carried out root cause analysis and put action plans in place. The service used this information to improve care, safety and outcomes.

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

Staff completed training in consent, including the Mental Capacity Act, Deprivation of Liberty Safeguards, mental health, dementia and learning disability. Mandatory training compliance was 95%.

Staff assessed patients’ capacity to consent and completed best interests' assessments where required. When patients lacked capacity, staff made decisions in line with policy, taking into account the person’s wishes, feelings and best interests. This ensured staff followed legal requirements and good practice.

Consultants provided patients with clear information about their procedure, including risks, benefits and alternatives. Staff gave patients written information and checked their understanding. Patients had opportunities to ask questions before giving consent. Staff confirmed consent again on the day of surgery to ensure it remained valid.