The New Foscote Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. This means we looked for evidence that people were protected from abuse and avoidable harm.

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 Safe.

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

We scored the service as 2. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice

The provider implemented a Patient Safety Incident Response Framework (PSIRF) policy and plan (PSIRP). This national approach supports learning from incidents and improving safety, rather than focusing on blame. The service reported one serious incident in the previous 12 months. Staff managed the incident appropriately and kept the patient safe. However, the provider did not notify the Care Quality Commission (CQC) as required. This meant they did not meet their duty to report notifiable incidents. This could limit oversight and learning. In future, the provider should ensure all notifiable incidents are reported in line with regulations.

The service used an electronic incident reporting system. However, not all staff had direct access, which could delay the reporting of incidents and limit timely escalation, oversight and learning. Staff understood what to report and completed incident forms, which managers then uploaded to the system. The service recorded, tracked and investigated incidents, and took appropriate action.

Between January and December 2025, the service reported 179 incidents and unplanned events across a range of categories. These mainly related to operational issues, such as cancellations and delays, as well as clinical concerns including post-operative complications, infections, medication errors, falls and needlestick injuries. A smaller number related to clinical governance processes.

Staff we spoke who understood their responsibilities in relation to Duty of Candour. They explained the importance of being open and honest with patients when things go wrong, including offering an apology and a clear explanation. Staff described an open culture within the service and an “open door” approach with senior leaders. The provider included Duty of Candour in staff training. We saw examples of Duty of Candour letters that clearly explained investigation findings and outcomes. Staff said they received feedback from complaints and incidents at morning meetings and acted on learning identified.

The provider used feedback to make improvements. For example, following patient feedback about discharge information, staff reviewed and updated discharge documentation to ensure patients received clear post-operative instructions.

We scored the service as 3. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service accepted referrals from external NHS providers and independent customers. Consultants reviewed each case, whether privately funded or NHS, to confirm the service was appropriate for the patient. The theatre booking team received referrals, obtained relevant tests and diagnostic information, and uploaded these to the patient record. The team contacted patients to arrange surgery and scheduled pre-assessment appointments.

The service used a digital pre-assessment system. Patients were sent a link to complete their own medical and surgical history. The system coded the planned procedure and generated a procedure-specific information video for patients to review. Clinical staff to review and update their information and completed or requested any required investigations. Staff carried out standard pre-assessment tests based on patient age and comorbidities.

We saw staff communicate effectively as patients moved from the ward to theatre and into recovery, handing over key information about care, risks and clinical needs to maintain continuity and safety. We observed staff used structured handovers and safety checks to ensure all relevant information was shared at each stage. Staff told us they worked well together during patient transfers and understood their roles and responsibilities. The provider planned to introduce tablets or laptops for nursing staff to update records in real time. This supported timely documentation, improved access to patient information and strengthened safe transitions of care.

The service worked with external stakeholders to support safe care. The provider had a service level agreement with the local hospital for the transfer of critically ill patients. Senior leaders engaged regularly with local Integrated Care Boards (ICB) to plan services for the local population. Staff also communicated clearly with GPs and other healthcare professionals about individual patients. This demonstrated clear referral and communication pathways and supported continuity of care and appropriate follow-up after discharge.

We scored the service as 3. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service maintained a well-defined, up-to-date and accessible safeguarding policy. The policy included clear guidance and contact details for local safeguarding agencies and supported staff to recognise and respond to concerns appropriately.

Staff demonstrated a clear understanding of their safeguarding responsibilities. They described how to recognise adults and children at risk of harm and explained how to raise concerns, including completing safeguarding alerts where required. The director of nursing acted as the named safeguarding lead who had received level 4 training, and staff knew how to contact them for advice.

The provider included safeguarding in staff induction and mandatory training. Compliance was high, with 97% of staff completing level 3 adult safeguarding training. Although the service did not treat children, staff completed advanced safeguarding training for children, with 96% compliance. This ensured staff could identify concerns when children attended the service with patients. The provider also trained staff in the Mental Capacity Act, ensuring they understood how to support and manage patients who could not make decisions for themselves, safely and in line with legal requirements.

We scored the service as 3. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Leaders had clear exclusion criteria to ensure risks were appropriately managed and that only patients whose needs could be safely met were accepted. Patients were excluded if they had complex or unstable medical conditions, required emergency or higher-level post-operative care, or had factors that increased clinical risk, such as significant cardiac disease, untreated sleep apnoea, liver failure or poor exercise tolerance. The service also excluded patients where physical or anatomical factors, previous complex surgery, or anticipated difficult airway could not be safely managed within the setting, or where appropriate equipment and specialist support were not available. These arrangements supported safe decision-making and ensured patients were only treated where their needs could be met. Patients completed a pre-assessment questionnaire remotely via a secure system before surgery. This included medical history, contact details, specific needs, equipment requirements and risks related to returning home.

Patients attended face-to-face pre-assessment clinics where staff discussed the proposed treatment, expected outcomes, risks and alternatives, and completed the necessary investigations, including blood tests and ECGs.

Anaesthetists and consultants assessed patients before surgery to confirm their suitability for treatment and identify any clinical or social risks at an early stage. Consultants ensured patients were fully informed about the benefits, risks and alternative treatment options before obtaining consent, supporting informed decision-making. Consent was reviewed again on the day of surgery to confirm that it remained valid and that patients continued to understand and agree to the planned procedure.

Communication is adapted to meet individual needs, with interpreting and translation services available to ensure information about risks is accessible and understood. This enables patients to be actively involved in decisions about managing risks and choosing the least restrictive and most appropriate options for their care.

The provider tailored care pathways to individual needs, with specific pathways for procedures such as knee replacement and short-stay surgery. This supported personalised risk management and planning. Where patients lacked capacity, staff completed best interest assessments and involved appropriate advocates to ensure decisions reflected the person’s wishes and best interests.

The service sought feedback from patients using accessible methods, including QR codes in patient rooms and discharge packs, supporting engagement and service improvement.

Staff maintained a consistent focus on safety. They used safety huddles to clarify roles and responsibilities and used recognised tools to monitor patients for deterioration, with clear escalation and transfer arrangements in place. Staff checked and maintained emergency equipment daily.

Staff used the World Health Organization (WHO) Surgical Safety Checklist, and audits showed high levels of compliance. However, we observed staff complete the ‘sign in’ stage of the WHO checklist on the ward by themselves, rather than in the anaesthetic room with the full team present, which is not in line with best practice. This reduces the effectiveness of final safety checks before anaesthesia. We raised this with service leaders during the inspection. The service responded immediately and we saw evidence they briefed all theatre staff, pausing surgical lists until checks were confirmed, assigning a senior clinician to oversee compliance, and introducing spot checks across operating sessions to provide assurance.

We scored the service as 2. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service had an in-house decontamination facility for the sterilisation of instruments and implemented a ‘validation, testing and equipment management’ policy to support safe practice and meet national standards. However, we saw an instrument set that contained an item not listed in the set contents. The in-house decontamination service had included a single-use item within a reusable instrument set, which staff identified at the start of surgery. This is unsafe as it can cause confusion, affect the accuracy of instrument counts, and shows a failure in the decontamination and checking process. This was escalated during the inspection, and the service provided assurance they were taking action to prevent a reoccurrence.

We observed staff did not always complete surgical counts correctly before use. Surgical counts are an important safety check to make sure all instruments, swabs and sharps are accounted for before, during and after a procedure. If staff do not complete counts accurately, there is a risk that items could be left inside a patient, which can cause serious harm. We raised these concerns with the provider at the time of inspection. The provider responded promptly, carried out a review of the incident and implemented a corrective action plan.

The environment was clean, well-maintained, clutter-free and followed infection prevention and control protocols. There was a dedicated cleaning team who carried out routine cleaning.

We saw the service maintained equipment appropriately through routine equipment checks and manufacturer servicing. Records included an inventory of medical devices, servicing schedules, maintenance certificates and audit outcomes, all demonstrating consistently high completion rates.

The service maintained clear fire safety signage and accessible fire exits. Staff ensured fire extinguishers were in place and completed fire risk assessments quarterly.

The service secured the premises and controlled access to protect patients, staff and visitors.

The service followed the Control of Substances Hazardous to Health (COSHH) regulations by managing hazardous substances safely. These were stored securely and restricted access to trained staff, reducing the risk of accidental exposure, misuse or injury.

We scored the service as 3. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service planned and managed staffing effectively using rostered templates. Data showed a 1% vacancy rate over the year, with 2% sickness and 2% staff turnover. The provider did not use agency staff and relied on its established substantive workforce for covering vacant shifts, which helped maintain continuity and consistency of care.

The service had clear policies outlining staff cover arrangements and escalation processes, including procedures for managing short-notice sickness and unfilled vacancies. Staffing records showed no variance between approved and actual staffing levels, demonstrating that planned staffing was consistently maintained. The service provided adequate 24-hour medical cover through an onsite resident medical doctor, as well as specialist consultant advisors providing clinical oversight and escalation pathways. Staff also had access to a senior leadership on-call service 24 hours a day, seven days a week, enabling them to seek timely guidance and support when managing issues or concerns.

The service carried out pre-employment checks to ensure staff were suitably recruited and had the required skills and experience, in line with legislation. The provider used an external recruitment platform for recruitment. The service used a more informal interview approach, described as a conversation, and sometimes included a supervised work trial lasting from one to several hours or up to a full day.

The service used online systems to maintain staff records. This system provided a clear overview of individual staff information, including Disclosure and Barring Service (DBS) checks, professional registration and right to work documentation. The service completed DBS checks and reviewed them every three years. An external occupational health provider managed pre-employment screening and immunisation records.

Managers carried out annual appraisals for staff. We saw 10 copies of staff appraisals, which were comprehensive and included objectives and personal development goals.

Staff were up to date with mandatory training, with 95% compliance among clinical staff. Mandatory training included safeguarding, immediate life support and information governance. The provider also included learning disability and autism awareness training within the mandatory programme to improve staff understanding and and strengthen the quality and safety of care for people with these needs.

We scored the service as 3. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Clinical areas and equipment look visibly clean and well maintained. There was an in date infection prevention and control policy in place, which set out safe practice, guidance and clear reporting arrangements for managing infection risks and outbreaks. The service maintained an audit schedule in line with National Institute for Health and Care Excellence (NICE) guidance and monitored effectiveness through audit compliance rates, which achieved 100%. Audits included hand hygiene, personal protective equipment (PPE), aseptic technique, antibiotic prophylaxis and environmental cleanliness. Staff used audit findings to develop action plans, re-audited to confirm improvement, and shared learning through lessons learned sessions and the company intranet.

The surgical site infection (SSI) audit had a benchmark of 2%. The overall SSI rate at the location was 1.3%, which was below the benchmark and indicated effective infection prevention and control practices.

Staff showed us up to date cleaning records, demonstrating that clinical areas received regular cleaning. The service used green 'I am clean' stickers to show that equipment had been cleaned and was ready to use.

This reduced clarity about whether equipment had been cleaned and was ready for use and increased the risk of cross-contamination and infection.

The service monitored hand hygiene through regular audits and spot checks, which showed 100% compliance. Staff followed appropriate hand hygiene practices and used alcohol gel correctly. Staff also demonstrated correct donning and doffing of personal protective equipment.

The provider employed five dedicated cleaning staff who carried out daily cleaning across the unit to maintain a safe and hygienic environment.

We scored the service as 3. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The service had a medicines management policy and a controlled drugs (CD) policy, which provided clear guidance on the safe handling, storage, administration and governance of medicines, including controlled drugs. Both policies supported safe practice and aligned with national guidance.

Staff kept clear and accurate medicines records in line with national guidance. The service ensured medicines were stored securely and monitored in accordance with policy.

Recent audits showed 100% compliance with medicines safety standards, including appropriate storage and governance processes. The service reported no medication errors in the previous six months.