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Inspection Summary


Overall summary & rating

Outstanding

Updated 26 September 2014

Frimley Park Hospital provides acute services to a population of 400,000 people across north-east Hampshire, west Surrey and east Berkshire. It serves a wider population for some specialist care including emergency vascular and heart attacks. In addition to the main site, it runs outpatient and diagnostic services from Aldershot, Farnham, Fleet and Bracknell.

Frimley Park Hospital has around 3,700 whole time equivalent members of staff and hosts a Ministry of Defence Hospital Unit with military medical, surgical and nursing workforce fully integrated into the NHS staff.

We carried out this follow-up inspection in addition to our comprehensive inspection in November 2013, as Frimley Park Hospital was inspected during a pilot period when shadow ratings were not published. In order to publish a rating, we needed to update our evidence and inspect all core services.  Because we had inspected the trust so recently (in November 2013) we did not repeat some parts of our usual inspection process.  This included the unannounced visit (which took place at night) and the public listening event.  At the public listening event in November we heard directly from about 100 people about their experiences of care. 

In addition, due to the proximity of the junior doctor changeover date (the significant majority of the junior doctors changed post a day before the inspection) we did not speak with many of them during this inspection.  However the feedback from those spoken with during the November inspection was overwhelmingly positive, describing a high level of support from their consultants and registrars which they told us had had a resultant impact on their personal confidence levels and medical practice.  They went on to describe why this led to medical staff frequently returning to Frimley Park at a later stage of their training or as consultants.  Specific comments included one doctor stating that the level of support she had received in her day-to-day work was “outstanding”, and another that although the workload was sometimes very heavy, the senior staff “led by example” and were very approachable.  These findings are corroborated by the fact that Frimley Park is rated top for training within the Kent, Surrey and Sussex deanery by foundation trainees.

Overall, this hospital was rated as outstanding. We rated it good for providing safe and effective care and outstanding for being caring, responsive to patients’ needs and being well-led.

We rated A&E, medicine, surgery, critical care and end of life care as outstanding. We rated children and young people’s services, maternity and outpatients as good.

Our key findings were as follows:

Safe:

  • Frimley Park Hospital was one of the first 12 trusts nationally to sign up to the NHS England “Sign up for Safety” Campaign. A safety culture was a priority for staff at all levels and was embedded throughout the trust. Learning from events was encouraged and we were given multiple examples throughout the services of how care had been improved as a result of incident reports and investigations.
  • Wards were well staffed from both a medical and nursing point of view. Where shortfalls had been identified, the senior team were aware and action plans were in place to address this. Where temporary staff were employed there was sufficient training to orientate them to the trust.
  • The hospital was clean and staff were witnessed to follow good hygiene practices. Audits were undertaken routinely by the trust and action was taken if areas or staff groups were not compliant with expected cleanliness standards.

Effective:

  • Staff based care delivered on best practice guidelines. Local outcomes were regularly audited and the trust was able to demonstrate how it had changed practice to improve results for patient’s year on year. The trust also benchmarked itself, and compared well against, national comparators.
  • There was strong multidisciplinary team working throughout the trust. Staff worked alongside each other for the benefit of patients receiving care. There were multiple Clinical Nurse Specialists who supported teams and patients in specific areas, bringing their own expertise and knowledge to develop innovative ways of improving services.
  • The trust was committed to developing seven-day services throughout. Good progress had been made towards this, and plans demonstrated that where this had not been completely rolled out, business cases had been accepted by the board and recruitment was ongoing.

Caring:

  • Treating patients with dignity and respect, as well as valuing them as individuals, was evident throughout the organisation and found to be a fundamental part of the culture at Frimley Park Hospital.
  • Throughout our inspection patients and their relatives told us how caring staff had been towards them, and how staff had ‘gone the extra mile’ to support them during their admission to hospital. We also witnessed exemplary care being given on many wards.
  • Gaining feedback from patients and their relatives was a priority and was used by the trust to improve the care that was delivered. The trust was above the national average in the national Friends and Family test, both in terms of those recommending the hospital to others and in the response rate.

Responsive:

  • We saw multiple examples of how services had changed the way they delivered care – either through feedback or by working with the local community to develop the service.
  • In areas where there were problems with the flow of patients, there was evidence of inter and intra departmental working to try and improve patient pathways. We witnessed many innovative solutions and saw examples where they had learned from other trusts that had experienced similar difficulties.
  • The trust had worked hard to embrace patients who were more vulnerable or had increased needs. There was good support for patients living with dementia or a learning difficulty, and the trust had worked with the local Nepalese community to improve methods of communication.

Well-led:

  • Staff engagement at the trust was impressive. The CEO led from the top with a clear mantra that staff worked ‘for Frimley’ not ‘at Frimley’ and the concept of the ‘Frimley Family’ was felt throughout the inspection. Staff were encouraged to, and rewarded for, improving patient experience and therefore at all levels staff reported feeling empowered to develop their own solutions to enhance their services. There was a strong sense of support and alignment between clinicians and managers, both of whom reported working together to achieve their aim of providing outstanding patient care.
  • There was a clear vision and values that had been developed with staff to ensure that they aligned with a service they wanted to work for. As a result “committed to excellence; working together; facing the future” was embedded throughout the trust and underpinned fundamental behaviours. The potential acquisition of another provider had been well communicated with staff and at all levels there was confidence that the service provided at Frimley Park Hospital would remain at the current high standard.
  • The trust demonstrated a strong patient-centred culture, which considered that public engagement was essential in developing services. The evident strength and depth of leadership at both board and ward level was outstanding, the benefits of which were clearly demonstrated by the consistency of high quality care provided across the domains and throughout the core services and should be congratulated.

In addition to the above, we saw multiple specific areas of good and outstanding practice:

  • The A&E department had been redesigned by taking patients’ views into account, and provided an environment that helped to deliver exceptional patient care (including specific dementia-friendly areas).
  • The four-hour target was consistently met, and the other core services that worked with the A&E department acknowledged that the target was everyone’s responsibility.
  • Joint working between the elderly care physicians and the A&E department led to improved patient experience and reduced unnecessary admissions.
  • ‘Round table’ discussions were used as a learning tool, and there were well-developed Mortality and Morbidity (M&M) meetings, which included dissemination to all levels of staff.
  • There was a drive to increase incident reporting by all staff groups, especially medical staff (i.e. doctors).
  • The management of medical outliers, including the method of communicating with teams, ensured ownership and daily (early) review. 
  • Specialist advice was available for GPs and the A&E department and rapid access clinics reduced unnecessary admissions.
  • Theatre utilisation had improved, and resulted in a cancellation rate of 0.6% between October 2013 and June 2014.
  • There were communal dining areas on the orthopaedic wards.
  • There was a high standard of care provided for patients at the end of their life, and we saw that staff went to great lengths to respect and accommodate the wishes of patients and their families, including the use of the ‘Time Garden’.
  • The trust used and audited the trust wide ‘Personalised Care Plans for the Dying Patient’ in place of the previously used Liverpool Care Pathway.
  • The A&E department used memorial boxes for recently bereaved relatives and contacted them six weeks following the death of a relative.
  • The ophthalmology service had received a ‘Clinical Service of the Year’ award from the Macular Society
  • Joint working with specialist providers allowed patients to attend outpatient clinics closer to their home rather than having to travel to another provider further away.

However, there were some very limited areas of poor practice where the trust needs to make improvements.

The trust should:

  • Review nursing staffing levels and skill mix in paediatrics (services for children).
  • Ensure paediatric staff have the necessary skills to identify and manage the deteriorating child.
  • Review how training data is recorded within paediatrics, to ensure that records are accurate.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 26 September 2014

Effective

Good

Updated 26 September 2014

Caring

Outstanding

Updated 26 September 2014

Responsive

Outstanding

Updated 26 September 2014

Well-led

Outstanding

Updated 26 September 2014

Checks on specific services

Maternity and gynaecology

Good

Updated 26 September 2014

Overall we rated maternity services as good.  The maternity department provided safe and effective care in accordance with recommended practices. Outcomes for women using the service were continuously monitored and where improvements were required action was taken. Staff were confident in reporting incidents, knowing these would be reviewed and lessons learned would be shared.

There were occasions where bed flow and capacity interrupted the provision of services to women. This meant that on occasion women were required to have their planned induction of labour postponed.

Resources, including equipment and staffing personnel, were sufficient to meet the needs of women although the midwife-to-women in labour ratio was lower than the recommended levels. Staff received the necessary training and assessments of their competencies so they could respond to women’s treatment and care needs. Midwives had supervision of their practice and staff had opportunities to get feedback on their performance as well as developmental opportunities.

The individual needs of women were taken into account in planning the level of support throughout their pregnancy. Feedback from women and their families was positive about the service they received, the level of care and compassion and respect for their dignity and privacy.

Staff said that there were clear lines of accountability within the maternity department and the good leadership was a positive aspect of the working environment and culture. Staff were clear about their roles and responsibilities and had a commitment to working in a manner that reflected the values and ethos of the trust.

Medical care (including older people’s care)

Outstanding

Updated 26 September 2014

Overall we rated medical care as outstanding.  Medical care provided at Frimley Park Hospital was rated as good for safety, as patients were protected from avoidable harm and abuse. Incidents were reported, learned from and in general fed back to staff. The trust was aware of areas in which it needed to improve (such as falls) and there were established work streams to improve harm free care. The department was clean and there was an active infection control and prevention team who audited practices regularly. The trust used its own early warning score (known as the Medical Emergency Team (MET) score) which again was well audited, and, as well as a Critical Care Outreach Team (CCOT), staff could call the Medical Emergency Team if they had concerns regarding a patient’s condition. With the exception of one ward, all wards were well staffed and frontline staff told us they felt confident that they could increase their numbers if their acuity or dependency changed and that this would be supported by their senior managers. There was increasing consultant presence on site from 8am to 12 midnight seven days a week and the number of junior doctors on the wards out of hours had been increased in response to the increased number of medical patients within the hospital.

Medical care services at Frimley Park were rated as good in terms of delivering effective care. There was evidence of easily accessible guidelines on the trust intranet and specific audit checklists had been developed for two conditions which have been raised nationally as a potential area in which care needs to improve. The Summary Hospital-level Mortality Indicator (SHMI) for the trust remains within expected levels and its readmission rate is better than the national average. National audits were contributed to as expected, and we were given evidence of changes made by specialities in response to their outcomes. We witnessed strong and respectful multidisciplinary team working during our inspection and this was corroborated by feedback from all disciplines spoken with. Enhancing seven-day services was demonstrated to be a priority for the medical directorate and, although this was not yet fully in place at present there was a clear and achievable business case in progress.

We rated the medical care services outstanding for caring. This was because a caring culture was felt to be fully embedded throughout the medical directorate and throughout our inspection we witnessed exemplary patient centred care being given. Wards felt calm despite some being very busy and the nursing staff were seen to be relaxed and cheerful whilst undertaking their work, taking the time to consider individual patient’s needs.  We heard very few buzzers sounding throughout our visit, and those we did were answered very quickly. Interactions between staff and patients appeared natural and easy-going - communication was respectful but friendly. All relatives we spoke with praised the staff and the standard of care that their relative had received.  

Medical care provided at Frimley Park Hospital was responsive to patients’ needs. In common with all acute trusts, Frimley Park Hospital struggled with the management of flow through the hospital due to the significant rise in emergency attendances and subsequent admissions. Consistent with the national picture, this was largely felt in the medical division. Significant work had been undertaken to reduce the number of unnecessary admissions in terms of developing robust ambulatory pathways and providing geriatrician input to the Emergency Department (ED). Achievement of the four-hour target was seen as much as the responsibility of the medical teams as the ED and joint admission proformas had been developed to allow flex in the admission pathway when either team was particularly stretched. Equally extensive work had been undertaken to improve discharge planning from both a medical and allied health professional standpoint seven days a week. There were still ongoing issues with the number of patient moves (and those occurring out of hours), and patient outliers; both of these were escalated to the chief nurse on a weekly basis. Following a previous inspection by CQC, there was increased visibility of the work being undertaken to improve the experience of patients admitted who were living with dementia.

We rated medical care services outstanding in terms of being well-led. There was a clear vision and strategy for the service, which, despite the potential for uncertainty regarding the acquisition, was well developed and well understood throughout the department. The behaviours and actions of staff working in the division mirrored the trust values of ‘Committed to Excellence, Working Together, Facing the Future’ of which we saw multiple examples of during our inspection. There was evident ownership of services and patient-centred care was clearly a priority. Risks (and potential risks) were identified early and discussed openly and there was a governance structure in place that allowed formal escalation where appropriate. The trust (and therefore directorate) welcomed views and input from staff and the local community allowing for a real sense of engagement and therefore empowerment from those involved in the services to improve the quality of care being provided.

Urgent and emergency services (A&E)

Outstanding

Updated 26 September 2014

Overall, we rated the Emergency Department (ED) as outstanding. The culture of the team working within the department was one of cohesiveness, with staff displaying a very high level of professionalism and enthusiasm for the work they did.

Our discussions with staff, and a review of over 150 individual pieces of evidence, revealed that there was an open and transparent culture within the department with regard to the management of risk. Staff were prepared to report incidents and accidents; incidents were investigated impartially, with a high emphasis placed on quality and service improvement.

Although patients were waiting marginally longer to be seen by a clinical decision maker when compared to College of Emergency Medicine standards, the ED at Frimley Park Hospital was one of only a small number of hospitals to consistently achieve the government’s 95% target for admitting, transferring or discharging patients within four hours of their arrival in the ED during each quarter for the previous two years. Furthermore, staff spoke positively about having the opportunity to recommend new ways of working to help improve the overall effectiveness of the department. Staff had recognised that the current process of streaming was not perhaps as effective as it could be. We found evidence that suggestions had been made by junior members of the team which would further reduce the time it took for patients to be assessed and to be seen by a clinical decision maker.

The clinical effectiveness of the emergency department varied depending on the presenting complaint of patients. Where the service was seen to be performing in low to median quartiles when compared nationally, the department was working to improve its overall performance. We reviewed evidence which demonstrated that the department had improved its management of neutropenic septic patients during 2014. However, where improvements had been made in specific areas such as pain management, we noted that these improvements had not always been sustained; this had already been acknowledged by the trust and action plans were in place to resolve these issues.

Feedback from patients and their relatives regarding the care they received while using the service was consistently positive. Where people had cause to complain, the senior management team had processes in place for meeting with complainants to address their concerns and to offer resolutions, as well as ensuring improvements were made to the overall service. Staff were observed to engage with patients in a compassionate and caring manner.

There were distinct subtleties with regards to the way staff considered their patients. For example, despite the fact that the majority of patients using the ED were only present in the department for no more than four hours, staff were seen to provide holistic care to people; people were referred to by name and not by condition or cubicle number. Examples of comments made by patients included “It is not possible to put a value on what was done for me in A&E”, “They [nurses and doctors] listened and were 100% professional yet still personal and friendly” and “Your complete emergency department were not only extremely efficient but caring, empathetic, reassuring and speedy. The care I received was exemplary… Every single person that we came across in this hospital has given us outstanding customer care. They are all an enormous credit to you [Chief Executive] and to the NHS”.

Careful consideration had been given to the design and layout of the ED during a refurbishment in 2012. Senior members of the ED team reviewed a range of existing EDs and incorporated innovative designs and ideas as part of their refurbishment plan. Staff visited internationally renowned trauma EDs in an attempt to learn and introduce new ways of working, with the ultimate goal of improving the overall quality of care patients could expect to receive when they visited the ED at Frimley Park Hospital.

Consideration had been given to the ageing population to which Frimley Park Hospital serves. Examples included the design of two majors cubicles so that they were “dementia friendly”. A bariatric cubicle was included in the re-design on the ED to meet the anticipated and evolving obesity epidemic. Patients presenting with gynaecology complaints could be cared for and receive treatment in a cubicle that was suitably designed so as to protect people’s privacy and dignity.

Surgery

Outstanding

Updated 26 September 2014

Overall we rated surgical services outstanding.  Patients who required surgical interventions were managed safely and effectively in accordance with recommended professional guidance. Procedures were in place to continuously monitor patient safety. There were sufficient numbers of skilled and knowledgeable staff to safely meet the needs of patients. Knowledge of the learning from training was demonstrated through the staffs’ attention to safe practices and adherence to hospital policies. The environment was suitably clean and the equipment needed to deliver care was readily available. Arrangements were in place to access prescribed medicines, including pain relief, and medicines were managed safely.

Patients’ needs had been assessed and reviewed. Records were completed for each stage of care and treatment given, and the consent was sought from patients or their advocate. Arrangements were in place for emergency care. Staff had access to consultant-led care for advice and guidance and there was access to diagnostic services and operating theatres outside of normal working hours. Surgeons, anaesthetists and clinical staff followed professional guidance, local policies and procedures. The multi-disciplinary team shared responsibility for delivering people’s treatment across all seven days. Surgical outcomes were monitored and information was communicated through the governance arrangements to the trust board.

Patients described their experiences positively, such as, “I have had excellent care on every ward. I have been told all about my progress” and “staff asked what I wanted to be called and offered help and support, and they can’t do enough”. Patients told us that staff respected their privacy and dignity. The majority of staff were observed to be kind, caring and attentive to people’s needs. We did hear confidential information being discussed as part of the nurse handover between shifts, which some patients may not have liked.

Patients told us they had been given information by doctors and nurses. Information was accessible in a range of formats. The nutritional needs of patients were being assessed and people’s religious, cultural and medical dietary needs were met. Although there were some bed capacity issues at times which resulted in surgical patients not being placed on the most appropriate wards, there were arrangements in place to ensure that the right surgical expertise led on their care, and clinical decisions were made responsibly. People who had particular physical or mental health needs were supported by staff who had been trained in these areas, including care needs associated with dementia. Although very few complaints had arisen directly from people’s experiences of using the surgical services, there were arrangements in place to respond to complaints in accordance with a local policy.

The surgical services were led by a highly committed, enthusiastic team of staff, each of whom shared a passion and responsibility for delivering a first class service. Staff described leadership as “excellent” and “visible”. Staff understood the ethos of the service and the corporate values, and demonstrated a commitment to delivering a quality service to the patients. Governance arrangements enabled the effective identification of risks, monitoring of such risks and the review of progress on action plans. Regular detailed reporting enabled senior managers and representatives of the trust’s board to be aware of performance and where improvements had positively impacted on service delivery. The views of the public and stakeholders had been actively sought. The surgical division was engaged in a number of research trials and had contributed to the body of knowledge in surgical specialties. Trainee doctors considered the trust to be an excellent place to gain experience in surgery and reported effective supportive networks.  

Intensive/critical care

Outstanding

Updated 26 September 2014

Overall we rated critical care services outstanding. Patients we spoke with told us of the “good reputation” the service had in the locality and also that they felt “very safe” when using its facilities.

Patients had access to a bereavement service and annual memorial service to remember their loved ones. The unit had implemented the use of patient diaries and a psychology service was provided. Relatives of patients who remained on the unit for more than one week had a meeting with the matron of their service to ensure any concerns they had would be addressed.

The unit delivered a consultant-led service with two consultants providing medical cover. One consultant was solely dedicated to being on the unit from 8am until 10pm daily. Another consultant provided support to the critical care outreach team and covered the unit on an on-call basis from 10pm until 8am. There were resident facilities provided for consultants who lived more than the recommended 30 minutes away from the hospital. There was nine hours of on-site consultant cover provided at weekends. The unit did not use locum doctors to cover unexpected vacancies. Medical oversight of the MADU was primarily by respiratory consultants with support from their intensive care colleagues when required.

Use of agency nursing staff was below the acceptable minimum rate set by the trust, and all agency staff were subject to a strict recruitment and induction process which mirrored the trust’s own recruitment policy. The unit had also rolled out an advanced Critical Care Practitioner training programme, one of very few nationally and the first regionally.

All aspects of care delivered in the unit were audited and reviewed to enable continuous improvements. The unit had implemented extra quality and safety measures to ensure it was delivering a high quality service in line with national guidance. The unit could demonstrate that it was achieving low mortality rates and good patient outcomes when compared to other units of a similar size. We found an open and transparent approach to incident management and a real focus on learning from these events through root cause analysis and peer review processes. There were continuous data submissions to national audits and participation in research programmes on the unit.

The unit was innovative. For example, it had implemented cardio pulmonary exercising testing and Intra-aortic balloon pumps. It regularly contributed to the CCN (Critical Care Network), RCN (Royal College of Nursing) and BACCU (British Association of Critical Care Units).

We found there was a real commitment to delivering multidisciplinary care and the nursing staff worked flexibly to ensure that a quality service could be delivered safely during busy times. Staff felt valued and supported by their teams and by senior management. They told us they received appropriate training to enable them to meet people’s individual care needs. Staff discussed the continuous learning culture on the unit and how they felt supported to engage in continuous personal development.

Staffing levels were continuously reviewed using the unit’s staffing acuity tool and we found the staffing levels to be adequate to deliver the service.

The environment was cleaned to a high standard and the trust’s infection control policy was being complied with. The unit demonstrated safe medication management and we saw adequate supplies of equipment to meet patients’ care needs.

Services for children & young people

Good

Updated 26 September 2014

Overall we rated the services for children and young people as good.  We found children’s services to be generally safe. However, we had concerns about nursing staffing levels and skill mix. For example, it had been identified as part of the annual clinical governance review that during periods of limited staffing, there had been an increase in medication incidents.

There were procedures in place to manage the deteriorating patient although the trust had identified that additional work was required to ensure that staff had the necessary skills to both identify and manage the deteriorating child.

Children’s services followed national evidence-based care and treatment and carried out local audit activity to ensure compliance.

Children and those close to them, such as their parents or carers, were involved in the planning of care and treatment and were able to make individual choices on the care they wished to receive. Leadership within the service was strong with a mostly cohesive culture. There was evidence of public and staff engagement as well as innovation within the service.

Services for children and young people followed the trust’s incident reporting system and demonstrated that learning from incidents that took place there. Perinatal and clinical governance meetings were held and staff were able to demonstrate that learning from these meetings was taking place.

The children and young people’s service was provided in a clean environment. Emergency equipment was checked in line with trust policy and was readily accessible and available.

End of life care

Outstanding

Updated 26 September 2014

Overall we rated end of life care as outstanding.  We found that Frimley Park Hospital was providing an exemplary quality of care to people approaching the end of their life. The few areas where there was potential for improvement had been identified and we saw evidence that work was in progress to make the service even better.

The trust’s End of Life Care (EOLC) Steering Group, which was responsible for the overall monitoring of the provision of EOLC, was established in 2008. It had developed policies and procedures to support end of life care and had a diverse multi-disciplinary membership from both the trust and local community. The EOLC Steering Group was chaired by the Clinical Director for Surgical Services, which meant that the trust strategy for end of life care was disseminated well across all services and we found that there was good ‘buy in’ to the end of life policies from staff working outside the SPCT.

The hospital’s palliative care team saw approximately 1,028 patients in 2013/14. Of these, 51% were non- cancer patients, which showed a good balance between cancer and non-cancer patients being provided with the specialist services of the palliative care team. We were told that 45% of patients who died at the trust were referred to the specialist palliative care team, which compares well with the national average of fewer than 40%. Where people received specialist palliative care input, less than a quarter (23.9%) died in hospital compared to national data for all deaths that showed 51.5% of people died in hospital nationally. This means that the good access to the expertise of the SPCT, coupled with a robust discharge policy, allowed more people to die where they wanted and reduced both the length and frequency of admissions for end of life care.  The first national VOICES survey of the bereaved (2012) found that 71% of people wanted to die at home and the trust’s staff talked with enthusiasm about their proactive stance in getting people home to die if at all possible. This was supported by a strong rapid discharge policy that was sufficiently resourced to make it workable. A strong culture of enabling rapid discharge supports people and their families in their desire to die in their home surrounded by the people they love and within a familiar environment that they retain more control over. We were told that the shortest recorded discharge was just 45 minutes but that this was not the norm; a one-day target for making the necessary arrangements for a safe discharge was more usual.

The trust had implemented the AMBER care bundle system, which provided a systematic approach to manage the care of hospital patients who were facing an uncertain recovery and who are were at risk of dying in the next one to two months.

A review of the data showed that the trust had robust policies and monitoring systems in place to ensure that it delivered good end of life care. However, it was the direct observation and conversations with staff, relatives and patients that made us judge the care outstanding. Individual stories and observed interaction provided assurance that staff of all grades and disciplines were very committed to the proactive end of life care agenda set by the board. One healthcare support worker said, “Is it odd that I enjoy caring for people at the end? I don’t mean I want them to die, because I have usually got to know them and care about them and their families, but I am really proud of the good care we give and how comfortable we make people. It is nice knowing you couldn’t possibly do any more for them.”

A porter told us that all his team treated the people who had recently passed away on the wards as if they were “our own nan or mum. We make sure we look after their dignity and that they are comfortable. Most of us talk to them about where they are going and explain what the mortuary will be like and that their fridge will be cold. It makes our job better if we do it properly and kindly”.

We spoke with many people who were approaching the end of their life and some of their relatives. All were extremely positive about the care and support they received at Frimley Park Hospital. People told us their symptoms were very well managed and that nothing was too much trouble for staff. We observed kind and gentle interactions between staff and patients and could see that the people we visited in their rooms were clean, comfortable and hydrated. We sat with one elderly person who was being cared for in bed, in a single room, as they were expected to die shortly. This person slid their hand out of the covers to hold our hand and said they weren’t really frightened as everyone was so kind to them. They said their grandchildren had visited and bought them lovely presents that were displayed around the room. Then they showed us the bright nail polish that they said one of the night nurses had used when they gave them a manicure. They said, “I used to like dancing and parties and my nails make me smile and remember those days”.

We asked numerous staff about the care and support they received when people died. Many acknowledged that it could be emotionally difficult when caring for people in their last days and hours, but all said they had excellent support and told us who they could turn to at these times. Staff mentioned their teams supporting each other, approachable and supportive ward colleagues, input from clinical nurse specialists and senior managers and the chaplaincy team. One junior nurse told us about a recent traumatic death where she had been upset after caring for the patient. They said, “One of the consultants took me to the quiet room and sat with me for ages explaining why the person suffered the symptoms they did and that they would not have been aware of the symptoms. He spent ages answering all my questions and making sure I was OK”. Good staff support is essential to enable the staff to provide effective end of life care. Well cared-for staff meant that they felt strong enough to provide good care in difficult circumstances and we found that the good staff support available enabled them to provide effective end of life care.

Staff across the hospital were justifiably proud of the quality of end of life care they provided; all the staff smiled easily as they went about their work. They talked about, “Loving their work” and “Really enjoying caring for elderly people”. Senior managers were effusive in their praise of the whole staff group and this had enabled ownership of care quality by the whole hospital staff team.

Outpatients

Good

Updated 26 September 2014

Overall we rated outpatients as good.  Patients attending for outpatient appointments at Frimley Park Hospital and other clinic sites provided by the trust received good care. The premises were, with the exception of the fracture clinic, appropriate for the service they were providing. Where issues around capacity had been identified, the trust had responded to reduce the impact on patients.

We did identify some minor shortcomings in care practice by individual staff members, but this was not widespread.

Staff were kind, attentive and spent time ensuring patients understood what their appointment involved and what their treatment plan was. Where necessary, people were assisted to make follow-up appointments and to access the hospital transport.

The trust generally compared favourably with other trusts nationally in meeting waiting time and treatment targets, and in ophthalmology was a market leader, having been presented with an award as Clinical Service of the Year by the Macular Society. There was scope for a more consistent and sustained level of achievement in meeting targets and delivering an above average service.

Leadership at all levels was visible and engaged with operational staff. Staff reported feeling supported and encouraged to innovate. There was some uncertainty in response to our questions by the nurse in charge of the main outpatients department, but we accepted they had been thrust into the position by the death of a senior colleague a very short while before the inspection. The impact of the loss of a close colleague was clearly felt throughout the department but this did not impact significantly on the delivery of patient care.

The Head of Nursing for the outpatients department said, “We put patients first. We work as a team. The patient pathway through the outpatients department links with so many departments and we communicate well with them. We always look ahead and we always deliver a level of care we would expect our families to receive”.  Our observations found this to be true.