Frimley Park Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection we rated this key question Outstanding. At this inspection the rating remained Outstanding.

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

We assessed six quality statements on leadership and governance. Leaders understood and embodied the culture and values of the workforce and the organisation. They had the skills and knowledge, experience and credibility to lead well. They demonstrated their integrity and honesty which was recognised by their staff. There was a clear system of governance and risk management based around delivering safe and good quality care and treatment. The service worked with stakeholders and partners to drive improvements to care pathways. The leaders encouraged an open and honest culture where people felt that they could raise concerns. Leaders also supported innovation both internally and with system partners. This improved the patient experience and access to services.

This service scored 100 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. Staff had contributed to the development of the services which was kept under review. They had also contributed to the vision and strategy in 2023. Directorate objectives were drawn up in line with the trust's objectives. Further consultation with staff was on going at the time of our inspection in relation to the Trusts draft strategy Frimley Health 2030. The service was aware of the projected increase in the local population and the pockets of deprivation. The trust was working with the Integrated Care System (ICS) and other partners to develop a strategy to manage these demands. The trust had access to several community hospitals which allowed them to increase the flow through the hospital. Services in the community had been developed to support people in their own homes. For example, working with some GP's to provide cardiology clinics closer to home.

Staff and leaders demonstrated a positive and compassionate culture with a focus on learning and improvement. The trust values of \"Committed to Excellence, Working Together and Facing the Future\" were displayed around the trust and in medical wards. Staff were living these values. We heard staff describe the staff body as "working together as a team to ensure patients get high quality care." We saw numerous examples of this whilst on site. These included a site manager collecting a confused patient from a non-patient area and safely taking them back to the ward which they had left. We observed volunteers assisting people in whatever they required whether it was directions, transport or something else and volunteers from the chaplaincy service listening to a patient in need.

There was a shared culture of learning and improving to enhance the patient experience. This culture ran from the top to the bottom of the organisation. The senior leaders were passionate about getting services right for patients and gave us several examples of changes to services including the cardiology community model to improve service for people with a heart problem. Staff were able to give us many examples of where services had changed to improve the patient experience, ward areas talked about the way in which they prevent falls, and the effort made to end pyjama paralysis (when patients lose their independence in hospital). We saw patients dressed rather than in pyjamas on many wards. The support teams including clinical teams, volunteers, porters and housekeepers all felt that they had a part to play in enhancing the experience of patients and those close to them. There were many volunteers in the corridors of the hospital waiting to assist patients and those close to them to departments or provide support. All staff welcomed visitors to the hospital in a friendly and helpful manner. The patients we spoke to commented on the positive manner of the staff they had encountered.

The trust had introduced a new Care Quality Programme to support a trust-wide focus on ensuring continuous improvement is at the core of everything they do, now and in the future, so that they can constantly enhance services. This was being complemented by a ward and departmental Clinical Accreditation Programme. This focused on leadership, safety and quality. The audit and clinical effectiveness governance structure supported the clinical teams to identify and address areas of challenge and risk. An improvement plan had introduced a ward recognition scheme to encourage service improvement. Achievements were displayed on designated display boards in medical wards. These provided information about improvements ward staff had identified to improve care and that the service had delivered.

Staff felt supported by all levels of their leadership team. Staff spoke positively about the immediate managers and matrons and the way they supported them. Matrons and senior leaders spoke with emotion about how proud they were of their teams, their dedication and compassion to deliver good care. Staff knew who the executive leaders were and told us they sometimes visited the ward.

The leaders were available when they were needed and led by example. They were knowledgeable about the issues and priorities in the medical service. The were keen to harness the improvement suggestions made by staff. They understood the challenges within the ICS and sought to address these through improvements to services. They focused on staff wellbeing and ensured a culture promoting good practice, good quality, and safe care and treatment.

Staff told us leaders in the service was approachable and responded to any concerns raised. Staff also told us leaders modelled the values of the practice. We saw leaders approached difficult situations with calm and a supportive manner. The site team whilst knowing that they needed to identify beds for patients waiting in other departments approach ward teams with a genuine offer of help to assist timely discharge of patients. Ward staff spoke of the site team as being helpful and understanding of issues and it was clear that flow was a collaboration of all staff.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. They often supported staff in the giving of clinical care so understood the challenges their team faced. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities. All staff had opportunities to develop, including for future leadership roles. There was inclusive recruitment and succession planning for the future. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust. The service was aware of the challenges they faced in recruitment and the areas which required further support.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. Staff at all levels of the organisation were available to support people who had a concern. Call 4 concern was available to staff, patients and those close to them to raise concerns and we saw that these were listened to and addressed by the team. Staff utilised Call 4 Concern or their line managers to raise any concerns. They felt very comfortable to raise concerns and knew that they would be dealt with appropriately.

The service had established Freedom to Speak up arrangements. Information about the guardian and how to contact them was available on the both the internet and the intranet. Telephone numbers and email addresses were included in the information along with a national helpline for whistleblowing. Staff were aware of how to raise concerns, and we saw examples where staff had used the arrangements in place to positive effect.

The number of contacts to the Freedom to speak up service was increasing as was the complexity of issues raised. The Freedom to speak up team raised several challenges due to the pressures on the hospital. This included a reduced champion and ambassador network and the reduction in their duties, lack of infrastructure and investment. The trust had recently invested in further posts to support the development of the service. Anonymous concerns are at 12% which is slightly higher than the national average.

Staff undertook effective governance and managed risk. We reviewed minutes from the governance meeting. There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate. Information held about patients was mostly secure and protected. Staff were part of the emergency preparedness network, and they had the strategies and guidance to respond to major incidents. Senior leaders met with ward leaders to discuss the issues in their areas in a supportive way to drive improvements.

There were monthly meetings of the medicine directorate board where issues and performance from both general and specialist medicine. We reviewed the action log and papers and found that these addressed salient points of good governance. We also reviewed audit reports across a number of areas including the fundamental and better care programme which demonstrated an improving picture across a range of measures.

There were regular and effective meetings led by a consultant and nurse who were leads for safety, audit, quality and governance. These discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve. Changes had been made when needed to improve the service. Good practice was recognised and celebrated. There was effective workforce planning including for managing major incidents or emergencies.

Staff were clear on who held which lead roles including those related to clinical care. Data systems in place enabled a good oversight of performance as evident in meeting minutes and in our discussions with staff. We saw action was taken to improve performance for example the reduction of falls in a number of areas.

The trust had made a commitment to reduce operational carbon emissions to net zero by 2040, and last year published their Green Plan 2022-2025- ‘Building greener Frimley Health’. Examples of the trust reducing the harm from carbon emissions and environmental degradation include: The launch of an electronic patient record – reducing the need for paper, the use of electric cars for staff needing to travel between sites, the increased use of dry powder inhalers in respiratory medicine, recycling of plastic such as oxygen masks and tubing and inhalers and making the endoscopy service greener buy reducing emissions from the Entonox used .The trust monitors it’s carbon emissions and have achieved reductions in the use of oil, electricity and business travel year on year since 2014. This is a reduction of 24% in carbon emissions.

As a combined acute and community services provider, the trust worked in partnership with the local system. This included a local community trust, the local ambulance trust, GPs and the integrated care board (ICB). They met monthly to discuss system initiatives to ensure processes and schemes were joined up as well as to discuss healthcare safety investigations.

There were positive and collaborative relationships with external partners to build a shared understanding of challenges within the system and the needs of the people. There were multi agency discharge events were held with system partners to identify what worked well and areas for improvement to ensure flow through the hospital. Staff felt that these events were very successful in assisting patients to be discharged and enjoyed working with the whole team readily available.

The trust worked in partnership with carers we saw evidence that the trust had worked with someone who had lived experience to improve the trusts booklet for supporting unpaid carers. They also worked with the ICB to develop an insulin pump pathway for patients with type 1 diabetes.

The service had strong external relationships that supported improvement and innovation. Staff and leaders engaged with external work, including research, and embedded evidence-based practice in the organisation. Examples include working with the ICB to move away from a Holter system of cardiac monitoring to an e-patch which is more cost effective and more comfortable and efficient for the patient. The hospital had also worked with GPs to develop a GP cardiology model in which specially trained GP's undertake reviews cardiology patients with a range of conditions to provide a more efficient service. The hospitals diabetics specialist nursing team have also run DAFNE training to 370 staff in the ICB. DAFNE stands for Dose Adjustment For Normal Eating. It aims to help adults with type 1 diabetes lead as normal a life as possible, whilst also maintaining blood glucose levels within healthy targets, to reduce the risk of long-term diabetes complications.

There was a fully embedded and systematic approach to improvement, which made consistent use of a recognised quality improvement (QI) methodology. The trust used a quality improvement methodology Frimley FX based on Lean methodology. They trained staff and expertise was marked using a series of "belts" like that used in martial arts. Each belt represented a distinct set of skills, responsibilities, and contributions to achieving quality improvement initiatives. Over 2700 staff had undertaken foundation level `White Belt' training so they can identify opportunities for improvement and use plan-do-study-act cycles to test changes and improvements. There were over 600 `yellow belts' who were trained in `Frimley Excellence' with its foundations in A3 thinking to deliver larger scale improvements, and over 60 staff trained to the `Green Belt' level meaning they are working to coach and grow improvement capacity across the organisation to tackle the biggest challenges.

We saw that staff who had undergone the training and managed quality improvement initiatives had different coloured lanyards to represent the belt colours. Improvement methods and skills were available and used across the organisation, and staff were empowered to lead and deliver change, for example, a ventilation project by an advanced physio practitioner which resulted in a 75% reduction in door to mask time, and a reduction in ventilation days for patients. Innovation was celebrated. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care. There was a strong record of sharing work locally and nationally.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. There was a strong sense of trust between leadership and staff. Staff were supported to prioritise time to develop their skills around improvement and innovation.

As part of a Trust wide focus on ensuring continuous improvement the Care Quality Programme was introduced. A clinical accreditation programme was introduced as part of the Care Quality Programme. The Clinical Accreditation Programme is a quality assurance tool of over 200 questions bringing safety and quality together in a specific timeframe. Wards were awarded bronze, silver or gold status. The service developed several innovations as described above in partnerships and communities.