Fairfield General 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant most patient’s clinical outcomes were consistently good, and patient’s feedback confirmed this.

The service worked well across teams and services to support patients. Staff assessed patient’s needs, advised them on how to lead healthier lives and supported them to make decisions about their care. Staff followed national guidance to gain consent. Most patients experienced positive outcomes following their care and treatment. However, mixed patient outcomes had been reported in some clinical audit indicators.

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 evidence showed a good standard. The service made sure people’s care and treatment were effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Admission policies were in place to provide guidance for staff around the assessments required on admission to the urgent and emergency care services.

Patients attending the emergency department underwent a triage assessment using a recognised tool. Staff carried out an initial assessment using a standardised NHSE acuity tool to assess severity and patient needs for adults and children based on an acuity scale of 1 to 5. An acuity score of 1 meant the patient had an urgent and life threatening condition that required immediate admission to the resuscitation bays, whereas an acuity score of 5 meant the patient did not require immediate treatment and could receive more appropriate care in another healthcare facility (such as primary medical or dental services). Patients were placed on care pathways and streamed to the relevant service based on their acuity.

Staff completed risk assessments for patients following admission to the urgent and emergency services and care plans were put in place where risks were identified. Staff carried out routine observations to monitor patients at regular intervals during their stay. Patients also underwent a medical or advanced care practitioner review and assessment following admission to the emergency department.

Most patients told us they had received timely triage assessments on arrival to the service. They told us staff identified key risks and took into account their needs and preferences. Most care records we looked at were complete and up to date and showed patient’s needs had been assessed and care plans had been put in place to provide appropriate care and treatment.

The department had a clear pathway for patients with mental health needs. Where patients attending the emergency department were identified as having mental health needs, the nursing staff completed an initial assessment of risk as part of the triage process, although this was limited in detail in the examples we reviewed. It included a list of potential risks to self, others and of absconding and a free text box to detail social history. The patient would be referred to the mental health liaison team who would do an initial contact within one hour of referral.

Staff we spoke to understood how and when to refer a patient to the psychiatric liaison team for further assessment. Staff told us the psychiatric liaison team responded to most emergency referrals within 1 hour. They reviewed all patients in the emergency department at least twice daily.

Clinical nurse specialists and paediatric liaison nurses were in place to assess children and young people attending the department. Doctors could access support from an on-call Child and Adolescent mental health service (CAMHS) consultant.

Staff followed guidelines for children and young people presenting in acute mental health crisis requiring care and treatment to support their mental health and emotional well-being. These guidelines provided a clear overview for staff to guide them in supporting children and young people.

Members of the psychiatric liaison team completed full bio-psychosocial assessments. We saw evidence of this in the patient records we reviewed. We also observed a home treatment team doctor come into the ED to assess a patient with mental health needs known to their team who had been brought in on a section 136 overnight. Section 136 of the Mental Health Act allows police to detain a person in a public place who appears to have a mental disorder and take them to a place of safety (such as a hospital) to enable emergency care and assessment of their mental health needs. The home treatment teams provide intensive, community-based mental health care as an alternative to hospital admission.

Patients with specific nutrition and hydration needs were assessed and fluid balance and food charts were in place for patients identified as at risk. Pain relief was managed on an individual basis and staff used pain assessment charts to monitor pain symptoms at regular intervals. Most patients told us staff gave them pain relief medicines when needed and their pain symptoms had been managed appropriately.

We scored the service as 3. The evidence showed a good standard. The service had systems and processes that were in line with legislation and current evidence-based good practice and standards.

Staff followed clinical guidelines and pathways that were based on national guidance, such as from The National Institute for Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) clinical guidelines.

Staff in the emergency department used a range of care pathways, in line with national guidance, such as for treatment of children, gynae pregnancy and gynaecological conditions, thoracic and lumbar fractures, diabetes, asthma, diabetic ketoacidosis, pneumothorax pathways, limb and head injuries and cardiac and stroke pathways. We reviewed a selection of care pathways and found they were up to date and reflected national guidelines.

The service routinely carried out baseline assessments to check compliance against new or updated NICE guidelines. The service reported there were no outstanding overdue NICE baseline assessments to be completed at the time of our inspection. Changes to clinical practice, national guidance and policies were reviewed and developed through routine departmental and divisional governance meetings and shared with staff.

Staff told us policies and procedures reflected current guidelines and were easily accessible in electronic and paper format. We looked at a selection of the policies, procedures and care pathways and these were up to date and based on current national guidelines.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They shared their assessment of needs when people moved between different services.

There was effective daily communication between multidisciplinary teams within the emergency department. Staff handover meetings took place during shift changes to ensure all staff had up-to-date information about risks and concerns. The nursing staff told us they had good relationships with the consultants, doctors and advanced / emergency clinical practitioners.

There were routine multidisciplinary meetings involving staff across the urgent and emergency services. Staff also participated in routine hospital and trust-wide meetings. Staff had daily communication with staff in the SDEC and UTC areas as well as other supporting services across the hospital and trust.

The alcohol and psychiatric liaison service was provided by a local NHS mental health trust. The service was commissioned to provide cover 24 hours a day, 7 days a week. The psychiatric liaison team planned to have 5 specialist nurses on each day shift and also provided support to other local emergency departments. The team provided an all-age service. They had a dedicated office within the ED department at this hospital and could be based there if needed.

Service partners and stakeholders told us there was clear communication and effective information sharing between services. They spoke positively about the way they worked with staff across the urgent and emergency care services. There was good partnership working with the regional ambulance service. The ambulance crews we spoke with were positive about their interactions with staff in the department.

Patients did not highlight any concerns about how their care and treatment was coordinated. They told us staff worked well together as a team.

Services such as diagnostic imaging, pathology and alcohol and mental health liaison were available 7 days per week. Clinical pharmacy services were available during routine hours on weekdays, with some limited cover during weekend days. On-call pharmacy support was available during out of hours service across 7 days.

Physiotherapy and occupational therapy support was available during routine hours during the day on weekdays and weekends, with on-call provision for respiratory physiotherapy support during out of hours service. Most other specialist support services (such as dietetics and speech and language therapy) were available during weekdays.

Staff told us they received good support from the pharmacy, physiotherapy, mental health liaison and alcohol liaison teams as well as diagnostic imaging support such as for x-rays and scans.

We scored the service as 3. The evidence showed a good standard. 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.

Patients told us they could access information around healthier living. Staff told us they routinely discussed health promotion and lifestyle choices with patients.

Health promotion information was displayed on notice boards, tv monitors and in information leaflets that were readily available across the areas we inspected.

Patient records showed that alcohol consumption was included as part of the nursing assessment when patients attended the emergency department. Patients identified as at risk of addiction to alcohol and drugs abuse could be referred to the alcohol liaison and mental health liaison teams for further support and advice.

Patients identified with weight concerns were referred to dietitians or signposted to specialist support services. Patients could also be referred or signposted to smoking cessation services.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The urgent and emergency care services participated in all 3 Royal College of Emergency Medicine (RCEM) national clinical audits it was eligible for during 2024/25. The clinical audit lead told us staff routinely participated in local clinical audits and local projects to improve services provided. Recent local audits included local anaesthetic use in arterial blood gas (ABG) sampling, coagulation test requests in ED and neck of femur patient care in ED.

Findings from clinical audits were reviewed during routine clinical audit meetings and departmental and divisional governance meetings and any changes to guidance and the impact that it would have on their practice was discussed.

Outcomes for patients were mostly positive but mixed outcomes had been achieved in some clinical audit indicators when compared with other services or to national standards. Most patients we spoke with were positive about the quality of the care and treatment outcomes.

The 2025 RCEM time for critical medications year 1 national quality improvement audit (based on data for period between October 2023 and October 2024) showed the urgent and emergency services achieved all audit standards. This included patients identified to be on time critical medicines (TCM) within 30 minutes from arrival, TCM dose administered within 30 minutes of expected time and for the proportion of patients that had not missed any ED administered TCM dose during their ED stay.

The Royal College of Emergency Medicine (RCEM) care of older people (year 2) audit (published in September 2025 but based on data for period between October 2023 and October 2024) showed the urgent and emergency services achieved national standards in 5 of the 8 audit standards. The 3 standards not met related to initiating delirium management plans, initiating comprehensive geriatric assessments and documenting safety rounds. An action plan was in place to improve compliance. The clinical audit lead told us they were also looking at ways to improve physiotherapy access at weekends and out of hours in the frailty SDEC.

The 2025 RCEM mental Health (Self Harm) year 2 national quality improvement audit (based on data for period between October 2023 and October 2024) included data for patients aged 18 years or older that presented to ED having intentionally self-harmed and had a referral made by the ED for emergency mental health assessment by adult psychiatric liaison services.

The audit showed mixed compliance against audit standards. The audit identified positive compliance against national standards relating to time to adult psychiatric liaison service patient review in ED following referral, total time spent in ED before discharge, admission or transfer and evidence of appropriate physical health assessment, relevant investigation and treatment carried out by the ED clinician appropriate to the patient’s presentation.

The audit also identified poor compliance for quality metrics relating to managing patients with self-harm risks and those with drug and alcohol concerns.

An action plan was put in place to improve compliance. This included actions relating to improving completion of parallel assessments, improving documentary evidence around compassionate and practical care and arranging and documenting a follow up plan for patients leaving prior to ED clinician or adult psychiatric liaison services review.

The RCEM pain in children audit (2024) showed the urgent and emergency services at this hospital achieved 100% compliance in all 4 relevant audit standards. This included timely pain assessment on arrival, administration of analgesia and documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic for patients with severe or moderate pain.

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

Staff followed trust policies around consent and understood how to obtain informed verbal and written consent from patients before providing care or treatment. The consent policies provided guidance for staff on how to obtain consent for care and treatment for adults, young people aged 16 or over and for children under 16 years of age. Staff we spoke with understood how to seek consent from young people using the Gillick competence / Fraser guidelines or consent of a person with parental responsibility if under 16 years of age.

Staff had the skills and knowledge to ask patients for consent and were able to explain how they sought verbal, implied and informed consent before providing care and treatment. Care records we looked at showed verbal and written consent was recorded prior to undertaking care and treatment. Patients told us staff explained what they were doing and asked for their consent before delivering care and treatment.

Written consent was sought for certain treatments and procedures, such as where sedation was required. Staff told us the risks and benefits of procedures were discussed with patients prior to treatment.

Managers monitored staff compliance against consent processes. The consent and operation note documentation audit for emergency admissions (March 2025) included data across the general medicine specialty, which included the urgent and emergency care services. The audit showed full compliance against 18 of the 26 audit standards had been achieved, demonstrating good levels of overall compliance. The audit identified shortfalls in areas such as documenting NHS / hospital numbers, patient name and the name of the responsible consultant in the consent records. An action plan was in place to improve consent documentation completeness and accuracy.

Staff told us they could seek support and guidance around consent, mental capacity and best interest decision making processes from the safeguarding leads and the mental health liaison team.

Staff received training in and understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs). The training was delivered as part of the mandatory safeguarding training as well as additional training delivered through bespoke teaching sessions and during staff training and development days.

There were policies in place for Mental Capacity Act best interest decisions and Deprivation of Liberty safeguards which provided guidance for staff. Staff considered patient’s capacity when assessing them. Staff appropriately recorded an assessment of mental capacity in the records we reviewed, where it was applicable.

If a patient lacked the capacity to make their own decisions, staff told us they sought consent from an appropriate person (advocate, carer or relative) that could legally make decisions on the patient’s behalf. When this was not possible, staff made decisions about care and treatment in the best interests of the patient and involved the patient’s representatives and other healthcare professionals. We saw evidence of this in 1 patient record we looked at as part of the inspection.

A Mental Capacity Act (MCA) audit for the period between July and September 2025 across the division of medicine (including urgent and emergency care services) at this hospital showed the services achieved at least 90% compliance in 7 of the 9 audit indicators, demonstrating good compliance. The audit identified poor compliance (67%) in 2 audit standards, relating to documenting patient wishes in best-interest decision records and around the information given to patients to support specific decisions.