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Provider: Frimley Health NHS Foundation Trust Good

On 12 March 2019, we published a report on how well Frimley Health NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

Reports


Inspection carried out on 13 April 2021

During an inspection looking at part of the service


CQC inspections of services

Service reports published 13 March 2019
Inspection carried out on 6 November to 5 December 2018 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 6 November to 5 December 2018

During a routine inspection

This is the first time we rated this trust overall. We rated it as good because:

  • There were arrangements to manage safety incidents and complaints to ensure these were adequately investigated, learning was identified and necessary changes to practice made.
  • The premises and equipment were clean and well maintained; infection risks were well controlled.
  • Staff managed medicines were in line with legislation and national guidance.
  • Accurate and accessible patient records supported staff to give safe care.
  • Generally, there were enough staff with the qualifications, skills and experience to meet patient needs.
  • There was a programme of mandatory training but not all staff had completed this. Staff were competent although not all had received an appraisal of their performance.
  • Staff delivered care and treatment were in line with national and recognised standards and guidance. Audit systems checked care was given in the best way and resulted in positive patient outcomes.
  • Patients received enough food and drink and any pain they experienced was managed.
  • Arrangements for consent took account of the needs of those who lacked capacity to give consent and followed relevant legislation.
  • Feedback from patients and their families was positive and they were treated with dignity and respect.
  • The trust worked collaboratively with partners in the Frimley Integrated Care System to provide joined up services that met the needs of the local population and of individuals, including those with disabilities or protected characteristics.
  • Senior leaders and managers at all levels in the trust had the right skills and abilities to run a service, a vision for what they wanted to achieve and workable plans to turn it into action. They promoted a positive culture and created a sense of common purpose based on well understood organisational values.
  • The trust had effective systems for identifying and mitigating operational risks through risk registers.
  • The trust collected, analysed, managed and used information well to support all its activities and to monitor its own performance.

However:

  • Midwifery staffing was a concern as staffing shortages meant one to one care in labour was not always achieved and staff felt pressured.
  • The trust lacked a systematic and coordinated approach to quality improvement although there were examples of good practice.
  • The trust did not have an effective system for identifying or managing and controlling strategic risks
  • The trust did not have a consistent or embedded approach to engaging patients and hearing their views and experiences although there were some examples of good practice.

Inspection carried out on 10-11 July and 7-8 August 2014

During a routine inspection

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 patients 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

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.