Frimley Park Hospital along side two other hospitals forms part of Frimley Health NHS Foundation Trust. Frimley Park Hospital is situated in Frimley. The hospital hosts the Defence Medical Group South East, with military surgical, medical and nursing personnel working alongside the hospital's NHS staff providing care to patients in all specialities.

We completed a focussed inspection of the surgery service at Frimley Park Hospital on 3 July 2018. This inspection was in response to information of concern about the safety of the surgical services. The focus of this inspection was to review how the hospital responded to risks, shared learning from incidents and how the service leaders ensured changes were implemented and adhered to.

Our key findings were as follows:

• The service developed  and implemented local safety standards for invasive procedures,

  ;

  however, not all staff were aware of these.

• There was a culture of openness and honesty and service leads encouraged staff to challenge poor practice.
• The service had a positive incident reporting culture,

  demonstrating, 

  which showed that there was learning from incidents, and was shared

   learning and sharing both locally and across the trust. 

• Governance arrangements were clear and structured ensuring leaders and staff received  information to enable them to challenge and improve performance.

• Staff did not adhere to the trust's surgical site marking policy.

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

The trust should:

• Ensure there are clear guidelines on safe patient transfers and responsibilities during patient handovers from all wards to anaesthetic room or theatres. This should include patient safety checks and the patient’s involvement.

• Involve all departments in the development of local safety standards for invasive procedures.

Professor Edward Baker

Chief Inspector of Hospitals

Patients told us what it was like to stay at the hospital and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether patients staying at hospital were treated with dignity and respect and whether their nutritional needs are met.

The inspection team comprised of three Care Quality Commission (CQC) inspectors and a practising professional. The team was joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We talked with 12 patients and 24 staff within the hospital and observed the care and support provided to other patients. We visited the elderly care wards, the stroke unit and the medical assessment unit. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people. We focused our observation over the lunchtime period on the four wards. We spoke with a range of staff from wards and departments and looked at 12 patient records.

Most patients staying at the hospital told us they were happy with the way they were looked after. We were told "staff are wonderful” and that,” the care is very good.” Patients told us that “Staff are all very caring people and always ask if you are OK.” However, there were some negative comments about one particular ward being noisy at night and one relative thought that the staff changes were too frequent and that “Care was not personalised.”

Most patients we talked with told us that they enjoyed the meals and that there was plenty of choice. One patient said " The food is beautiful” others told us “The food is very good”

The majority of patients staying at the hospital said that they felt safe and knew how to report concerns.

We were only able to speak to only one patient during this visit. The patient told us that he felt extremely well cared for and nothing was too much trouble for the staff. Staff were said to have explained all aspects of care to him and gave him appropriate choices.

During our visit, we spoke to patients in a variety of ward settings, including elderly care, a stroke ward and the pre and post natal ward within maternity services. We received many positive comments from these individuals, such as “The level of care and staffs attention has been top notch.” “I have been well looked after and the staff are good with visitors too.”

Patients described staff as treating them as individuals, with personalised care. We were told that information was regularly supplied by staff and that the patients were kept informed regarding their progress and changes in treatment plans. Patients felt that they received care that was delivered with dignity and respect.

The environment was said to be clean and staff were seen to wash their hands regularly. In general the supply of food, choices available and quality were found to be good.

Our rating of services stayed the same. We rated them as outstanding because:

• We rated the hospital as outstanding overall. We rated caring, responsive and well led as outstanding and, effective and safe as good. In aggregating ratings we took account of the ratings from 2014 for the six services we did not inspect at this time.
• On this occasion we rated both surgery and maternity as good in effective, caring, responsive and well led. For safe we rated surgery as good and maternity as requires improvement.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The hospital controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. The hospital had suitable premises and equipment and looked after them well.

• The hospital followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.

• Generally, the hospital had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• The hospital managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support in line with the duty of candour.

• The hospital provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance and monitored the effectiveness of care and treatment and used the findings to improve them.

• Staff gave patients enough food and drink to meet their needs and improve their health. The hospital made adjustments for patients’ religious, cultural and other preferences.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs. The trust was a leader in the Frimley Integrated Care System and collaborated well with partners.

• The hospital treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. However, the trust did not always meet its own standard in response timeliness.

• Managers at all levels in the hospital had the right skills and abilities to run a service providing high-quality sustainable care.

• The trust had a vision for what it wanted to achieve and workable plans to turn it into action. This was underpinned by a set of values that staff at the hospital understood.

However:

• Although the trust provided mandatory training in key skills to all staff the trust was not achieving its completion target of 85% in all topics.

• Although there were systems for managers to appraise staff’s work performance not all staff had received an up to date appraisal.

• Midwifery staffing did not always meet national guidance. Women did not always