Nuffield Health Brentwood 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service did not always make sure people’s care and treatment was effective by referring to pre-operative documentation.

During our onsite assessment we reviewed 10 care records. Staff consistently completed timely and comprehensive health assessments at or shortly after admission, with documentation initiated during the pre-operative assessment. Risk assessment tools such as moving and handling and Venous Thromboembolism (VTE) were applied to all eligible patients. However, in half of the records reviewed, not all identified risks were accurately documented at admission, indicating gaps in risk recording practices. This meant there was a risk of potentially missed or delayed interventions for VTE . Following review of all reported incidents in the last 6 months 2 related to a lack of prescribing VTE identified at pre admission.

Staff told us that care plans were reviewed prior to admission and care was personalised to meet patient’s needs. For example, 1:1 staff would be requested for patients that were living with dementia or had a high risk of falls.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

Staff had access to interpreters over a phone line if required and gave examples of a time when other staff members were used to support translation where English was not the primary language spoken by the patient. Staff in Endoscopy reported they found the language line difficult to use and had raised this with their manager. The service was exploring an option to video call to enhance communication and efficiency in translation but were yet to have an update on this proposal.

Types of anaesthetic was discussed with patients prior to their procedure, in consultation with the consultant, to ensure their needs and preferences were appropriately considered.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Patients had meal options to choose from during their stay, which met a range of specific dietary needs. These were offered flexibly around their medical needs and care. For example, we observed housekeeping staff offer a variety of options for breakfast and preference on time to allow medications to be administered. April 2025 patient survey results showed that most patients were happy with the catering. Stating “plenty of choices and allergy options” and “well presented fresh and very good quality food and service”. However, a few patients reported not being satisfied with their meal. For example, “ meals I had were bland and not too fresh, but service was good” and “unfortunately the porridge was horrible”.

Policies and standard operating procedures (SOP) supported evidence-based practice and standards. For example, the Endoscopy service SOP was based on guidance from and, where required, in compliance with the British Society of Gastroenterology (BSG), Joint Advisory Group for GI Endoscopy (JAG) and the National Institute for Health and Care Excellence (NICE) standards.

Staff conducted Pre Operative Assessment (POA) screening. Patient Health Screen Questionnaire reviewed risks in line with NICE guidance and relevant blood tests were requested. For example, blood tests were completed to review for iron deficiency. This was in line with NICE guideline, NG180: Perioperative care in adults. We saw evidence of low iron patients being referred for consultant review prior to surgery. The last POA notes audit conducted in July 2024 showed a compliance of 79%, below the 90% target. Leaders did not provide evidence of actions taken in response to the POA audit results, when this was requested as part of our assessment.

Physiotherapists were able to refer to specialist services such as occupational therapy through the NHS, if a need was identified pre or post operatively.

The service worked well across teams and services to support people.

Patients who did not meet the admission criteria were discussed at the patient safety meeting with a senior leader and heads of departments. The anaesthetist and treating consultant would not be present during these discussions. However, concerns raised by Pre Operative Assessment (POA) team were reviewed via email and responses to proceed were reviewed by the Director of Clinical Services. Staff told us that they did not receive feedback on the rationale for proceeding with surgery where patients fell outside the admission criteria and this limited their understanding of decision-making processes.

Patient pre-operative advance notification sheets were completed by POA team in line with policy. These were to aid effective communication and adjustments on admission. For example, we saw one completed for a patient with a nut allergy.

Staff shared information about patients at handover meetings within the team. For example, staff were told about a patient who had low blood pressure overnight and how this was treated.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. We observed the physiotherapist informing nurses that a patient was now able to mobilise using crutches.

Patient records were paper based and staff told us that at times they had difficulty locating them. This resulted in having to manually locate them as they are not electronically tracked for their location within the hospital or a new set of records were made and surgery would need to be delayed . This had the potential to impact on patient care, however staff reported this had not occurred. The hospital was looking at moving to an electronic based system, however, this had been delayed corporately.

The service supported people where possible, reduce their future needs for care and support.

Staff conducted POA health screening to ensure that patients’ health was optimised prior to elective surgery. For example, deficiencies in iron were addressed with supplements.

Where patients lived independently but may need support on discharge, this was identified pre-operatively to ensure people had the required support necessary for a safe and timely discharge.

Endoscopy patients were screened, and bowel preparation medication was supplied, with telephone advice on how to prepare for their procedure. This was in line with national guidance, to ensure safe care and health outcomes.

Staff told us that they did not always have the tools or time to support patients to live healthier lives. For example, if they had identified increased body mass index (BMI) they would not give advice on ways to reduce this.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. Staff identified deteriorating patients using tools such as the national early warning score 2 (NEWS2). NEWS2 audits completed in the last quarter showed a compliance of 96% for recording and escalating NEWS2 scores in line with policy.

Quarterly patient records audits were carried out to review the standard of record keeping as well as identify if correct and timely action was taken at all stages of the patient journey. The last audit showed a compliance of 94.9% against a target of 90%.

The service submitted outcome data to the National Joint Registry (NJR) Patient Reported Outcome Measures (PROMs). This is national patient-reported data on the quality of care provided during joint replacement surgeries. This data, collected through pre- and post-operative questionnaires, helps assess patient-perceived health gains and overall quality of life improvement after the procedure. We reviewed the hospital’s data for hip and knee surgery. The hospital was within the expected national average or above against each measure. This meant that patients reported an improvement in health in line with or better than the national average following surgery at Nuffield Health Brentwood.

Hospital Reported Adverse Events (HRAE) reported data showed that unplanned re-admissions were at a rate of 4 per 1,000 discharges, compared to an England average of 2, for self-pay patients using independent health services. Senior leaders told us that they were aware of this but had not identified any themes or causes following investigation. They told us that they would continue to monitor data.

Morbidity and mortality reviews were conducted corporately. Within the 12 months prior to our assessment there have been 2 reported deaths within 30 days of surgery. Although there were no failures in care during their admission, the hospital introduced follow up calls within 48 hours of discharge to ensure any potential complications were identified and escalated to reduce harm.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

The hospital had a consent policy which outlined all staff’s roles and responsibilities. This was in line with national guidance and legislation, such as the Mental Capacity Act (2005). Staff received training in the mental capacity act and audit data showed a compliance of 99% within Surgery.

Staff took all practical steps to enable patients to make their own decisions. Consent for sharing information with the patient’s GP and other health care professionals involved in their care was obtained and documented within the care record booklet. In addition, POA staff would confirm patients’ understanding of the procedure and surgical site corresponded with details on the booking form. Where concerns for a patient’s capacity was identified, staff would apply the Mental Capacity Act principles, this was supported by the local policy.

Consent audit data showed an overall compliance of 96%. Of the 10 records reviewed as part of the audit, 7 patients were not given a copy of the consent form in line with policy. During assessment, we reviewed 9 care records and found all 9 had retained the patient copy.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. However, staff we spoke with during the assessment did not have any experience of this.

A manager told us that 2nd stage consent had been brought in following a complaint. This meant following the initial consent performed by the clinician in the outpatient appointment, the consent form was reviewed with the patient by ward staff before being taken to theatre for the specific surgical approach or technique.