Nuffield Health Exeter Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question as requires improvement. However it was combined with the diagnostic imaging and was under a different methodology. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

Staff were confident to report incidents and knew what to report and when. Staff had effective systems to raise concerns both formally and informally.

We reviewed incidents, some of which staff described to us at the site visit. We found these were appropriately reported and investigated as necessary. Staff received feedback on incidents they had raised, and incidents were discussed at daily safety huddles to share any learning. There were 12 incidents raised in the 6 months prior to our inspection. All had been investigated and closed.

Staff understood the duty of candour regulation and the need to be open, honest, and transparent with people when things went wrong with their care.

The service had a freedom to speak up guardian. Staff were aware of how to contact them.

The service worked with people to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured all essential information about the patient was received to determine if the patient’s needs could safely be met. There was an admission criteria policy for patients who used the service, which helped ensure patients needs could be safely met by the organisation. There was a policy for each of the surgeries offered.

There was a bookings team which took the initial information from the patient and ensured the necessary information was passed onto the medical secretary to obtain an initial outpatient appointment with the relevant consultant. However, there was sometimes difficulty receiving digital imaging from private referrers which were not compatible with the IT system. Nuffield Health Exeter Hospital was communicating with these providers to ensure they had access to scans.

The department worked effectively with other hospital services, including physiotherapy and the pre‑assessment clinic. During our site visit, we observed 5 consultations and saw patients were appropriately referred to physiotherapy to support and optimise their recovery. One patient described the process of seeing both the consultant and the physiotherapist as “seamless”.

Patients were seen by their chosen consultant unless a referral to another specialist was clinically appropriate. For example, we observed a patient who had undergone a knee replacement being referred to a consultant with specific expertise in a surgical technique that could enhance sporting performance.

New patients who required surgery were now “optimised” at their outpatient appointment. This was where staff completed several medical tests for example, blood tests and ECG to check on their fitness for surgery prior to attending the preadmission clinic. Senior staff told us this was set up to reduce the number of surgery cancellations. They could identify any problems prior to preadmission clinic, so the patient could receive treatment or take appropriate actions, to ensure the operation would not be delayed.

Patients, post-surgery, had follow up appointments with the relevant consultant to ensure there were no difficulties. Patients had their wound checked by the outpatient nurses or visited their GP.

The service used an electronic computer system to record notes about patients. Consultants dictated their notes and these were passed to the medical secretaries to be put on the patients files. Medical secretary staff said these notes were typed up within 48 hours of being received. Patients and their GP’s were sent a summary of the appointment by letter.

The service had a deteriorating patient policy which clearly set out roles and responsibilities for the health care team. It was clear in an emergency the patient should be transferred to the local NHS trust following the guidance. On each shift there was a staff member identified as the paediatric life support lead and the bleep holder.

The outpatient’s department was responsible for the pre-assessment clinic. Patients attended this clinic prior to any surgery. Depending on the criteria some patients were able to have a telephone consultation with a nurse, whereas other patients attended face to face. Staff showed us the criteria they had to follow to make sure a patient was suitable for surgery at this location. Preadmission staff were able to refer patients for a review by an anaesthetist if they had any concerns. We observed a patient in the clinic and saw they were appropriately assessed and there was good communication between the nurse and the patient.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Patients we spoke with during the inspection said they felt safe. There was information about the patient’s right to a chaperone clearly displayed in clinic rooms and the waiting room. Consultants had a buzzer in the consultation room they could press should they require a chaperone.

All staff were required to complete safeguarding training. Staff demonstrated a good understanding of safeguarding principles and were confident in how to raise a referral. When asked, staff were able to identify the safeguarding lead. The provider required all staff to be trained to Level 2 for both adults and children. At the time of inspection, all staff had completed Safeguarding Adults Level 2, and only one member of staff had not yet completed Safeguarding Children Level 2.

Registered staff, heads of department and the safeguarding lead were trained to Level 3 adults, and the organisation also had a central safeguarding lead for all Nuffield hospitals who was trained to Level 4. There had been no safeguarding concerns reported in the previous 6 months.

For further information on safeguarding arrangements for children and young people, please refer to the children and young people’s assessment.

The service worked well with people to understand and provide care which met their needs in a safe and supportive manner.

Risks were documented and managed, and patients said the consultant gave them information about their care which meant they felt fully informed.

Patients we spoke with said they were actively involved in decisions about their treatment and felt well informed about the care they were due to receive, as well as care already provided. Our observations of outpatient appointments supported this. Consultants gave patients sufficient time to ask questions, conducted consultations at an appropriate pace, and explained treatment options clearly to support informed decision‑making. They also gathered relevant information from patients to assess risks and provided clear explanations about any associated risks.

The protocol for patients who deteriorated during an outpatient appointment was to call an ambulance and transfer them to the acute trust. Although such incidents were rare, staff described an example where, during an optimisation visit, a patient was found to have an irregular heartbeat and an ambulance was requested.

Staff in the preadmission clinic assessed patients' suitability for surgery against a set criteria. This was rated as green, amber and red. Red patients were not suitable for surgery at this location, and amber patients were reviewed by medical staff to check their suitability. Patients who were rated as green could be called by telephone. This meant the patient did not have to travel to the appointment saving their time and expense.

The resuscitation trolley situated between the outpatient department and the diagnostic imaging department had daily checks undertaken so it was ready to be used in an emergency. Paediatric and adult resuscitation policies were available as well as resuscitation council guidance. Staff received training in life support.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The hospital, despite being clean and functional, was in the process of being upgraded. At the time of the inspection the lifts were being serviced. The provider had tried to minimise disruption to patients by using consulting rooms that were away from the works.

The environment was accessible to patients in wheelchairs. Consulting rooms were spacious and wheelchair friendly so patients could be cared for safely.

The service had sufficient and suitable equipment to support safe patient care. Staff were trained in its use, and equipment was maintained appropriately, and consumables were in date. Portable electrical equipment had been safety tested, and servicing schedules were clearly displayed. The service had a log for when equipment required maintenance and all equipment was within date or had a service booked.

Clinical waste was disposed of safely. Domestic and clinical waste bins were clearly labelled and emptied regularly, and sharps and hazardous waste bins were stored appropriately.

There were measures to support staff safety. Chaperones were offered to patients ensuring lone working was kept to a minimum. There was a panic alarm located at the outpatient’s reception which was tested regularly.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff and consultants worked well together to provide safe care that met people’s individual needs.

Staffing levels were planned in line with the number of clinics running each day. The service had a tool to help with planning staffing levels in advance. A daily huddle took place, during which staffing and clinic activity were reviewed.

The service did not use agency staff, instead relying on bank staff. Staff reported they mainly worked with regular bank staff and there was an induction process for new staff members. The department lead could also work clinically when required.

Staff had received and were up to date with appropriate mandatory training. Mandatory training completion rates were above 94%. Staff had a clear competency framework for various outpatient procedures such as performing electrocardiogram (a diagnostic tool for measuring the electrical impulses of the heart) and venepuncture (obtaining a blood sample from the vein). We saw competencies were monitored by senior leaders and all staff had either completed their competencies or competencies were in progress.

Staff new to the service said they were supported to shadow minor procedures within the treatment rooms and only undertook these independently once they had gained sufficient confidence and competence.

There was adequate medical cover provided by a resident doctor. Outpatient staff told us the medical team were approachable and readily available to answer any queries. The service had two medical resident doctors who alternated weekly, each working one week on and one week off.

The service was fully established for registered nurses and healthcare assistance. There were low levels of sickness below 4% and a low turnover for registered nurses. There were 3 health care assistants who had left in the previous year and these positions had now been filled.

We reviewed a sample of recruitment files and found the provider was compliant with relevant regulatory requirements. Appropriate pre-employment checks had been completed to ensure staff were suitable to work with patients. Professional registrations were checked at appointment and monitored to ensure they were maintained and renewed within the required timeframes.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed effective infection prevention and control (IPC) practices, as well as safe hazardous waste and sharps management. Both a dedicated housekeeping team and clinical staff maintained cleanliness and hygiene across the environment. The service carried out monthly cleaning audits which showed results were consistently above 88%. In the last audit in February 2026 non clinical staff cleaning was at 100% and housekeeping cleaning was at 98%. The service had a target for these audits of being between 89-91%.

Staff understood the policies and processes for maintaining good infection control. We observed staff were bare below the elbow and followed correct hand hygiene procedures. The location conducted hand hygiene audits and bare below the elbow audits every quarter. The last 3 audits showed compliance at 99% and above. Results and any actions to take from the audits were fed back to staff. Staff were trained in aseptic non touch technique, which is a clinical practice designed to prevent infections.

The overall clinic environment and the toilets were mostly visibly clean. A patient commented on the cleanliness of the environment. We observed cubicle curtains were clean and dated to ensure they were changed regularly. All curtains checked were within their change date. Hand gel was available in patient facing areas.

The service carried out appropriate risk assessments for Legionella bacteria every 2 years and there was a system to ensure taps and showers were flushed regularly. Legionella bacteria can thrive in warm and stagnant water and can cause serious lung infections.

The service made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The service had safe systems for the appropriate and safe handling of medicines. There were processes to ensure people received the medicines they needed.

In pre-assessment clinics, staff followed national practice to ensure they had a complete medical history and list of current medicines the patient was taking. This aided decision making on any medicines changes that might be required prior to surgery. Patients were given both verbal and written information about their medicines in the outpatient clinic. The hospital pharmacy staff dispensed medicines prescribed in the outpatient clinic and counselled patients on any new medicines prescribed.

There was an electronic prescribing system which enabled tracking and auditing of prescribing. However, staff told us not all consultants used this system, some still preferred to prescribe on paper. This meant there was not always clear oversight of all prescribing in outpatients. This issue had been escalated through appropriate governance channels.