Nuffield Health Exeter Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question as good. However, it was combined with the diagnostic imaging and was under a different methodology. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a clear vision which staff knew and understood. The service had a new 5 year plan which included introducing new services and ensuring an increase in the utilisation of the outpatient facilities.

There was a positive culture amongst staff who worked in the outpatient department. Staff were engaged and passionate about the services they provided and delivering person-centred care. Most staff said the leadership team were approachable and all staff wanted to deliver patient centred care.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience required to carry out their roles and demonstrated a strong understanding of the services they managed. The outpatient’s department at Nuffield Health Exeter Hospital was led by the head of department, who reported to the senior leadership team, the registered manager and the director of clinical services. The registered manager for the Exeter site also held responsibility for a nearby Nuffield location; we were told this was a temporary arrangement until each site had its own dedicated registered manager.

The leadership team worked collaboratively to ensure the delivery of safe, high‑quality patient care. We observed effective processes for ensuring consultants submitted all required documentation to obtain practising privileges. This process was overseen by the registered manager.

Most staff across the different teams said they felt supported by their manager. They said senior leaders were visible and approachable.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies and procedures for staff to encourage a positive culture where people feel they can speak up and their voice would be heard. Most staff we spoke with felt confident to raise any concerns with their manager.

The service had a freedom to speak up policy which identified roles and responsibilities of staff and provided guidance on raising concerns. Staff had access to 2 freedom to speak up guardians and knew who they were. Staff told us they would approach their line manager about any concerns but felt if they used the freedom to speak up process their concerns would be taken seriously. Staff could raise any issues both in person and anonymously.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders worked to create an inclusive working environment. We observed leaders being approachable and supportive to all members of staff.

The hospital had a room that could be accessed by staff wanting to pray or have space for quiet reflection. This doubled as the well-being room.

A patient forum met quarterly to ensure that patients’ views were heard and considered. The forum also provided opportunities for learning, with representatives such as the infection prevention lead and the cardiology lead attending to share information and answer questions.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were clear structures, processes and systems of accountability to support the effective delivery of the outpatient service. The service operated within an established meeting framework that provided senior leaders and managers with regular opportunities to review operational performance. The outpatient’s department held monthly team meetings and daily huddles, which were used to share information, provide updates and allow staff to raise concerns or suggestions.

Monthly quality reports covering all areas of the service were reviewed by the senior leadership team to monitor performance and maintain oversight of departmental activity. The service monitored outpatient cancellations and patients who did not attend. In January 2026, 2% of patients did not attend their appointment and 4% of appointments were cancelled.

A Medical Advisory Committee (MAC) met regularly to oversee patient safety, quality of care and compliance with regulatory requirements. The committee reviewed incidents, adverse events and applications for practising privileges. The chair of the MAC told us there was good consultant engagement with the committee.

We reviewed 3 consultant practising privilege files and found robust governance processes to ensure consultants submitted the required documentation to support safe patient care. Practising privileges were reviewed every two years. Practising privileges allow medical professionals to provide specific clinical services within the organisation without being directly employed by it.

The service had governance processes and policies which followed best practice. Staff were able to access these policies on the system. Staff said new and updated policies were shared at the relevant meetings and safety huddles.

The service had a risk register, which highlighted risks to the service and any controls to mitigate them. There were 10 risks on this register and the risks were regularly reviewed to ensure they were being mitigated and to see if they could be removed if the mitigation steps were successful.

There was an emergency preparedness plan which gave details for who to contact in the event of an emergency.

The service had regular meetings with partnership organisations to ensure the regular flow of information between services. For example, it worked with the local trust to ensure information on the performance of consultants was shared appropriately to ensure safety for patients.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborate for improvement.

The hospital offered free public events where people could attend presentations on a range of health topics. These sessions could be booked through the provider’s website. The hospital also ran a programme of charity events throughout the year to support its nominated charity. For more information, please see the Surgery report.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had implemented a patient optimisation process that was fully embedded in practice, with all staff actively engaged. This approach had led to measurable improvements in patient experience and surgical outcomes.

Optimisation was carried out by outpatient staff. The purpose of optimisation was to identify and address any medical issues before a surgery date was confirmed, through a set of standardised tests and observations. Previously, these tests were carried out during the pre‑assessment appointment, which often took place shortly before surgery. By moving the optimisation process to immediately after the initial outpatient appointment, patients were given sufficient time to address any concerns identified during optimisation. This change resulted in a reduction in last‑minute theatre cancellations, which had previously caused distress for patients and led to inefficient use of theatre capacity.

The provider produced monthly quality reports that enabled it to monitor themes and trends and take action to reduce the likelihood of reoccurrence. We saw evidence within these reports that trends were reviewed and risks were tracked effectively. For example, the service identified an increase in pathology incidents where blood samples had been incorrectly labelled, resulting in patients needing repeat tests. The service implemented targeted actions in response, which led to a reduction in these errors.

Staff were committed to continually learning and improving services. Staff received training on the Patient Safety Incident Response Framework (PSIRF). Meeting minutes showed that staff participated in SWARMS to support timely and effective incident reporting. SWARMS huddles are a PSIRF tool in which staff come together immediately following a patient safety incident to rapidly explore what happened, understand the contributory factors and identify actions to reduce the risk of recurrence. Staff we spoke with confirmed that incidents were discussed and learning was shared.

The service supported staff development and career progression. Apprenticeship programmes were available, and staff were encouraged and supported to enrol and complete them. Certificates for staff who had achieved national apprenticeships were displayed on a ‘celebration wall’. The service also offered bursaries to enable staff to attend national conferences, such as the Wounds UK conference.