Nuffield Health Exeter 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 people and communities had the best possible outcomes because their needs were assessed. We checked 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 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 remains 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Daily morning huddles were used to review patient lists and share relevant information with staff, enabling planning for any specific patient needs. This included sharing when children or younger people were due to attend the service.

We reviewed 3 care records, including young people on the adult surgical pathway and a children’s outpatient record. Pre‑admission assessments for younger patients were completed by a Registered Sick Children’s Nurse (RSCN) from another site, in line with appropriate clinical pathways. One record included a surgeon’s letter sent directly to the young person outlining their treatment plan. All records were fully completed and demonstrated assessment and planning consistent with relevant provider guidance.

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.

Care and treatments were planned and delivered in line with legislation and evidence‑based guidance. Younger people who underwent surgery followed the adult surgical pathway. Staff worked in accordance with current policies, supported by monthly safety bulletins highlighting clinical and corporate updates. Changes to clinical guidelines were discussed at governance meetings.

A programme of audits, including consent, hand hygiene and medicines management, provided assurance of compliance with required standards.

Please refer to surgery, outpatients and diagnostic and imaging reports for more information.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses and allied health professionals all worked together to meet the needs of children and young people.

Daily huddles attended by senior staff highlighted when children and young people were due to attend and if they had any specific needs.

Where appropriate, consultants provided written correspondence to other services, including GPs, outlining diagnoses, treatment and medications.

Refer to outpatients, surgery and diagnostic imagining reports for more information.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service supported children, young people and their families to manage their health and wellbeing. Staff provided advice during outpatient appointments, including guidance on allergy management. The service promoted healthier lifestyles and, where possible, helped reduce future care needs.

Please refer to surgery, outpatients, and diagnostic and imaging reports for more information.

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 identify and respond to clinical deterioration, supporting patient safety and outcomes. Younger people undergoing surgery were managed on the adult surgical pathway, with observations recorded using NEWS2.

Managers completed regular audits to review outcomes and drive improvements in care. Audit findings and outcome data, including activity for children and young people, were shared with staff and monitored to ensure sustained improvement.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

There were no dedicated children’s staff at this location. Younger people who were referred for surgery were assessed by a RSCN from another location. Staff told us they assessed if the younger person was able to consent and understood the procedure.

Staff told us a child’s parents or guardian would consent to any treatment on their behalf.

Please refer to surgery, outpatients and diagnostic and imaging reports for more information.