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 good. At this assessment the rating remains good. This meant people were safe and protected from avoidable harm, However, staff who provided care and treatment to children and young people were not trained to the recommended level of safeguarding children as directed by national guidance.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had a current incident policy, which reflected the provider and national guidance.

There were no dedicated staff purely working only with children and young people due to the limited services offered. Staff in outpatients, surgery and diagnostics and imaging knew how to report incidents.

There were no serious incidents in the 12 months involving children and young people.

Staff understood their responsibilities under the duty of candour and were open, honest and transparent with people when things went wrong with their care.

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

The service worked with people and healthcare partners 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.

Referral and admission processes ensured essential information was received to assess whether children and young people’s needs could be met safely. The service had clear criteria for which services were provided to children and young people, and not all specialties accepted this age group. Some surgical procedures were limited to young people aged 16–18 following a review and risk assessment by a paediatric nurse from another provider location. If deemed appropriate staff followed the adult surgery pathway when young people were admitted for surgery.

There were limitations in diagnostics and imaging services. For example, children and young people could only be seen for an MRI scan if they were over 14 years old.

Staff worked effectively with other healthcare providers to ensure continuity of safe care during admission and after discharge. There were clear procedures with the local NHS acute trust, defining responsibilities for both organisations if staff had to transfer an unwell child or young person. This helped ensure timely and safe care.

The service did not always train their staff who provided care and treatment to children and young people to the recommended level of safeguarding children to protect them from the risks of abuse.

Staff who provided care, treatment and support to children were only trained to level 2 safeguarding children as directed by the providers' policy. However, this is not in line with the national guidance Intercollegiate document (2025) Safeguarding children and young people & children and young people in care: Competencies for health care staff. The guidance says clinical staff working with children, young people, and/or parents/carers who could potentially contribute to assessing, planning, intervening, or reviewing the care of a child or young person must be trained to level 3.

The provider’s policy stated that staff must work more than 75% of their time with children and young people to be eligible for safeguarding children Level 3 training. At this location, the provision of services for children and young people was limited, and no individual staff member met this threshold. However, national intercollegiate guidance relates to the nature of clinical roles undertaken when providing care to children and young people, rather than the proportion of time spent delivering care. The registered manager was assured they had appropriate measures to safeguard children and young people from the risk of abuse.

The safeguarding lead held level 3 safeguarding children training. A national level 4 safeguarding lead was accessible to staff, which met national guidance.

There had been no safeguarding referrals for children and young people to the local authority in the previous 12 months. Staff spoken with were aware of their responsibilities to safeguard children and the processes to follow to report safeguarding.

Staff were trained in learning disabilities and autism and understood how to identify adults and children at risk of harm. They could describe how to safeguard people from abuse, harassment and discrimination, including those with protected characteristics.

The service carried out appropriate recruitment checks. This included checks with the Disclosure and Barring Service (DBS) for both adults and children barred lists. There was a process to review risks identified in recruitment checks.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service worked with people to understand and manage risks. This supported the provision of safe care that met people’s needs and enabled them to do the things that mattered to them.

Following the assessment, the provider submitted evidence confirming staff had completed Paediatric Basic Life Support (PBLS) training. Five staff had also completed Paediatric Immediate Life Support (PILS), providing assurance staff were trained to respond to the sudden deterioration of a child or young person.

Staff took part in a ‘missing child’ scenario. Following a debrief, actions were identified and implemented to support a timely and effective response should a similar incident occur.

A resuscitation trolley with paediatric equipment was located between the outpatient and diagnostic imaging departments and was checked daily to ensure it was ready for use. Relevant paediatric and adult resuscitation policies and Resuscitation Council guidance were available.

Young people aged 16 and 17 admitted for elective surgery followed the adult pathway, with their vital signs recorded and monitored using the National Early Warning Score (NEWS2) chart. NEWS2 is the standard clinical tool used in the UK to identify, score, and respond to acute physical deterioration in patients.

Staff enabled children and young people, and their parents or guardians, to give feedback on the service. Child-friendly feedback tools were available in designated areas.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a small designated waiting area for children. This was located within a main outpatient waiting area and was segregated as much as the space would allow. Parents/guardians were required to always be present as a hot drinks machine was available in this area for patients to use. There were no other designated areas within this location for children.

For younger people undergoing surgery they used the single occupancy rooms on the ward. Staff told us they were able to have their parent/guardian always stay with them.

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

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.

As the location provided a limited range of services for children and young people (CYP), there were no paediatric nurses or staff designated specifically to work with this group. Staff told us there was a competency framework for staff in outpatients this was based around the tasks they had to perform when caring for a child or younger people. For example, how to weigh and take the height of a child/younger person.

Consultants seeking practising privileges completed a Nuffield Health application. As part of the process, the hospital director met with the consultant to assess their suitability to practise independently. Applications were then reviewed and approved by the medical advisory committee (MAC). We reviewed records for a consultant providing care to children and young people and found all required documentation was in place, including evidence of safeguarding children training to level 3.

Please refer to outpatient, surgery and diagnostics and imaging report for more information.

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.

The designated children’s waiting area, located within the outpatient department, was visibly clean, uncluttered and equipped with well‑maintained, appropriate furnishings.

Staff told us children’s toys were cleaned each day or after they had been used. A cleaning schedule was in the designated children’s area. We checked this and it was up to date.

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

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

There were no dedicated medicines for children and young people.

We reviewed the emergency trolleys in the outpatient area and found daily check records fully completed, with all equipment present and in date.

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