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 good. At this assessment the rating remains 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.

Staff understood the provider’s vision and values and how these were embedded in day‑to‑day practice. The service promoted equality and diversity, supported staff development, and fostered an open and inclusive culture where concerns could be raised without fear.

Staff reported feeling valued and respected, with positive working relationships, strong teamwork and visible leadership. Leaders encouraged skills development and recognised staff achievements through regular feedback and daily team huddles.

The service used benchmarking, including monthly comparisons with other Nuffield hospitals, to monitor adverse events, transfers and patient satisfaction.

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

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.

The service did not have dedicated leaders solely for children and young people’s services; however, leaders had the appropriate skills, knowledge and experience to manage the services effectively. They demonstrated a clear understanding of service delivery and how teams worked to provide high‑quality care.

Staff reported they were well supported by senior leaders, who were visible, approachable and responsive. Leaders acted on staff and patient feedback, took incidents seriously and responded appropriately to concerns, which supported a positive and open culture.

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

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

Staff and leaders demonstrated openness, honesty and transparency, and the culture supported staff to raise concerns with confidence their voices would be heard.

Freedom to Speak Up (FTSU) information was visible throughout the hospital, supported by a clear policy outlining roles, responsibilities and escalation routes. Staff knew who the FTSU guardians were and told us they felt confident raising concerns with line managers or the FTSU team.

Staff reported concerns were taken seriously, investigated sensitively and responded to appropriately. The provider had clear complaints processes, including escalation routes for both NHS and private patients, and encouraged early resolution of concerns, supported by relevant policies.

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

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

The provider had an up‑to‑date Equality, Diversity and Inclusion (EDI) policy and leaders actively promoted an inclusive working environment. Equality of opportunity was supported through transparent access to project work, new roles and external development opportunities.

The service had arrangements to prevent and address bullying and harassment, with consideration given to staff with protected characteristics and those from marginalised groups. Reasonable adjustments were provided to support staff with disabilities.

Staff had access to colleague networks to share experiences, and the hospital provided a dedicated space for prayer, reflection and wellbeing.

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

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 act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had clear governance structures, processes and systems of accountability to support the effective delivery of children and young people services. An established meeting framework and monthly quality reports enabled senior leaders to monitor performance and maintain oversight.

A Medical Advisory Committee (MAC) met regularly to oversee patient safety, quality and regulatory compliance, including the review of incidents, adverse events and practising privileges. There was good consultant engagement with the MAC. Practising privileges processes were robust, with documentation reviewed and privileges renewed every two years to support safe care.

The service worked collaboratively with partner organisations to ensure information sharing and oversight of consultant performance. Governance policies reflected best practice and were accessible to staff, who told us updates were shared through meetings and safety huddles.

A risk register was maintained and regularly reviewed, with controls to mitigate identified risks. There were no risks pertaining to CYP. The service also had an emergency preparedness plan, which clearly outlined escalation arrangements and key contacts.

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

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff and leaders worked collaboratively with external stakeholders and agencies to improve patient care and outcomes.

Safeguarding learning was embedded within governance arrangements, with leaders engaging in commissioner safeguarding updates and local training networks.

Senior leaders also participated in regional networks to understand community needs and support the provider’s strategic aims.

The service engaged openly with patients, staff, equality groups, the public and local organisations in the planning and delivery of services. The hospital hosted free public health events and presentations, accessible via the provider’s website, and supported community engagement through a programme of charity events.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff demonstrated a commitment to continuous learning and service improvement. The provider used structured processes to identify and share learning from incidents and good practice, informed by local and national themes.

Monthly quality reports enabled leaders to monitor trends, track risks and take action to reduce recurrence.

Staff received training in the Patient Safety Incident Response Framework (PSIRF) and participated in SWARM huddles to support timely incident reporting and shared learning. Staff told us incidents were discussed openly and learning was embedded into practice.

The service supported staff development and career progression through apprenticeship programmes and access to external learning opportunities, including bursaries to attend national conferences. Staff achievements were recognised and celebrated within the service.