Nuffield Health Exeter Hospital

On this page

• 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.

Staff completed comprehensive health assessments of patients in a timely manner. Care plans were personalised and met patient needs identified during assessment. Patients who attended for review for surgery were now optimised at outpatient appointments and asked to complete health screening questionnaires. Staff completed medical tests to check patients’ fitness prior to attending the preadmission clinic for review.

The physiotherapy team reviewed patients prior to surgery to provide advice, explain the process and what to expect. Some patients were identified for prehabilitation through an electronic tracker system such as decreased mobility and walking aids. Prehabilitation is the process of improving a patient’s physical, nutritional and psychological health prior to surgery.

Patients were reviewed post-surgery to check if they were safe to go home or to arrange follow up in clinic, and care plans were updated when necessary. Mobility assessments were timely to help reduce extended bed rest following surgery. The nursing team contacted the physiotherapy team if there were any mobility concerns.

The physiotherapy team had an enhanced recovery programme. Following a total knee replacement (TKR), patients were reviewed by physiotherapists in clinic and then referred to a knee class. After classes, patients were either discharged or referred back to physiotherapy for follow up as required. Patients undergoing orthopaedic and spinal surgery were seen by physiotherapists prior to surgery for initial assessment and advice. Spinal patients were also followed up by the team as required. Patients were provided with leaflets and a telephone number to call if they had any concerns.

Patients told us information about their care and treatment was clearly explained and they received pain relief quickly when required.

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.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses there were physiotherapy staff to support patients to regain mobility, manage pain and restore function following surgery. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction and supported staff to develop through constructive annual appraisals of their work and regular clinical supervision. Competencies were checked during appraisals. Senior staff worked with new staff who were supported by mentors. For the year 2025, 88.8% of staff had completed their appraisals (some staff were on maternity or sick leave).

Staff participated in many clinical audits, including consent, orthopaedic surgery and venous thromboembolism (VTE) risk assessments (to identify risk of blood clots and determine appropriate preventative treatment).

Staff assessed and met patients’ needs for food and drink. The surgical ward menu offered a range of food, catering for gluten-free, vegetarian and vegan meals, and asked people to inform staff of any intolerances or allergies.

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.

Leaders described teamwork as strong across the ward, outpatients, theatres and physiotherapy departments. Teams had effective working relationships, including good handovers with other relevant teams within the organisation (for example, care co-ordinators, discharge teams, and specialist teams).

Staff held regular and effective multidisciplinary meetings and shared information about patients at effective handover meetings. Staff from all teams attended, including pathology, radiology, pharmacy and bookings. We observed a daily huddle (meeting) which was attended by staff from all departments. Huddles were well run and had clear purpose; staff introduced themselves and learning was discussed. Meetings were minuted and shared with staff.

There were effective working relationships with other teams within the organisation including physiotherapy and the pre-assessment clinic. For example, incidents were discussed at monthly senior staff meetings with other locations within the organisation to review themes and trends across sites and to share learning.

The IT system supported the sharing of patients’ needs when they moved between external services, such as the local NHS hospital.

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 had a range of health promotion information available through the provider’s website including mental health, women’s health, and cancer awareness. There was information available to promote wellbeing, such as menopausal awareness and men’s health.

The service provided people with information for the different types of surgery undertaken which detailed what patients could expect and how patients should prepare for surgery.

Community and primary care engagement focused on education rather than direct public health interventions. Leaders described extensive GP education events with high attendance, using local rugby club hospitality for events, and outreach education sessions. They also described patient education sessions in community settings (residential community). They encouraged GPs to suggest future education topics such as menopause and dementia.

At the time of our assessment the hospital was running a month-long campaign to raise awareness of heart health. There were displays with heart health information.

The hospital offered private health assessments which members of the public could access. There were a variety of assessments and price plans.

As part of the enhanced recovery programme, physiotherapists provided knee classes for patients who had undergone total knee replacement surgery.

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.

The hospital participated in national clinical audits such as the national joint registry (NJR). This showed (for knee and hip operations) it was performing within the expected range for all measures of the audit (data reviewed was up to August 2025). In 2024 they were awarded the gold quality data provider award for meeting the 100% NJR target for sharing data to improve clinical outcomes for the benefit of patients.

Patient Reported Outcome Measures (PROMs) are questionnaires completed by patients to assess their health status, symptoms, and quality of life before and after procedures, primarily to measure the success of care from the patient's perspective. This includes tracking surgical recovery, monitoring clinical progress, and ensuring high care standards. Data provided for 2025 showed 598 PROMs were collected out of 744 patients (80% participation).

There were no inpatient readmissions to the provider for the previous 12 months prior to our assessment for total hip and knee replacements.

The effectiveness of the physiotherapy service was monitored by monthly audits which were reviewed by their peers and reviewed quarterly by managers. The physiotherapy team received thanks from patients for their good recovery following subsequent physiotherapy sessions after surgery.

Patients told us they were informed of their next steps for recovery and follow up care. They spoke positively about the quality of care and treatment they received.

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

The service had a consent policy which was up-to-date and provided patients with written information about the consent process prior to attending appointments. Staff received training in consent.

Staff also received and kept up to date with mandatory training in the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS) and knew where to access current polices. Staff understood how and when to assess whether patients had capacity to make decisions about their care.

The consent process was discussed during outpatient appointments and again prior to surgery. The consultant surgeon met patients before surgery to ensure appropriate consent had been obtained. Consent was again confirmed as part of the world health organisation (WHO) checklist followed in theatres.

We observed a complete patient pathway from ward to theatre and then to recovery with good communications between all staff and patients. Handovers were well documented and consent was obtained and documented at every stage.

The consent process was also audited to ensure it was safe and to verify patients were informed prior to procedures. Auditing validated compliance with standards and identified any improvements in communication if required.

Chaperones were provided if requested.