Nuffield Health Exeter Hospital

On this page

• 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 knew and understood the provider’s vision and values and how they were applied in the work of their team. The service promoted equality and diversity in daily work and provided opportunities for career development. There was an open culture where patients, their families and carers as well as staff could raise concerns without fear.

Staff reported the leadership culture was inclusive and they felt valued and respected. Relationships between staff of all grades were positive, with strong teamwork and collaboration. Staff said the senior leadership team was visible and talked to teams.

Leaders spoke to us about the importance for staff to develop skills and were supportive of staff to seek development opportunities.

Team and individual staff achievements and successes were recognised and celebrated. Staff were thanked for their work. Service leads recognised staff’s work and contributions daily during daily huddles (meetings).

Benchmarking included monthly comparisons with other Nuffield hospitals regarding adverse events, transfer data and patient satisfaction surveys.

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 to perform their roles with a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

All the staff we spoke with told us they were well supported by their senior leaders and were confident in how they led the service. Staff told us senior leaders of the hospital were visible and approachable for patients and staff.

Leaders responded to staff and patient feedback. Leaders took incidents seriously and knew how to respond to concerns when raised by staff which promoted a positive culture in the service.

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

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and the culture allowed staff to be confident their voices were heard.

We observed freedom to speak up (FTSU) posters around the hospital. There was a FTSU policy which identified roles and responsibilities of staff and provided guidance about raising concerns. Staff had access to 2 FTSU guardians and knew who they were. Staff told us they would approach their line manager about any concerns first but knew they could also approach the FTSU team.

Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported. Staff were confident leaders would investigate concerns sensitively and confidentially. For example, concerns raised regarding compliance with completing electronic forms were responded to by leaders. Data was collected and reviewed by local and regional managers at regular intervals.

The provider’s website detailed how people could raise concerns and how they would be investigated. There were complaint escalation routes for private and NHS funded care. Staff were encouraged to respond to immediate concerns or complaints with a view to resolution. There were policies to support the complaints process.

Staff received training in FTSU and records showed 90% of staff had completed training.

The service gathered staff views with 6 monthly staff surveys. 80% of staff participated in the last survey. Leaders had set up action plans for each department to respond to survey themes.

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 equality, diversity and inclusion (EDI) policy was in date and leaders worked to create an inclusive working environment. Leaders promoted equality of opportunity and experience for the workforce within the workplace, and throughout their employment. There were opportunities to apply for project work, new roles and to undertake external studies through an open application process.

The service acted to prevent and address bullying and harassment at all levels and all staff. There was a focus on those with protected characteristics under the equality act and from excluded and marginalised groups. Staff with disabilities were offered reasonable adjustments to support them. For example, adjustments were made to enable staff with visual restrictions to carry out their roles.

The provider had colleague networks for specific groups to share experiences.

The hospital provided a room which could be accessed by staff wanting to pray or have space for quiet reflection. This doubled as the wellbeing room.

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.

Leaders described structured internal processes for business case approval and escalation. The service operated effective governance processes through various committees and on-site activities. There was a range of information collected, monitored and communicated internally at relevant committee meetings and fed upwards to the provider. Performance data was analysed and compared within the provider organisation and where improvements were needed at the location level, action plans were developed to enable this.

There was a medical advisory committee (MAC) led by a chair and supported by the service leadership, which included approval of practicing privileges and review of clinical outcomes of individual doctors. If there were any concerns about performance, there were processes to follow and if necessary, information would be shared with professional bodies. The committee was a group of senior doctors and consultants responsible for clinical governance, patient safety, and advising senior management on medical standards. The MAC chair told us there was good consultant engagement with this committee.

We reviewed 3 consultant practicing privilege files and saw there were effective governance processes to ensure consultants submitted the necessary documentation to ensure safe care for patients. Practising privileges were reviewed every 2 years and allowed medical professionals to provide specific clinical services within the organisation without being directly employed by the organisation.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions and these set out expectations and responsibilities. When senior staff had designated tasks related to audit and monitoring quality of services, they understood what was required of them.

Staff could find the data they required in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.

Leaders ensured accurate information was discussed and shared with key staff. There was a risk registers and risks were clearly identified and formal logs were used to keep oversight and manage mitigations and/or bring to resolution. Staff contributed to decision-making to help improve sustainability and improve quality of care.

Audit processes and outcomes were used to ensure the quality of services was maximised. When improvements were required, leaders ensured action plans and the monitoring of these led to positive changes.

The service had not reported any data breaches and systems were secure. Patient identifiable information was handled correctly.

We reviewed several service level and provider policies which were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of policies.

The service had a business continuity plan which could be put into operation in the event of unexpected disruption to the service, this included a short-term disruption plan and major incident plans.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. The audit dashboard for October to December 2025 showed 94 to 100% audit completion compliance, such as the endoscopy safety checklist audit and the consent to examination audit.

Staff had implemented recommendations from reviews of deaths. The organisation held quarterly review meetings (morbidity and mortality) to discuss any themes or trends, good practice or recommendations.

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

Staff and leaders collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service. There was a contract with NHS England (NHSE) and the senior management team worked with commissioners to support waiting list initiatives for NHS patients. The booking team worked with the NHS to support reducing the NHS backlog for orthopaedic patients. They worked with consultants to identify urgent patients and ensure they were booked appropriately.

Safeguarding learning links were part of the governance culture. Leaders linked into commissioners’ safeguarding updates and attended local training and networking.

Some senior leaders were part of regional networks to help understand the needs of the community and the provider ambitions.

Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

The hospital ran free of charge events where the public could attend presentations on a variety of health topics. These could be booked on the provider’s website. The hospital also had a programme of charity events to support their chosen charity of the year.

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 were committed to continually learning and improving services. There were processes for learning when things went wrong or of good practice, both locally and nationally.

Ongoing development included the recruitment of a new breast surgeon to enhance breast services in response to perceived local gaps (including an adjoining county), and development of a separate endoscopy recovery area.

The service was the first hospital outside of London to use the advanced robotic-arm to assist in surgery and we saw staff skills in advanced robotic-arm assisted surgery.

The service was participating in a research project with the local NHS hospital to help speed up the diagnosis and treatment of bowel disease.

The service’s infection prevention quality review tool 2025 listed good adoption of sustainability initiatives such as recycling in clinical and non-clinical areas and re-usable sharps bins.

The senior team were developing a five-year plan focused on capacity and service development, including moving to more day-case capacity with a day-case suite rather than using inpatient rooms.