Nuffield Health Hereford 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 that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient were at the centre of their care. We also looked for evidence that 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 has remained good. This meant patient’s outcomes were consistently good, and patient’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 patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 10 care records for evidence of completion of care plans and risks assessment of patients and found that all were complete, holistic, personalised and well documented.

We reviewed the pathway for people who were admitted for elective orthopaedic surgery and any other procedures on the NHS choices route, as well as self-pay/insured patients having other surgical procedures.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

Staff completed a comprehensive health assessment of the patient in a timely manner at, or soon after, admission. Staff developed care plans that met the patient’s needs identified during assessment.

Care plans were personalised and holistic. We saw examples in the record review of staff completing care plans that included all aspects of the patient’s life relevant to their inpatient stay and discharge. We reviewed 10 care plans and saw these were tailored to individual needs and circumstances.

The service planned and delivered patient’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance to staff.

Polices and processes took account of changes to the Royal Colleges and National Institute for Health and Care and Excellence (NICE) guidelines.

The service was part of a larger organisation that delivered care and treatment nationally. Policies and procedures were standardised across the services for staff to follow locally. All policies we looked at were within their dates for review. These covered a range of healthcare needs to support care delivery.

The service participated in a range of internal audits that were benchmarked within the organisation with learning shared across all locations.

The service participated in a range of local audits that focused on patient risks and ensured treatment was in line with best practice. These included: national early warning scores (NEWS2) observation audits. NEWS2 is a system used in healthcare to standardise the assessment of acutely ill patients and identify those at risk of deterioration.

As part of the National Joint Registry (NJR) there was a process in place to record all implants. Paperwork was completed at the time of insertion of an implant and was documented on the NJR by theatre staff. The service also participated in the breast implant registry, this records the details of any individual who has undergone breast implant surgery, so that they can be traced if needed.

Staff used surgical pathways which were in line with national guidance. This included integrated care pathways specific for a day case procedure. National Safety Standards for Invasive Procedures (NatSSIPS) were available in the theatre department. NatSSIPS provide a framework to produce Local Safety Standards for Invasive Procedures (LocSSIPS). We saw the service had a LocSSIP for the safe standards for invasive procedures, created for the Nuffield Health group. It had been recently updated in line with 2023 guidelines.

The service completed audits of the pressure ulcer risk primary or secondary evaluation tool (purpose-t) which is a tool to help healthcare professionals identify adult patients at risk of developing pressure ulcers (bed sores) by assessing mobility and skin condition.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition and used this to inform care planning and delivery. Patients requiring special diets for clinical reasons, were assessed and advice given. The service completed audits of the malnutrition universal screening tool (MUST). This is a five-step tool used to identify patients at risk of malnutrition and provide support to improve nutritional status.

Staff fully and accurately completed patients’ fluid and nutrition charts where needed. The information was used to inform care planning and delivery. We saw posters in the ward area promoting and embedding knowledge around the importance in documenting a patients fluid balance. Patients waiting to have surgery were not left nil by mouth for longer than necessary. Intravenous fluids were used to ensure pre-operative optimisation for surgery, when needed.

The service reported information to the Private Healthcare Information Network (PHIN). Intelligence reports were reviewed by service leaders. These reports contained data on PHIN’s existing performance measures, including; patient activity volumes, length of stay, never events, Patient Reported Outcome Measures (PROMs), infections and also data submission levels. In addition, it also includes complaints data that the hospital receives from private insurers.

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

The resident doctor and consultants, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. We saw and heard examples of effective team working which was based on mutual respect and trust.

The provider had introduced Multi-disciplinary (MDT) meetings twice weekly to discuss complex pre operative patients to help prevent cancellations. These meetings were attended by, the heads of each department, consultant anaesthetist and the pre assessment lead.

There was a twice daily huddle for all heads of departments and the senior management team to share any information relating to incidents, complaints, high risk patients and risks within their service for that day. These were carried out in the morning and evening.

Service leads told us that learning was shared between the hospital and external services such as GPs and other NHS hospitals.

We observed good working relationships between the pre assessment team and anaesthetist. They held multidisciplinary team meetings to discuss patients’ suitability for surgery and considered options to keep patients safe from harm. Staff had a good relationship with the consultants and anaesthetists and were able to call them for advice when required.

There was effective MDT working between the physiotherapists and other health professionals involved with patients undergoing surgery. The teams worked together to prepare patients for what to expect post-operatively and when they returned home.

Plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Discharges were planned at an early stage to ensure they were safe and appropriate for the person’s needs.

Information was shared between teams and services to ensure continuity of care. Multidisciplinary reviews and meetings were held for some specialties, for example in cancer care, the service would link into the local NHS trust.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, they held monthly meetings with the NHS providers and produced quarterly reports detailing learning, outcomes, and establishment updates.

Peoples’ records showed there was input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways. Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care.

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

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control. Staff supported them to live healthier lives and where possible, reduce their future needs for care and support. For example, patients attended a pre-operative assessment appointment where their fitness for surgery was checked. Staff asked patients a series of questions about their lifestyle such as smoking and drinking. Patients were given advice about smoking cessation when required.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health.

The service monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff monitored the effectiveness of care and treatment through audit and benchmarking to compare with similar services. The service used the findings to make improvements and achieved good outcomes for patients. The service participated in relevant national and provider led clinical audits, including the Private Healthcare Information Network (PHIN) and patient reported outcome measures database (PROMs). Overall Nuffield Hereford performed well within the expected safe range, with good patient-reported results for National Joint Registry (NJR) and PROMs.

The service had been accredited under relevant clinical accreditation schemes. The NJR data for April 2024 to March 2025 showed a total of 1748 total procedures were undertaken. There were no outlier alerts. The service was awarded the Gold Standard Award by the NJR for 2025.

Outcomes for patients were positive, consistent and were in line with national standards. Clinical audits and risk assessments were carried out to facilitate this. The hospital participated in some national audits to monitor patient outcomes including the elective surgery Patient Reported Outcome Measures (PROMs) programme and the National Joint Registry (NJR).

PROMs data for 2025-2026 hip replacements showed that they had excellent outcomes with a 96-97% improvement, which was above the UK benchmark for hip replacements.
PROMS data was collected for patients who underwent shoulder surgery using the Oxford Shoulder Scores tool. This tool was developed by researchers from the University of Oxford and is widely used to assess outcomes of shoulder surgery.

The service had a low number of readmission's for patients having elective care and, from March 2025 to March 2026, there were 2 unplanned returns to theatres.

The surgical site infection rate was low. The service had a low surgical site infection (SSI) rate with 9 recorded SSI’s within the 12 months prior to our inspection. These incidents did not meet the threshold to report and were classified as either no or low harm to patients. Staff carried out a full root cause analysis for all readmission and return to theatre patients and discussed these during the infection prevention and control committee meetings.

The provider considered health inequalities and took steps to ensure that outcomes across people with protected characteristics were in line with the wider community.

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

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the services policies related to consent, mental capacity, deprivation of liberty and restrictive practice, as relevant.

The service had started ‘consent’ appointments. These were when a patient needed more time to go through the procedure and make an informed decision. Staff gained consent from patients for their care and treatment in line with legislation and guidance. Consent for surgery was sought by the most appropriate doctor and included discussion about the benefits, potential complications, the risks and alternative options. Patient consent was checked at various points before they went to the operating room and immediately prior to surgery. There were consent audits completed and outcomes shared with staff.

There was a consent policy and when patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions. They would involve the patient’s representative and other healthcare professionals. Staff told us most patients admitted had the capacity to make their own decisions. Patients who lacked capacity were identified during the pre-operative assessment process, where it was determined whether they could be admitted for treatment at the hospital. Patients said they were involved in decision making about their care and treatment. They could describe the risks and benefits they were told about prior to surgery.

Staff had training on the Mental Capacity Act 2005; 100% of staff were compliant with this training.

We observed staff seeking verbal consent before providing care or treatment. People were involved in decision making at all levels.

Where specific requests had been made by patients, for a same sex health care professional or theatre team, this was discussed and provided whenever possible. Chaperones were provided if requested.

Interpreters were used to support patients to give informed consent, including, British Sign Language interpreters for face to face appointments when necessary.

Staff sought permission before sharing patient information with family or friends.