Nuffield Health Hereford Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that patients and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of patients and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that patient could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question good. This key question has been remained as good. This meant patient’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service made sure patients were at the centre of their care and treatment choices and they decided, in partnership with patients, how to respond to any relevant changes in patient’s needs.

The service had systems to support patients with complex healthcare needs, sensory loss, mental health, learning disabilities and dementia. Staff were able to access support through the providers intranet and local facilities. Staff are trained in equality, diversity, inclusion and human rights.

Staff could access a range of documents to support patients with additional needs, including a passport, ‘this is me,’ a hospital communication booklet and a poster: ‘which language do I speak?’. The provider shared a recent example with us of how a patient with a hearing impairment was supported through their surgical pathway.

The ward area was designed to meet the needs of patients. Each patient had their own room with a bathroom. Patients were given a choice of food and drink to meet their cultural and religious preferences.

Managers made sure staff, and patients, families and carers could get help from interpreters or signers when needed.

We reviewed 10 patient records and care plans to assess how staff gave choice and involved individuals in decisions. For example, during our onsite assessment, we spoke with patients who told us they had been involved in their care and treatment and involved in decision making. We were told there was good support from the physiotherapists regarding discharge readiness.

As per Royal College guidelines private or self-pay patients were told about and knew all the planned and possible costs, including the costs of future surgery and dealing with possible complications. When a patient was responsible for paying the costs of their care or treatment (either in full or partially), they were provided with a statement specifying the terms and conditions in respect of the services to be provided, including as to the amount and method of payment of fees. Where possible this was always provided in writing prior to the commencement of the services.

Each patient had their own room with a bathroom. Patients were given a choice of food and drink to meet their cultural and religious preferences.

All patients were made aware of the arrangements the hospital had for emergency provision and intensive care. This was usually included in the pre admission information.

The service understood the diverse health and care needs of patients and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service planned and provided care in ways which met the needs of local people, and the communities served. They worked with others in the wider system and local organisations to plan care where relevant. For example, leaders had met with other organisations, such as the local NHS trust, local churches and gymnasiums to discuss specific needs in their area.

The service provided care to NHS patients and those who self-funded their care. NHS patients were referred from local areas through an electronic referral service (e-RS), whereas self-funded patients may be from a wider geographical area. The e-RS is an online system, where once the patient has been referred to a specialist consultant by their GP, they can choose from appointments at different hospitals.

Following staff handovers, nurses were allocated patients to care for. Where possible, nurses were allocated the same patients, providing a point of contact for the patient and continuity of care during their stay. The nurses name would be on a board in the patient’s room, also staff introduced themselves on their arrival to the ward.

The service had reached out to a number of organisations such as GP’s but also local schools, mosques, local churches and social clubs to widen the work and services they could offer to local communities. The service was located in a rural area and provided care and treatment to people in the locality.

Managers ensured that patients who did not attend appointments were contacted to make alternative arrangements.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

A range of information was available to patients, including leaflets on various surgical procedures, investigations and advice for maximising their health. We asked if information was available in alternative languages and were shown how required leaflets could be produced. Information was also available on the services website and there was a member of staff with responsibility for keeping all information updated.

The pre-operative assessment, ward care and theatre records were all within a booklet, that was kept in the patient records. This meant all healthcare professionals could follow the patient pathway clearly and has access to all records.

Staff were aware of how to use and store confidential information. Staff had to complete mandatory information governance training; 97% of staff had completed this on the ward and 96% of staff were compliant in theatres.

The hospital submitted data to the Private Healthcare Information Network. They also collected Patient Reported Outcome Measures (PROMs), data for certain surgical procedures, such as hip and knee replacements. The service is also required to submit notifications into the Care Quality Commission, which is held evidence to show that they complied with this requirement. A notification is a formal communication required by registered providers regarding specific changes, events, or incidents that affect their service or the people using it.

The information provided was in a form accessible to the particular patient group, such as, patients planned for a hip replacement.

Staff ensured carers and families were regularly updated about the patient’s progress, if the patient consented to this.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Leaders told us patients knew how give feedback about their experiences of care and support, including how to raise any concerns or issues and could do so in a range of accessible ways. People, their family, and carers could feel confident that if they complained, they would be taken seriously and treated compassionately. Staff involved patients in decisions about their care and told them what had changed as a result.

Complaints or concerns were investigated thoroughly, and patients received a response in good time. Complaints were dealt with in an open and transparent way, with no repercussions. We reviewed records and investigations of formal complaints and noted they had been fully investigated and responded to within the time frame set out in the local policy.

There had been 6 formal complaints in the last 6 months, 2 of these were upheld. Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint.

Managers shared feedback from complaints with staff and learning was used to improve the service. We saw clear actions implemented following the complaints received in the service. For example, a patient had raised concerns that could not get hold of anyone over the weekend for advice regarding post operative pain. The consultant and anaesthetist had meetings with the clinical governance lead, director for clinical services and the ward manager. The minutes from these meetings were discussed with the patient and learning was actioned regarding communication at weekends.

Leaflets were available to indicate how to submit feedback, including signposting to the Parliamentary and Health Service Ombudsman (PHSO) for NHS patients and Independent Sector Complaints Adjudication Service (ISCAS) for self-funded patients.

There had been no confirmed cases escalated to the Parliamentary and Health Service Ombudsman (PHSO) or Independent Sector Complaints Adjudication Service (ISCAS).

Learning from complaints and concerns is seen as an opportunity for improvement and leaders could give examples of how they incorporated learning into daily practice. For example, following a complaint regarding lack of communication once at home, the hospital looked at the out of hours process for contacting patients once discharged, and ensured staff were allocated at weekends to provide this service.

When patients complained or raised concerns, they received feedback. This would be done verbally, or if the patients preferred face to face, a letter would always be sent after these meetings and the investigation.

Staff protected patients who raised concerns or complaints from discrimination and harassment. Staff knew how to handle complaints appropriately. We saw evidence of this through meeting minutes and the complaints log. Staff received feedback on the outcome of investigation of complaints and acted on the findings.

The service made sure that people could access the care, support and treatment they needed when they needed it.
People could access the service when they needed to and received care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards (NHS patients via the choose and book). Where there were large waiting lists, these were monitored and reduced over time.
Managers monitored waiting times, where this was necessary and made sure patients could access services when needed and received treatment within agreed time frames and national targets. The hospital staff managed the bed occupancy and patient flow well.
Managers worked to keep the number of cancellations to a minimum. When patients had their appointments or operations cancelled at the last minute, managers made sure they were rearranged as soon as possible.
Managers and staff worked to make sure patients did not stay longer than they needed to. Staff planned patients’ discharge carefully, particularly for those with complex mental health and social care needs. Staff liaised with GP’s and community services when patients had complex needs.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service monitored patient access and outcomes to identify potential health inequalities. This information was used to inform service planning a delivery. There were systems and processes for gathering feedback which enabled collection of information about equity of patient's experiences and outcomes.

We saw information which showed the provider had undertaken equality impact assessments, to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff are trained in equality, diversity, inclusion and human rights. Compliance for the surgery service was 98%.

Staff could access a range of documents to support patients with additional needs, including a passport, ‘this is me,’ a hospital communication booklet and a poster: ‘which language do I speak?’ The provider shared a recent example with us of how a patient with a hearing impairment was supported through their surgical pathway.

The provider shared examples with us of how patients had experienced person-centred care and reasonable adjustments had been made to support their surgery at the hospital. Care plans were individualised with patients feeling positive about the care and treatment they received.

People who did not speak English as their first language could access the service. Staff had access to interpret services by telephone.

Discharge arrangements optimised the outcomes for all patients, including those with protected characteristics. Where necessary, carers and community services were involved to encourage and support a return to the patient’s pre-admission condition.

Patients were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Patients were supported to make informed choices about their care and plan their future care, with the support and involvement of their family or carer if they wished.

Staff discussed health lifestyles for going home and recovery from the patient's operation. They reinforced key information and gave written advice based on current best practice.

Patients who had undergone surgery that altered their body appearance or functions permanently, were provided with access to ongoing support and advice for managing their condition.

Discharge summaries were given to the patient to take home and for their GP and follow up appointments were made before discharge.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.