Nuffield Health Leeds 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

Peoples needs were assessed and care and treatment was delivered in accordance with best practice and national guidance. Staff, teams and services worked in harmony with people at the centre of their care. Staff were proactive in ensuring people received care that was individual to their needs and handovers between teams were comprehensive. Staff understood the need to gain peoples consent to care and treatment following a recognised process. However, consent was not always completed in line with guidance. There were not always processes in place to ensure care, support and treatment reflected the needs of those with protected characteristics.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients we spoke to told us they were asked about their additional needs and chaperone requirements. One patient told us the kitchen staff had been very attentive in managing their food allergy.

Patients were able to self-refer or access services through the National Health Service (NHS) electronic referral choose and book portal. At this initial entry stage, all patients completed a health screening questionnaire, which was reviewed before submission for consultant review. This included assessment for suitability of procedure and initial consent. We saw information obtained from patients General Practitioners (GP) to ensure all known risks were identified prior to admission. Managers told us a comprehensive suite of documents were completed for each patient, depending on their procedure and risk associated with this procedure. Staff told us that patients with specific risks or complex health conditions would be further discussed as part of a multidisciplinary meeting to ensure suitability for surgery. We reviewed 3 patient records and saw these had been completed fully. However, we saw a number of incidents relating to patients where consent had not been correctly gained. We did not see an action taken by the provider to prevent future errors.

Children accessing services also received pre-operative assessment processes. Ward staff told us patients experiencing anxiety or required additional support during surgery would be allocated additional time throughout these processes.

Paediatric nurses told us they used the Paediatric Early Warning Scores (PEWS), as part of the post operative care.

The provider shared an inclusion / exclusion criterion at the time of inspection. This outlined the adult general anaesthetic / spinal guidance for the service. It was used to determine which patients were suitable for surgery and to avoid last minute cancellations. The standard operating process outlining the criteria stated that it would be reviewed quarterly or as required in the event of new guidance or a relevant adverse incident. The issue date was January 2023. We did not see evidence of alterations to this procedure following reported incidences of haematoma in patients with a known bleeding risk.

We asked leaders how patients with specific needs such as a learning disability or autism would be supported but managers were not able to identify a clear process for understanding the potential requirements for these patients.

Recent audits carried out by the provider showed high compliance scores. For example, we reviewed results relating to documentation and PEWS scores, which showed a 96% compliance score along with pain and medication scores which were 90%.

We did not seek direct feedback from people regarding this quality statement. However, we reviewed audit scores regarding fluid management. We saw that these scores were low at 74% in quarter one, 78% at quarter two and 85% in quarter three for the wards. We saw evidence in team meeting minutes that this had been discussed with staff and additional support offered to any staff who felt they required it along with additional spot checks to monitor this.

We saw that processes were in place to ensure people received care and treatment that was evidence based, however, did not see any recent evidence of additional learning or service development in relation to new research or evidence-based practice within the surgical teams.

Leaders told us there was a national lead for evidence-based practice and the service would be directed by information received from the national lead. We heard there were quarterly governance meetings that would allow time for discussion regarding any new evidence-based developments. We also heard there was a consultant in post who acted as evidence based lead.

Physiotherapists told us about a proactive approach to review of National Institute for Clinical Excellence (NICE) guidance and identifying need for changes in practice based on available evidence.

We reviewed team meeting minutes and saw there was a standard agenda item for review of any new service specific guidance from NICE or other evidence-based guidance. We saw that there was a NICE tracker in place to ensure the service was able to keep up to date with NICE guidance.

Mentors and buddies were also allocated to new staff to ensure completion of clinical competencies were completed, which were aligned to NICE guidance and other evidence-based practice.

Staff and leaders had the opportunity to learn about new and innovative approaches that evidence shows could improve the way the service delivers care. These discussions were held through the clinical effectiveness meetings.

Patients receiving care during our inspection had positive experiences of staff working together as a team to provide their care.

Staff told us their teams worked effectively together to meet the needs of people. We heard transitions were planned in advance, for example, the need for transition to the critical care unit after surgery for patients who were known to benefit from this additional level of care.

We reviewed incidents where there had been transfers out of the service. We saw these transitions had been managed well.

We observed a morning brief which was attended by heads of departments, and members of the senior leadership team. The brief outlined operational plans for that day, including patient activity, operational pressure points, on call arrangements and any incidents or issues which may affect patient care and delivery. Each department was able to feedback any concerns for the day. Numerical grades were used by staff to indicate how prepared the department felt. For example, 4 indicated feeling good.

Each department held a briefing at the start of each shift. We reviewed the inpatient morning briefing in which every patient was reviewed and surgical priorities were established for each day. We saw staff engaged fully with these processes and liaised with each other to ensure patients journey and surgical experience was maximised. For example, ensuring patients pre surgical scans and blood tests were completed.

We saw physiotherapists ensured care was delivered in a way that met assessed needs through provision of identifying needs at a pre-assessment appointment and follow up care post-surgery.

We did not speak to people directly about support to live healthier lives, however we saw people were provided with a range of leaflets and information through access to QR codes on living healthier lives. There was also information displayed on TV screens in outpatient waiting areas.

Gym membership was offered for patients waiting on elective care lists at the local NHS trust as a way of managing and optimising fitness whilst waiting to be offered an appointment.

Discharge letters were completed on discharge following surgery. We saw examples of these letters from one surgeon including links to websites for suggested patient reading on living healthy lives following surgery.

We saw limited evidence of effective approaches to monitor peoples care and treatment and their outcomes. However, we did see the limited data was recognised by leaders and there was a newly implemented digital collection system that went live in June 2024.

Staff shared details of audits that were regularly completed and outcomes from audits used to identify actions. These included specific audits relating to clinical areas of practice and PLACE (Patient-Led assessment of the Care Environment) audits.

We heard the service had an action plan in place to achieve JAG (Joint Advisory group) accreditation by June 2025. This is a quality assurance framework set up to meet endoscopy assessment standards.

There was a hospital wide quality improvement plan in place. We saw some findings from outcome monitoring were included on this plan as actions for improvement. Senior leadership took responsibility for the plan and heads of departments had access to it for sharing more widely with staff teams.

Data was bench-marked across the wider Nuffield Organisation and reported through board meetings.

The provider submitted data to the Private Healthcare Information Network (PHIN). We reviewed the latest published data, which showed the hospital was performing as expected for all submitted quality measures. These included revision rates, readmission and 90-day mortality indicators.

People we spoke to during inspection told us they had been fully informed regarding their rights. Their views and wishes had been taken into account when their care was planned. We reviewed incidents and found examples of cancelled surgery including: consent was not clear; there was no interpreter booked for ensuring consent; patient had felt pressured to make a decision; patient consented for incorrect surgery; theatre lists not matching consent lists and not enough time allowed for consented surgery, therefore planned later patient cancelled.

Staff we spoke to understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before surgery following the consent policy. Theatre staff we spoke to felt able to challenge surgeons if they felt consent was not fully gained according to policy.

There was a consent policy. We reviewed consent forms during our inspection and found that some forms were completed fully and in some the required second stage of consent was not always completed. This was highlighted to the senior leadership team at the time of inspection. There were consent audits in place for ongoing monitoring.

We saw that incidents were reported where there were concerns regarding consent processes not being followed. We saw evidence that surgery would be cancelled if it was not possible to gain appropriate consent, for example where there was no interpreter present when required.