Nuffield Health Leeds 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

People told us care was coordinated and staff worked well together to meet their specific needs. Peoples individual preferences were considered. Staff understood the diversity of the population accessing care in the service. People were encouraged to provide feedback and to express their wishes about care and future planning. People understood how to make complaints. However, complaints were not always investigated appropriately with full involvement of people. Information was not always available in an accessible format. There was no process in place to ensure equity in access to services or in experiences and outcomes. Care plans we reviewed were not personalised to the individual but were aligned to the procedure, treatment or clinical pathway, in which the patient was to be admitted.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people we spoke to told us they had been involved in discussions and decision making regarding their care.

Care plans focused around the procedure or surgery undertaken but were not designed to allow for documentation of individual needs. For example, preference for management of pain following surgery. Staff told us they acknowledged the care plans were pathway focused and some adaptation was necessary to ensure all needs were individualised.

People we spoke to during inspection told us they felt their care needs were joined up and supported individual choice. These views are limited to those we spoke to during inspection and may not reflect views from the full diversity of the community.

Staff we spoke to gave us examples that demonstrated an understanding of some of the diverse needs of the people receiving care. For example, we heard from admin and nursing staff about adjustments that would be made for people with reduced mobility, requiring a quiet space to wait or for breast feeding mothers.

Local network partners told us the service was involved in identifying the needs of the local population and were active in finding ways to work in partnership to support the needs of the local population. For example, through offering a free joint pain programme for local general practitioners to signpost patients to.

Some staff told us that there was no clear standard operating process for checking individuals needs when booking appointments. We reviewed content of call audits and found that an accessibility question was included in the requirements for booking calls.

People were able to access information from the website regarding a range of surgical procedures. The website also provided an option to request further information from the service. There was no option available to request information in differing formats on the website.

There was an information booklet available for children about surgery in an illustrated format.

Staff told us interpreters would be booked as required. This meant information could be provided verbally in a range of languages. However, the need for an interpreter relied on the appointments booking team making a note at the top of a patients notes or referral form as staff told us they were not aware of a standard process or place to record this need.

The service did not have a clear process in place to ensure provision of appropriate, accurate and up to date information in formats that were tailored to individual needs as identified in the Accessible Information Standards (AIS).

People we spoke to were aware of how to make a complaint and how to provide feedback. We reviewed concerns, complaints and incidents but did not see active engagement of patients in learning from safety incidents or complaints.

Staff and leaders told us about patient forums for children and young people, patients who had received care on the coronary care unit after surgery and general patient forums. These forums were aimed at seeking feedback from all patient groups. Leaders recognised that attendance was low.

We reviewed minutes from patient forums and found these minutes referred to meetings attended during late 2022 or 2023. Therefore, we heard no recent examples of how learning from such forums had been put into place. There was no clear process that ensured people were kept informed about how their feedback was acted upon or to continually involve them in shaping service improvement and measure impact.

There was a complaints policy in place. We reviewed the complaints log and saw that patients had opportunity to discuss their concerns with members of the medical team as appropriate or members of the senior leadership team. The complaints log had a section for identifying any learning for complaints. Out of 153 concerns raised we saw that two were recorded as ‘yes’ and two recorded as ‘no’ for any learning. There was no detail regarding the learning from these two and no confirmation regarding whether there was any learning from the other 149 concerns. We were not assured that learning from complaints and concerns was always seen as an opportunity for improvement.

We did not speak to any patients who identified themselves as having additional needs, however, there were no clearly identified processes in place to support equity of access for patients.

People were able to choose appointment times to suit them.

The hospital was accessible with ramp access to the main entrance and lift access from the parking area. However not all people were able to access the limited parking spaces - this was dependent on how care for each individual was funded and some people were advised they would need to seek parking offsite in the local area.

Hearing loops were in place.

Additional dementia friendly clocks and signage had been put in place following a PLACE audit carried out in October 2023.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care. Staff were able to give us examples of how they would make reasonable adjustments for patients with additional needs. Staff told us that they provided support or reasonable adjustments based on the advice of staff with their own personal experiences whom were then viewed as experts. For example, staff who had personal experiences of autism.

There were no processes in place to ensure the provider prioritised or allocated resources to tackle inequalities and achieve equity in access. There was no clear recognised process for identifying staff as experts or leads. There was limited signage supporting equality, diversity and inclusion within the building, for example we did not see any rainbow signs in support of people from the LGBTQ+ community. We reviewed a PLACE audit carried out in October 2023. This audit identified that no access audit or review of reasonable adjustments had been carried out in the last two years.

Staff told us they aimed to provide a positive patient experience and protect peoples rights by promoting equality and removing barriers. This was often through use of staffs own experience and knowledge rather than through an established proactive method of seeking out ways to address barriers to improve peoples experience and outcomes.

Staff told us about autism training that had been completed. Staff demonstrated to us that they were alert to discrimination and inequality. Staff provided examples of adjustments they might make for people to ensure equity in experiences, for example, adjusting the theatre recovery environment for people with sensory needs.

Staff were provided with equality and diversity training. Staff also completed autism awareness training.

Most people we spoke to felt they were able to make informed choices about their care and plan their future care at a time that they were able to.

End of life care was not a routine provision and was not reviewed during the assessment of the service. Staff and leaders told us that future planning of care for rehabilitation following on from surgery was considered.

Physiotherapy staff and out patient teams had processes to allow for follow up care after surgery taking into account peoples wishes and goals. There was a process to support consideration of referrals for occupational therapy for people with complex care needs.