Nuffield Health York Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Staff were kind, caring and compassionate. Hospital staff took account of young people’s personal, cultural, social and religious needs. Staff always offered young patients’ choice within their treatment plan, supported their independence and involved them in decision making. Hospital staff communicated effectively with young people to anticipate their needs and respond to them quickly. The hospital offered all staff extensive support and wellbeing resources and initiatives.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service accommodated one young school-age patient with autism by booking them last on their list for that day. This meant the patient and family did not feel anxious or rushed as no other people or visitors were waiting. CQC reviewed the hospital’s patient satisfaction surveys from January to April 2024. However, none gave CYP specific feedback, but included young patients on an adult pathway.

The service had supported a young patient with autism who needed to visit a paediatrician. The hospital provided the patient and their parent with a sensory pack of photos of the department and consultant’s room to put them more at ease. This meant the patient was more prepared for their visit and the parent was happy with the hospital’s response. Staff planned to offer this to future young patients with autism or a learning disability.

We saw staff maintaining young people’s privacy, confidentiality and dignity during procedures, and treated them with respect. For example, staff offered young patients blankets, chaperones, and always sought consent to do anything, especially when it involved an examination.

The service was flexible to allow young people to attend alone if they preferred on the adult pathway. The service tailored care and made reasonable adjustments to meet the individual needs of CYP. For example, one recent patient with autism had a teddy bear for comfort and to help calm them during a diagnostic scan. Staff had the capacity, time and space to provide holistic wraparound care to young patients. CQC spoke to the parent of one child patient who attended the service for an outpatient appointment. The service provided the parent photographs of the areas her daughter would be visiting, which included reception, outpatients and the actual consulting room together with photos of the staff and consultant who would be on duty. The parent was very thankful staff took action and provided information.

The hospital had put in place a pathway for young patients with autism, with help from their parents and lead staff member who had a son with severe autism. They sought help and guidance from the autism society, but did not see enough patients with autism to be granted a licence. The provider’s equity specialist had plans to create a neurodiversity hub with toolkits to support hospital leaders.

Young patients on an adult pathway could access religious materials and links from the local acute trust. The hospital’s ward area had a culture box, baby changing facilities, and breast-feeding space available. Staff could access Big Word for any young patients who needed translation services. The relatives of young patients could stay at the hospital overnight if required as they had suitable facilities.

The hospital’s pharmacy allocated additional time to young people, for example those receiving a type of vitamin A used to treat acne. This gave them the opportunity to discuss any aspects of their risk assessment again. The process highlighted the patient’s choices to them with treatment, and this meant the pharmacist was satisfied the patient was aware of all risks associated with the drug. Pharmacists often explored the available dose options with the patients, so they made choices to suit their personal needs.

We reviewed the service’s ‘risk assessment for young people aged 16-17 years attending for invasive procedures including inpatient and outpatient areas (appendix 4)’. This comprised a checklist where all patient answers must be ‘yes’. Hospital staff sent this assessment to their neighbouring type A hospital site RCNs who conducted a phone pre-assessment with the patient and parent who were given all information. If staff deemed patients unfit, patients were offered a paediatric pathway at their neighbouring type A hospital, as the service prioritised patient choice. The service could provide specialist adaptive equipment to promote patients independence where needed. There were processes to ensure patients were provided with wellbeing support and advice. Young people were encouraged to have choice and control over their care where appropriate.

CYP was a set agenda item at most hospital meetings,. This prompted ward staff to discuss any young people entering the department. There were processes to ensure staff could respond to patient’s immediate needs. Hospital staff had 24-hour access to a senior children’s nurse for advice and policy development. They worked in collaboration with the local NHS children’s services network as required in the Royal College of Nursing guidance. There was evidence of good interactions with patients and their families.

We saw the surgeon completed considerations for young patient’s care around their nutrition and frailty. These were highlighted in the electronic patient record. Theatre and pre-assessment staff fully discussed, documented and summarised risks with all young patients. We reviewed a local anaesthetic surgical safety checklist. This had been fully and appropriately completed by staff.

The provider offered staff and young patients a range of mental health facilities and resources through their staff portal. The hospital had three wellbeing champions who sent regular communications and event information to staff. They could signpost other staff to appropriate resources and encouraged staff to have a conversation. Wellbeing and employee forum boards were displayed near the staff dining area, and they had plans to create a wellness room where the champions would be based. An external company could provide staff with additional wellbeing support. Staff told us they were well looked after with lots of wellbeing support.

The hospital undertook a quarterly anonymous staff survey. The latest survey in June 2024 achieved an overall engagement score of 8.0 out of 10. Results were compared across 14 categories with the previous survey in December 2023. 10 of the 14 categories scored slightly lower, with slight improvement in four categories. The heads of department (HoD) received the responses, held an answer session giving staff the chance to respond, and then devised comprehensive departmental action plans. HoD could view and review each other’s actions plan. The director of clinical services (DCS) held a 1-2-1 with all the HoD on staff morale and any areas, topics or themes for improvement. We saw the hospital’s health and safety representatives across several departments displayed along with other health and safety contacts in infection prevention, protection supervisors and manual handling trainers. The hospital had also appointed a change manager who helped to streamline intranet processes. Staff had financial and other wellbeing resources available on their employee assistance programme (EAP) hub. Staff could access health assessments to find out more about their health and wellbeing. They were given related and expert information with support available, facts and figures on the wellbeing noticeboard outside the canteen. Female staff could access free menopause advice, specialist emotional support and information through a counselling service as part of the provider’s EAP. We also saw wellbeing noticeboards outside the canteen displaying information about Men’s health week 2024, men’s mental health, erectile dysfunction, the prostate and libido, how they could speak to a therapist and other resources.