Nuffield Health York 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

Hospital staff delivered good care and treatment following evidence-based practice and young people had good outcomes. They followed and adhered to best practice guidance and standards. Staff coordinated, collaborated and shared information about young patients with partner organisations where appropriate. They promoted and signposted information and resources on health and wellbeing. The hospital had systems in place to monitor clinical outcomes for young patients. Hospital staff gained and fully recorded all young patient’s consent to care and treatment.

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 hospital’s EPRs covered and flagged any individual patient needs. Staff recorded all basic observations such as height, weight and blood pressure. Nurses carried out initial admission assessments such as Waterlow, VTE, safeguarding and nutrition scores. The service used MUST scores to determine the dietary and nutritional needs of any child patients on a surgical pathway. Leads felt a screening tool for the assessment of malnutrition in paediatrics (STAMP) was not applicable, as all their patients were outpatients unless they were on an adult pathway.

The service carried out documentation audits for a CYP patient on an adult pathway.

We heard the new national children and young people (CYP) lead in post since early 2023 was reviewing all the provider’s paediatric policies and care pathways. This was done using standardised World Health Organisation (WHO) and American Society of Anaesthesiologists (ASA) theatre staffing levels, as well as early warning scores (EWS). As the hospital treated and operated on a very small number of younger patients, these changes would apply more to the hospital’s neighbouring type A hospital.

Staff adhered to the WHO's private edition surgical safety checklist for all procedures on young patients. The checklist had standardised open-ended questions. Staff checked the surgical site marked. The surgeon confirmed time out was completed and correctly done in theatre. The team used the American Society of Anesthesiologists (ASA) grade; this was a metric to determine if patients were healthy enough to tolerate surgery and anaesthesia. The scrub practitioner confirmed any instrument sterility, and completed the final equipment count. The provider followed NHS England’s national safety standards for invasive surgery (NatSSIPS), other than for endoscopy and local anaesthetic which did not require as much detail. NatSSIPS were designed to reduce misunderstandings or errors and improve theatre team cohesion. The hospital had general and spinal anaesthetic guidance which was in date and clearly outlined the scope of any procedure involving an anaesthetic. This helped staff determine young patient’s suitability. For example, if a patient’s BMI or weight, ASA grade or age was above or below the agreed level they would be deferred or cancelled. Staff completed monthly checks by incident reporting monitoring and compliance to ensure all patients admitted were suitable for surgery at the hospital so patient safety was maintained.

The provider’s national audits were purely observational for their WHO surgical safety checklist. Theatre staff observed three WHO audits per quarter. The hospital’s latest WHO checklist compliance was 97%. The provider had appointed a new central role covering interventional radiology and outpatients. This lead role was rewriting their theatres policy. This meant radiology and outpatients staff expected future changes around ‘stop and check’, to ensure this was more embedded. Audits were also being reviewed as part of this work.

Hospital staff could seek advice and support from their neighbouring hospital registered children’s nursing (RCN) staff. Staff were aware of their limitations and could get support and advice from the RCNs and external partners. They avoided deskilling quickly in PBLS by doing simulation scenarios involving resuscitation of an infant. Nursing staff on the ward held PBLS certification and safeguarding Level 3. The hospital held a PBLS training session in the training room during our inspection. Hospital staff nominated the other hospital RCNs for an ‘working together’ award as they were so effective and responsive in following the provider’s values. This arose from RCNs going to great lengths to meet a young person's needs.

The hospital held daily safety huddles attended by a representative from each department. These covered any CYP related issues across all departments. We attended a huddle on 4 July 2024 chaired by the governance lead. The huddle followed an agenda and shared key messages for CYP services including safeguarding, feedback from parents and positive recognition for staff. We reviewed copies of the hospital’s last three daily safety huddle minutes including CYP from 5 April to 7 June 2024. Minutes noted several young patients in outpatients and the June huddle outlined a safeguarding concern around a young patient who DNA or “was not brought”. We observed good multidisciplinary team (MDT) working with other services including physiotherapy and pharmacy. MDT discussions were detailed under clinical notes on young patients’ EPRs, including with parents. Staff told us they maintained good relationships and communication between departments, teams and other provider sites. The hospital pharmacy was open weekdays from 9am to 5pm for young patients.

We saw the hospital used a private catering supplier who displayed customer notices citing the UK government’s mandatory calorie labelling regulations on all food and drink sold. This helped young patients, staff, adults and visitors make informed choices in the canteen or at vending machines. Customer information about food allergies was also clearly displayed outside the canteen. Written allergen information detailed the 14 major allergens in the ingredients. Hospital leads had ordered a noticeboard for the outpatients waiting area with relevant information such as ultraviolet radiation awareness. Governance leads had reached out to the wider health economy to share information and resources to better manage young people’s mental health.

CQC reviewed the provider’s site toolkit for a CYP initiative they had launched called ‘move together’ in June 2023. This flagship programme for young girls was free at the point of delivery, to encourage them to exercise more. Girls were paired with a personal gym trainer to deliver a bespoke fitness plan. Move together’s mission was to empower 20,000 girls to have fun and get active in their community. The provider participated in community projects and a free exercise programme with the NHS for young cystic fibrosis patients. The provider also had a young people’s wellbeing hub for children and families to access interactive wellbeing resources, from exercise videos to fun wellbeing activities and fact files. The provider had a children’s health resources page on their website. This included advice on all children’s health issues including mental health, controlling their allergies and staying calm during blood tests.

The hospital had appointed a surgical safety champion from late 2023. They had attended a relevant full day course to ensure their role was known and well understood by other staff. The registered manager told us the champion had helped enforce best practice and standardisation, for example around the surgical debrief.

The hospital had two assessment pathways in operation. One pathway focused on patient flow, as well as keeping young people well for longer. This gave them choice and control which prevented avoidable admissions. The other focused on a pre-assessment pathway. This helped staff identify medical problems in CYP which may need treatment before surgery. Both pathways helped staff deliver earlier screening, quicker risk assessments and health optimisation for young people. The service aimed to reduce length of stay, late notice cancellations for avoidance clinical reasons, as well as improve short and long-term health outcomes and quality of life for their patients.

The hospital had a suite of audits in place to monitor systems and outcomes for young patients. CYP audits were proportionate to the service’s size. We reviewed a consent audit or form review from 21 May 2024 which evidenced staff followed and recorded all necessary steps in the child’s patient record. Five members of clinical nursing staff could explain consent and decisionmaking requirements of legislation and guidance, as well as how to support young patients to make decisions around consent. Ward staff knew about the service’s consent audit after one error was noted around no written consent for a young patient. Other monthly and quarterly audits affecting young patients included an antimicrobial audit in February 2024 which identified one action completed by 30 March 2024. Medicine security audits also took place across the hospital. Audits had taken place in the ward, theatres and outpatients department. Compliance scores across these areas ranged from 83% to 89% for 2024 quarters 1 and 2. No action was required.

Staff understood how and when to assess if a young patient had the legality or capacity to make decisions about their care. Hospital staff’s latest deprivation of liberty (DoLS) training compliance was 74 out of 82 eligible staff (90%). Mental Capacity Act training compliance was 75 of 82 staff (91%). Both these modules met the provider’s target of 90%.

Staff gained consent from young patients for all their care and treatment in line with legislation and guidance. The four young patient records CQC reviewed all had consent fully recorded. Staff gained patient consent as a wet signature on the day of surgery. Staff also clearly recorded young patient’s consent in all records we checked as part of their provider surgical safety checklist. Staff supported young patients to make informed decisions about their care and treatment. Governance leads reviewed pre-operative consent to ensure patients were fully aware of the surgery’s risks and benefits before their preassessment. The surgeon evidenced in their clinic letters that the patient had enough time to consider the risks and implications of their planned procedure. Patients were individually risk assessed against specified admission criteria. The hospital rarely had patients subject to Deprivation of Liberties Orders (DoLS).