Nuffield Health York 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

Young people could access care and treatment when they needed it. Staff involved and empowered young patients and families in all aspects of care planning and decision making. CYP services were readily available and allocated regionally, to respond to eligible young patient’s needs. Staff clearly explained all care and treatment pathways, options and likely outcomes to young patients and their families. The hospital encouraged, monitored and learned from feedback and complaints. Staff tailored care and made reasonable adjustments for young patients. Hospital leads and staff were aware of barriers to care, support and treatment and worked to remove them. Hospital staff considered the impacts of treatment and young patient’s sometimes complex care needs.

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.

Staff involved and empowered young patients and families in all aspects of care planning and decision making in a way which considered their needs and preferences. The service involved both young people and their parents in the risk assessment process for suitability for surgery on an adult pathway. Staff collaborated as a hospital with their local type A provider hospital to ensure they met the needs of young people. Staff explored and took into account young people’s individual values when making decisions about their care. The service gave all 16-17 year olds the choice as to whether they wanted their parents present for examinations.

We saw surgeon’s clinic letters included mention of parents being present. These letters also mentioned the risks, benefits and potential implications were clearly explained to the patient and their parent along with all their care options in good time for their full consideration pre-procedure. For example, the risks of post-operative bleeding and pain were outlined to a tonsillectomy patient a few weeks before their planned surgery.

Staff completed holistic assessments of post-operative young patients during wound care. They reviewed how patients were coping at home and ensured they had adequate support. Staff signposted people to external sources where they needed more support. Staff also escalated any concerns over patient’s diet or pain. They promoted education for all areas of care and involved their family when required.

The service had a close working relationship with the local acute trust’s phlebotomy service. All under four-year-old’s attended one of their wards, rather than an outpatient facility.

We saw the surgeon and anaesthetist explain to young patients the aims of the operation and what it would achieve. They each covered what the anaesthetist will do and explained the benefits of eating and drinking post operation. The surgeon discussed the recovery to the patient over the next two weeks. This covered the risks of bleeding, what happens and what to do if the patient bled post-operatively. The surgeon explained that if the patient was slow to recover, they would have to stay in overnight. We saw provider cards outlining the diagnostics and imaging and musculoskeletal physiotherapy services. Both had five facts about the service, weblinks and contacts to book a consultation.

Patients were sent information before surgery, such as leaflets on what to expect. Staff then asked them to consent on the day of surgery, once they had time to absorb this information. The provider had an in-date clinical care of children and young people policy (CL20 version 7). The policy outlined responsibilities and accountabilities of the medical, nursing and management teams.

The hospital had staff and patient forums. Leads had tried to engage children and young people (CYP) for a specific forum, giving people the chance to engage. However, there was no demand. Hospital staff attended regional and national provider forums. This included a safeguarding forum where staff shared learning around a young patient who did not attend (DNA) their appointment.

The provider had a complaints policy CQC reviewed. This clearly outlined their process. However, the service had received no complaints in relation to CYP. There were no CYP specific satisfaction surveys. However, the hospital sought patient family, visitor and wider feedback through all available communication channels. Completed survey data was anonymised, so this could not be filtered down to service level. Staff had received no CYP feedback from which to make service improvements. They reviewed and acted upon all feedback received.

One parent of a young patient used a wheelchair and found the premises fully accessible to meet their needs. Young patients and family visitors could leave feedback using a QR code provided in departments. They could also check into the hospital or department promptly using a quick QR code three stage process.

Hospital staff could re-route young people’s pathways to be seen sooner at their provider’s neighbouring type A hospital. This had more capacity and specialist children’s staff. Children and young people of all ages could access hospital services. CQC reviewed the service’s 0-19 year olds outpatient activity from 1 April 2023 to 31 March 2024. This showed 1213 patients were seen across the specialties during the 12 months. Ear, nose and throat (ENT), orthopaedics and dermatology patients had the highest levels of attendance. CYP theatre procedures from the same period was a small proportion of their overall activity. These showed staff carried out 63 total procedures on 16-19 year olds. Orthopaedics and ENT specialties had the highest activity, with 30 and 18 sessions respectively.

Patients and their families could access the service easily through a referral process with their GP or directly. The service captured and took actions to address did not attend appointments (DNAs) for children and young patients (CYP). For example, staff were reminded to red flag alert all young patient DNAs following a safeguarding incident where a young patient ‘was not brought’.

Parents we asked about their child’s treatment were very positive about the staff. They told us staff provided information throughout the process, and explained everything in language they and their child could understand. Both parents and patients were very happy with the process. They told us all aspects of the care were to a very high standard. They would use the service again.

All services which saw CYP were running on time. During CQC’s assessment one paediatric outpatient clinic appointment was double booked, so it was delayed by an hour. The CYP service had one unplanned transfer or return to theatre in the last 12 months. This entailed a young patient returning to theatre for a tonsillectomy. It was noted in the clinical governance minutes from 8 April 2024. The service had seven cancelled procedures for young patients on the adult pathway from February to June 2024. The most common reason was the procedure was undertaken at an NHS service, which occurred in four of the seven cases. Staff captured any cancellations on their incident management system.

Staff considered external disruption to young people and their families. They factored in school attendance, college absence or upcoming examinations when planning their care and treatment. The service provided a QR code to young patients going through radiology to fast track their diagnostic imaging pathway and experience.

Staff could evidence they carried out venous thromboembolism (VTE) assessments on young patients and managed them appropriately. Staff made post-operative follow up phone calls to young patients with information about VTE, wound management and infection. The hospital planned to adapt some ward side rooms to better meet the needs of young inpatients. For example, introducing ambulatory care for young patients and installing recliner chairs. Ward staff planned to upskill in order to better care and treat CYP postoperatively. They could decide to rotate their allocated numbers if other areas needed covering. The hospital displayed noticeboards with links for young patients and parents including signposting for mental health services, care in the sun and nutrition.