Nightingale Hospital Exeter

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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

This is the first assessment for this service. This key question has been rated good.

We looked for evidence that people were always treated with kindness, empathy and compassion. We also looked for evidence that every effort was made to take people's wishes into account and respect their choices, to achieve the best possible outcomes for them. We checked that people's privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people's wishes into account and respect their choices, to achieve the best possible outcomes for them. This meant people were well-supported, cared for and treated with dignity and respect.

This service scored 80 (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 was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

We saw staff took the time to interact with people who used the service in a respectful and considerate way and gave them all the time they needed to understand information provided.

Staff ensured when intimate personal care and support was given by a member of the opposite sex, service users were offered the option of a chaperone. Staff ensured, where possible, that chaperones were the same gender as the service user.

Service users were able to speak to the receptionist or radiographer without being overheard and there were plenty of additional rooms and space where sensitive conversations could be held if needed or requested. This included if a patient became distressed.

The department generally did not see anyone under the age of 16, except for some specialist full body spinal imaging. Staff explained that children over the age of 12 were invited into the examination room on their own so that they could speak to staff without a parent present. This was helpful where staff needed to enquire about the possibility of pregnancy before any imaging.

Staff responded in a compassionate, timely, and appropriate way when people experienced physical pain, discomfort or emotional distress. We saw staff sit and hold patient’s hands and were genuinely caring and unrushed.

Staff were compassionate and sensitive in their response to patients who might be frightened, confused or phobic about medical procedures or any aspect of their care. Patients we spoke to told us they felt seen and had things explained in a way they understood. In MRI, patients were invited to see the scanner if they were concerned about claustrophobia.

People were given appropriate and timely support and information to cope emotionally with their care, treatment or condition and were advised how to find other support services, such as linking in with cancer support services based at the main hospital site.

Staff understood and respected the personal, cultural, social and religious needs of people and this information was recorded and shared as needed. For example, use of pronouns and preferred names was some of the information recorded.

Staff members displayed understanding and a non-judgemental attitude towards (or when talking about) patients who had mental health, learning disabilities, autism or dementia diagnoses. Staff shared their own experience of loved ones living with some of these conditions which they told us helped them shape how they spoke to people in similar circumstances.

The service utilised patient surveys, and questions were sufficiently open ended to allow people to express themselves. A selection of feedback provided showed patients were very happy with their care. For example, patients described the service as “Efficient, friendly and quick”, “Everything was excellent” and “Everything was explained and clear with empathy and kindness”.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff identified and met the information and communication needs of people with a disability or sensory loss. Services were delivered, made accessible and coordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act. The entire hospital had been planned so that all examination rooms, examination couches and toilets were as accessible as possible.

Staff made reasonable adjustments so people with a disability could access and use services on an equal basis to others.

Staff worked across services to coordinate people's involvement with families and carers and arrange appointments for the same day if possible.

Staff communicated with people, so they understood their care, treatment and condition and any advice given. Easy read leaflets were available in all areas we visited plus there were leaflets in other languages such as Polish and Arabic. Patients were clear and staff communicated with them in a way they understood.

Staff sought accessible ways to communicate with people including the use of translation where a patients’ first language was not English.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People were empowered and supported, where necessary, to use and link with support networks and advocacy and patients were signposted to various support groups for long covid, cancer and some carers networks.

Staff made sure people who used services and those close to them were able to find further information or ask questions about their care and treatment.

Appointments were appropriately timed and staff told us they felt they had time to speak with patients and answer any questions. All patients received written information about where they would get their results and what to do if they had any questions or concerns following their examination. Staff had access to communication aids to help patients.

Imaging and treatment options were discussed with people, and they were encouraged to be part of the decision-making process.

Staff communicated appropriately with children and young people and their relatives. Staff explained they invited children to view the imaging equipment to ensure they could independently do what was needed of them before carrying out any imaging.

Information was provided in a child friendly format to help children and young people make decisions about or agree to care and treatment. The service worked on the principles of the Gillick competence for its spinal imaging patients. This means it was assumed children could consent to their own care and treatment if they were mature and had a suitable level of understanding of their care or treatment.

Support with transport was available to service users with mobility issues, and the service had issued a comprehensive guide to public transport links to the site, including a free park and ride a very short distance away.

Patients told us they felt listened to, respected and had their views considered. Feedback from patients had enabled the service to procure more mobility aids in some of the imaging rooms.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Following their tests, service users understood how and when they would receive their test results and had received copies of letters sent between the hospital and their GP. Service users described knowing who to contact if they were worried about anything following their scan or procedure.

In areas where ethnic minority groups formed a significant proportion of the local population, there were processes to aid translation, both verbal and written.

Where people’s needs and choices were not being met, this was identified and used to inform how services were improved and developed. For example, the fluoroscopy room purchased additional mobility aids following patient feedback.

Children’s needs were met at the service. The environment was appropriate, and patient centred with a small separate play area for children outside the spinal imaging room. Staff explained waiting times were always kept to a minimum for children and as part of any preparatory work for imaging, children could come and view the equipment to make sure it was something they understood and could stay still for without assistance.

The department was clearly signposted with volunteers to help, and used coloured lines painted on the floor, to guide people to where they needed to be.

The hospital offered limited weekend services, but we saw plans to extend both CT and MRI to seven-day service following the purchase of three new scanners. Plans were being drawn up and finalised at the time of our assessment.

There were multiple quiet areas or examination rooms where patients could wait if they found busy environments distressing. However, the whole hospital was calm and composed which patients and staff described as wonderful.

Service users told us they were offered a choice of appointments and there were some same day appointments available if needed, although these were largely to support any ad hoc scanning request from the one stop sarcoma or gynaecology clinics.

Good quality diagnostic images and reports were available to cancer multi-disciplinary teams in a timely way, with many radiologists and additionally trained reporting radiographers attending the meetings.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

There was a monthly staff newsletter which celebrated staff achievements and feedback plus various other initiatives including health and wellbeing champions.

There were cooperative, supportive and appreciative relationships among staff. Staff and teams worked collaboratively, shared responsibility and resolved conflict quickly and constructively. All staffing types were treated with respect and supported, including smaller more remote teams such as the in-house engineers and medical physics.

Staff were actively engaged, and their views were reflected in the planning and delivery of services and in shaping the culture. We saw senior staff were actively involved in the design of the planned new layout of the department.

The service undertook an annual staff survey which showed the department was performing in line with the rest of the trust in terms of responses. The survey identified areas for improvement including appraisal quality and staff fatigue. We did not see evidence of action at the time of our inspection.

Staff did not work alone. In all areas we visited, staff worked as a team. Staff felt the work booked for each scanner was appropriate and allowed time to carry out safety checks necessary before scanning. Staff and patients did not feel rushed.