Nightingale Hospital Exeter

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• 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

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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics. This meant people’s needs were met through good organisation and delivery.

This service scored 71 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff worked to coordinate people's involvement with families and carers, particularly for those with long-term conditions such as children with spinal deformities who required regular imaging to help plan treatment.

Where possible, the service scheduled several investigations together, especially in plain film imaging.

Services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. Patient feedback contributed to improvements such as the purchase of additional mobility equipment.

Staff communicated with people so that they understood their care, treatment and condition and any advice given using easy read leaflets, and translation services if needed.

Staff supported people to access additional services such as advocacy and support groups to improve their choices of care.

People’s carers, advocates and representatives including family members and friends, were identified, welcomed, and treated as important partners in the delivery of their care. Patients were always given the option of having a carer or loved one accompany them so long as this complied with radiation safety protection measures.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Managers reviewed the demands of patients using the service and made arrangement to meet changes in demand. Additional staff had been recruited to accommodate an increasing number of referrals.

There were arrangements for one stop clinics to request on the day urgent MRI or CT scans which were reported by the radiologist on site. This meant patients could receive scan results and in some cases treatment, on the same day.

People with mental health, learning disability, autism or dementia needs could get extra support when they attended for their examinations or procedures.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Service leaders ensured lessons were learned when there were data security breaches, and the service had a comprehensive information governance policy. Data showed 87% of diagnostic imaging staff had completed information governance mandatory training against a 95% trust wide target.

Staff had access to communication aids to help patients become partners in their care and treatment. Staff used patients' preferred methods of communication, such as letters or phone calls.

Staff provided people who used services with information leaflets and written information to explain their diagnostic test both before and after their appointment.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

People’s views and experiences were gathered and acted on to shape and improve the services and culture, which included people in a range of equality groups. People who used services, those close to them and their representatives were actively engaged and involved in decision-making. The hospital had strong links with local carer networks and the trust wide patient and public forum.

Staff were actively engaged so their views were reflected in the planning and delivery of services and in shaping the culture. Patient surveys were in use and questions were sufficiently open ended to allow people to express themselves. Yellow feedback cards were used to identify any themes and trends, and a quarterly patient experience report was used to feedback overall themes to various teams

There were very positive and collaborative relationships with external partners to build a shared understanding of challenges within the system. This also included understanding the needs of the relevant population, and to deliver services to meet those needs.

Staff were transparent and open with all stakeholders about the performance of the service.

People were supported if they needed to complain, and staff viewed complaints as valuable feedback and opportunities to learn and improve. There was support available to assist patients with sensory loss or communication difficulties to make complaints. There had been no formal complaints made about the service in the past 12 months.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Overall, across the whole trust, performance against the 6-week standard had improved over the past 12 months. However, in February 2025, the provider was not meeting the six-week diagnostic test national standard in every modality such as CT patients, MRI patients and non-obstetric ultrasound patients.

The service monitored waiting times for diagnostic waiting times monthly return (DM01) which showed the CDC was seeing patients with and average request to test wait of under 4 weeks; against the standard 6-week diagnostic benchmark. MRI was the only modality where waits were longer, however, senior staff explained capacity should increase with the installation of 3 new CT and MRI scanners. The scanners had been purchased and were in storage whilst the building was being expanded which was at planning stage at the time of our assessment.

However, services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. The service was proactive in ensuring they provided access for all patients where they could. When patients were referred for x-rays, they could use a booking system to access care at a time to suit them.

The hospital was planning to extend their weekend services. We saw plans to extend both CT and MRI to seven-day services following the purchase of 3 new scanners. Managers made provision for some same day appointments to be available for those who needed them.

Managers provided comprehensive information about how patients could access the hospital using public transport as there was limited parking available.

People told us they could access care and treatment at a time to suit them.

People had timely access to initial assessment, test results, diagnosis, and in some one stop clinics, such as the shoulder clinic treatment. People told us they could access care and treatment at a time to suit them.

Appointments were only cancelled or delayed when absolutely necessary and explained to people. Those cancelled were supported to access care and treatment again as soon as possible.

The service ensured that it met local and national Key Performance Indicators for report turnaround times.

Services ran on time and people were kept informed if there was any disruption.

Information was provided to service users in accessible formats before appointments, including contact details, hospital map and directions, consultant name and information about any tests. The hospital had a hearing loop for those patients with hearing impairment or loss and sign language or other translators could be arranged, either in person or via telephone in the case of spoken languages.

Information was given to patients verbally and in writing for reference when at home.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. Staff were trained in equality, diversity, inclusion and human rights.

The service communicated its values and minimum standards of care people could expect to receive. Managers took steps to include all patients and were engaging with a range of groups in the community. This included minority communities such as transgender groups in respect of inclusive pregnancy checking and non-gender toilet facilities. Staff used translation services for patients whose first language was not English.

People were supported by planning for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff assessed patients’ needs and communicated this with health professionals using booking forms and patient records. This included choices patients had made about how they would like to be treated. For example, patients’ choice about resuscitation if they became very unwell. Test results were provided in a timely way for decisions about ongoing care and staff provided information about support groups.

Patients felt they understood information staff provided and had time to consider their options.