Nightingale Hospital Exeter

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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was the first assessment of this service. We rated this key question as good.This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 83 (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’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used a range of tools to assess and review people’s health needs. The tools were standardised, so staff understood how to use them. The type of tools used to record and monitor people’s health depended on the clinic being held, and the individual needs of the patient. For example, we observed a rheumatology staff member completing an arthritis body map tool for a patient in order to monitor progress of the disease and see which areas were affected.

Staff updated care plans where necessary and patients were discussed at regular multi-disciplinary meetings. We reviewed 6 care plans and saw staff had completed appropriate assessments.

Staff flagged where people had specific needs around accessibility and communication on the trust’s patient electronic recording system. Patients had access to information leaflets online and at the location. Ophthalmology leaflets were printed in yellow and black which made it easier for visually impaired patients to read. The leaflets could be provided in different formats and large print. The Buttercup unit did not hold a stock of leaflets in large print but said they would take extra time to go through the leaflet with the patient if requested.

The service always planned and delivered people's care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff planned and delivered people's care and treatment in collaboration with the service users. We observed 4 patient consultations. We saw staff discussed treatment options with patients, and there was collaboration between the staff and patient to agree treatment plans.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The Nightingale outpatient service had contributed to informing best practice guidance and shared learning regionally and nationally by sharing examples of the work it had undertaken. Examples of this work was the innovative and 1 stop pathways it had implemented at the Buttercup unit and also the work the rheumatology department had carried out regarding the management of waiting lists which it presented to the ‘Getting it Right First Time Further Faster Rheumatology national meeting'. Staff participated in clinical audit, benchmarking and quality improvement initiatives.

Staff and leaders worked consistently to improve the service to benefit patients. Staff said they were listened to and ideas for improvements were welcomed.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers ensured staff had access to regular team meetings to ensure staff were kept up to date

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The trust had an electronic patient record system which was used at the Nightingale service. This meant patient information was easily accessible to different teams and this could be updated by each team so that patient information was up-to-date.

Staff shared information about patients at effective handover meetings within their teams. Daily staff safety huddles were held at the start of each day to discuss any issues that had occurred the previous day, to discuss workloads and patients who were due to seen that day.

Staff worked collaboratively to ensure patients received the care they required and did not need multiple visits to the hospital. For example, diagnostic services were located at the same site and it was possible for some consultants to refer patients for a scan to ensure they were seen on the same day. We observed a rheumatology appointment with a clinical nurse specialist. The patient required a change in prescription which the service was able to facilitate because the service had purposefully made the appointment on the same day as the patient consultant was also seeing patients. The consultant was able to talk to the patient and agree the change of medication which ensured the patient did not have to wait with pain and make a return visit.

The teams had effective working relationships with each other and other specialist teams. One staff member told us, “It’s a really good team where we help each other”.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

There was a range of literature available in outpatient waiting areas designed to provide education to patients in a range of services. We observed consultations where diet and exercise were considered holistically to manage patients’ health and wellbeing.

The website provided a range of useful information on health and wellbeing for patients receiving treatment at the service.

The service monitored all people’s care and treatment to continuously improve it. They

ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The maximum number of weeks patients should wait to be seen by a doctor is set by the NHS Constitution to try and make sure people were seen in a timeframe that means their medical condition will not get worse while they were waiting. The longest time the Constitution says people should wait is 18 weeks for most non urgent referrals, and 2 weeks for suspected cancer. However, for patients with suspected cancer there was also a 28-day faster diagnosis standard, a 31-day decision to treat standard, and a 62-day referral to treatment standard.

Data for the outpatient waiting lists was managed by different specialities and was combined with the trust performance. We saw the trust as a whole was working to reduce its waiting lists so that it met the standards set by the NHS Constitution. Some services were performing well against the 18 week non urgent referrals, for example the Rheumatology department was at 80% as at March 2025, however ophthalmology remained at 60.6% against this target for the same time period. The trust was making progress with reducing the number of people who had been waiting a long time to access services. For example, in April 2024, there were 73 gastroenterology patients who had been waiting longer than 52 weeks which had reduced to 10 patients by March 2025. Although we cannot separate out the data for the Nightingale Exeter location specifically, there was clear evidence patients attending this location had reduced number of hospital visits and a reduced time to wait from investigations to diagnosis. For example, the Breathlessness clinic had seen the number of patients who received a clinical outcome at their first appointment improve from 5.8% to 68.2%. This meant patients were either discharged from the service or referred to a sub-speciality clinic in a single visit. One patient stated, “The speed at which I have been seen was absolutely phenomenal; this is an incredible service. For someone who suffers from anxiety it was incredibly reassuring to receive the results in the same day”.

The provider monitored waiting lists to ensure people were seen in order of clinical need. This locations services had been recognised for the innovative work it had carried out on reducing waiting lists by national improvement teams such as the Getting it Right First Time (GIRFT) team from NHS England. GIRFT helps share best practice between hospitals to reduce the variation in the way services are delivered and reduce inefficiencies.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The patients we spoke to told us they had been asked to consent to treatment where this was applicable.

The service did not accept patients in crisis as it was a non-urgent care facility, however staff were able to support patients’ needs as required. Staff received mandatory training in assessing mental capacity as well as training on learning disability and autism. The number of staff that had completed this training was 88% and 94% respectively.