Nightingale Hospital Exeter

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

We looked for evidence that the service met people’s needs. This was the first inspection of this service and we rated this key question as good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (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.

Care was planned so that patients’ needs and preferences were respected. Patients were given the opportunity to choose their appointment time or to rearrange it to a time suitable for them. Patients were sent a text message to remind them of their appointment date and time which they were able to respond to with a free text to confirm their attendance, let the hospital know they no longer needed their appointment, or request they were contacted to rearrange their appointment. Patients also had access to a patient electronic portal which listed their appointments and the results of any tests undertaken.

Care was planned so that the number of times a patient had to visit the hospital was reduced and the time to receiving a diagnosis or discharge was reduced. For example, the lung cancer 1 stop model of care had been in place at the Nightingale Exeter Hospital since November 2024. Since this service was introduced, it showed a reduced wait time from referral to diagnosis from 28 days to 6 days. The Nightingale Exeter Hospital benefited from having diagnostic imaging on site which helped to expediate some patient’s diagnosis. Some of the outpatient services enabled patients to self-refer back into the service. This allowed flexibility for patients who were managing their condition and being monitored in the community to self-refer back to into the service should their condition change. This provided more flexibility for the patient and had the benefit of freeing up appointment slots for new patients, if a follow up appointment was not necessary. There was strict criteria for patients who were put on this pathway which meant generally they were not poorly or with complex conditions. We spoke to 1 rheumatology patient who had been put on this pathway who said they felt they were receiving patient centred care and that she was able to obtain an appointment with the service when it was needed.

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.

The trust was looking at other services which could benefit from being located at the Nightingale Exeter Hospital. We were told the trust were thinking of bringing further musculoskeletal service to this location as it would benefit from bringing together the clinical assessment, diagnostics, and treatment planning within a single patient visit.

There was scope to provide more services from the Nightingale Hospital Exeter for example, we carried out our inspection visit on a Thursday and Friday and found the service to be underutilised on the Friday. The service opened Monday to Saturday and was closed on the Sunday. The service had scope to provide more ECG Holter monitoring bookings. An ECG Holter monitor is a portable, non-invasive device used to continuously record the electrical activity of the heart over an extended period. There were only 6 booked at the location for a clinic in June 2025 and there were vacant slots. However, we saw the service was proactively trying to ensure available slots were filled.

Outpatient admission criteria was set out, so all patients irrespective of age, gender, race, religion, belief or sexual orientation could access the services. We saw the site had been working with a local prison so prisoners had access to the service. There were processes in place to support prisoners privacy and dignity.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. For example, the service had an agreement with the Royal National Institute for the Blind to convert documents into braille for blind or partially sighted people.

The service mostly complied with the Accessible Information Standard. The Accessible Information Standard (AIS) is a legal requirement in England that ensures people with disabilities, impairments, or sensory loss receive health and social care information in formats they can understand. It has been mandatory for NHS and adult social care providers since 2016, and was updated in 2025 to strengthen its impact. Information could be provided in different languages and there were processes to use should a person using services require translation services. The location website did have accessible features such as allowing users to zoom in up to 300% without the text spilling off the screen however some images on the homepage and menus had contrast issues and some older PDF and Word documents were not fully accessible to screen reader software. The location was aware of this issue and was planning to have these issues fixed by October 2025.

The service had information governance systems which kept patient records confidential.

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.

The location used a variety of engagement and feedback tools to gather feedback on the service. These included friend and family (yellow card) forms, an external provider used for collecting feedback on a range of care services and the hospital incident reporting system. The Nightingale site services received 12 formal complaints during the period from June 2024 to June 2025, 6 of which were closed via the trust early resolution process.

The location had a dedicated support to systematically collate, analyse, and theme the feedback received. The Lead Nurse reviewed this information monthly, ensuring any identified learning points were promptly addressed. Actions taken in response to patient feedback were documented in the team's 'You Said, We Did' tracker tool. Themes for improvement were also added to the patient experience workplan.

Staff knew how to handle complaints appropriately. Patients were informed how to make a formal complaint and if they were not satisfied with the response, where to go to take their complaint further. Patients said they knew how to complain and raise concerns. Patients said they were able to raise issues with staff members and these concerns were addressed by staff immediately.

Patient surveys were regularly carried out by the provider. The information from the survey was used to improve the service.

The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The innovative design of the outpatient services operating from the Nightingale Hospital Exeter had helped to substantially improve the patient journey by cutting times from referral to diagnosis or discharge. This meant more people were able to access the services because the number of hospital visits was reduced meaning the service was able to offer slots previously taken up with follow up appointments to new patients. The data on the improvement in time for referral to diagnosis was across all pathways. For example, for a person suspected of having lung cancer, the average number of appointments had reduced from an average of 5, to 1 chest x ray and 1 appointment with a consultant. The diagnostic tests were completed at one of these 2 appointments.

Waiting times for patients to be seen were collected by the trust as a whole and were not location specific. The hospital had made good progress in reducing waiting times for appointments and this was helped by the outpatient and one stop clinics provided by the Nightingale Hospital Exeter.

The outpatient service worked to ensure clinic sessions were filled. If there was a cancellation then this would be offered to other specialities to fill or hold an additional clinic.

Each speciality monitored patients who did not attend their appointment. The trust worked to reduce the number of people who did not attend their appointment by routinely reminding people of their appointment time and date.

We were told that some patients were given virtual clinical appointments, this normally meant their appointment took place over the telephone. These were the patients that had the least complex health conditions.

Some patients were also put onto a Patient Initiated Follow Up (PIFU) pathway. The trust only had trust wide data for the number of patients on this pathway, however the trust utilisation rate of this pathway meant that it was the 8th best in the country as of February 2025. As previously stated PIFU was being used to reduce the number of appointments that were offered for follow up patients who were managing their condition and being monitored in the community which then freed up consultant time to see more patients.

Staff made reasonable adjustments for patients. For example, a patient that was partially blind was met by a member of staff from the taxi and escorted to their appointment inside the hospital. Reasonable adjustments that were required were noted on the patient electronic record so that they could be accommodated for at all visits. The Lead Nurse at the unit was a member of the trust’s learning disabilities group. This meant she could input into best practice for supporting this group of service users.

The outpatient leadership team were proactively engaged in ensuring the premises were accessible to everyone. It had commissioned an accessibility audit in 2024 and was currently working to ensure all the areas raised were being addressed.

If there was a medical emergency at the hospital, it was protocol to dial 999 for an ambulance. There was, however, medical cover at the site which could be called on to help with patients during the time it took an ambulance to arrive.

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 outpatient service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. The service received a large number of compliments and very few complaints. Patients we spoke with said they were happy with the care received by the service.

Nightingale Hospital Exeter was part of the wider trust which 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.

People were supported to plan for their future.

People were given time to ask questions about their treatment options and extra support to understand what the treatment options meant, and to help them plan their future treatment.

Patients were supported by consultants to make decisions about their care and treatment and where appropriate to make plans regarding their wishes around Do Not Attempt Cardiopulmonary Resuscitation.