Nightingale Hospital Exeter

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated good.

We saw staff had a positive culture around continuous improvement. The service followed safe recruitment practices. Patient areas were safe, clean, well equipped and fit for purpose. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer and record medicines.All registered nurses and healthcare assistants had been provided with competency-based training to enable them to facilitate any of the clinics held in the outpatient department.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff were confident to report incidents and knew what to report and when. Staff had effective systems to raise concerns both formally and informally. We reviewed incidents and found staff reported these and managers investigated them as necessary.

Staff understood the duty of candour regulation and the need to be open, honest, and transparent with people when things went wrong with their care. We saw evidence from incident reports that duty of candour was followed.

Staff reported incidents as part of the monthly performance and assurance framework. This meant incidents were reviewed and discussed in order to identify themes and trends which could then inform service improvements. For example, the service had 19 incidents in April2025 and 4 of these were around communication. This led to a booking issue in ophthalmology being addressed.

Incidents were also discussed at specialty meetings to inform any necessary learning.

Patient safety alerts were noted and actioned as and when necessary and in governance minutes. Patent safety alerts are notifications that require action to be taken by healthcare providers to reduce the risk of death or disability.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

The Nightingale Hospital Exeter operates as an integrated care board (ICB) asset. This means the hospital is managed and used directly by the ICB. The ICB allocated the management of the hospital to Royal Devon University Healthcare NHS Foundation trust (RDUH). This meant the service takes patients from RDUH and also takes patients from other neighbouring hospital trusts in Devon. When patients were seen from other neighbouring trusts, they were still seen by the referring hospitals staff members which helped to ensure continuity of care. This meant the staff at Nightingale worked with doctors from different trusts.

Referral into the services provided was reviewed by the different specialty services to ensure they were suitable to be treated at the Nightingale Hospital Exeter.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding arrangements for the location were aligned with the trust and staff had a close working relationship with the trust’s safeguarding team.

Staff knew how to escalate a safeguarding concern. They would use the online safeguarding referral system via the Trust Hub for both adult and child safeguarding concerns.

All staff were required to undertake safeguarding training. We were given information for mandatory training which included all Nightingale staff within outpatients, surgery and diagnostic imaging. Mandatory training rates for adults and children’s Safeguarding Level 1 and 2 met the providers target and were at over 90% compliant. All staff had access to the trust’s safeguarding team if additional knowledge regarding a safeguarding concern was required. Clinical matrons on the site were currently undergoing Level 3 safeguarding training for adults and children.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We observed staff communicating well with patients, so they understood their care and treatment. We observed 6 patient consultations and saw service users were given ample time to understand the information provided. Staff displayed a professional curiosity about how current treatments were impacting on people’s lives. We observed staff discussed the clinical risk of different treatment options with patients.

Staff used telephone calls instead of face-to-face meetings to monitor groups of patients who had been assessed as safe to be seen in this way. These patients were typically the least complex patients at low risk of their condition worsening. Staff said if patients self-reported a worsening of their condition they could easily be switched from virtual to face-to-face appointments.

Staff enabled patients to give feedback on the service they received. Patients said they felt supported by staff. Patient choice was respected when deciding which treatment option to choose.

The hospital was located on a different site to the trust’s emergency department. There was an agreed process for transporting patients to the emergency department if and when this became necessary. Patients could also be escalated to be seen by medical staff on site.

Resuscitation trolleys were located throughout the main outpatient department and the speciality outpatient areas. Staff regularly checked trolleys and ensured they were fully equipped. The resuscitation trolleys were easily accessible to staff if required.

The location detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

The service had enough suitable equipment to help them to safely care for patients. Staff were trained in its use and kept equipment maintained. We saw portable electronic equipment had been safety tested in June 2024, and evidence of when equipment was next due to be serviced was visible on equipment.

Staff disposed of clinical waste safely. The domestic and clinical waste bins were clearly identified and staff emptied them regularly. Sharps and hazardous waste bins were stored safely.

Signage for the premises was clear and easy for patients to follow. There were different coloured lines on the floor for patients to follow depending on which service they were visiting. Patient feedback said this made navigating the hospital simple and easy. One patient said “My son dropped me off for my appointment and I was seen 10 minutes early. It was very easy to find – you just follow the lines on the floor, It was a very pleasant and wonderful experience”.

The management team were focused on making the environment accessible to all patients. Consulting rooms were spacious and wheelchair friendly. The premises were audited against the accessible standards. It performed well against these standards and was working towards making the improvements suggested by the audit to the environment. For example, the service was working on providing a bariatric toilet.

The service did not have a car park for patients. There was a drop off area for patients arriving by car or taxi and there was free shuttle bus from the local park and ride areas as well as public transport services. Patients we spoke with during the inspection said they used the local shops carpark facilities if they travelled by car. The service leads were aware parking for patients was a problem and were looking at ways to improve the car parking facility at this location.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

There was a mixture of vacancy rates across the outpatient service. The Buttercup Unit was fully established for nursing and healthcare assistants however, there were some gaps in staffing for the diagnostic services for example the trust was currently recruiting for 2.4 Band 7 ECHO technicians and the vacancy rate was at 92%. There is a national shortage of Cardiac Echo Technicians, however the trust reported this was not impacting on the service provision as temporary staff were employed to fill any gaps in staffing.

The ophthalmology outpatient service had recently recruited to its health care assistant vacancies and was fully established. Staff were trained to use the different specialist ophthalmological equipment, however whenever there were any unexpected absences then the clinic patient numbers had to be reduced as it was not always possible to find suitably qualified agency or bank staff to backfill these gaps.

As new services were introduced to the Nightingale Hospital Exeter outpatient department, the department had effective governance processes to ensure the service had enough staff to safely care for people using services. Agency staff were booked in blocks and used to cover long term staff sickness. Consultants from different NHS trusts worked in the department under a service level agreement. They completed an induction before working at the Nightingale Hospital Exeter.

All registered nurses and healthcare assistants had been provided with competency-based training to enable them to facilitate any of the clinics held in the outpatient department. For example, health care assistants working in the Buttercup outpatient unit had been enabled to work in clinics at the main hospital site as an upskilling exercise and to improve their competencies.

Staff had received and were up to date with appropriate mandatory training.

Most staff had received an annual appraisal although the service wasn’t meeting the trust target of 85%. The trust stated that overdue appraisals were mostly attributed to staff who were on long term sickness. At the time of the inspection 78% of outpatient staff had received an appraisal. Nursing appraisals were being supported by a clinical matron to support individuals returning from complex long-term sickness. Reasons for staff absence were monitored and return to work interviews were completed. We saw managers worked with staff to make necessary adjustments to help staff to continue working at the location.

We reviewed 6 recruitment files for employees and found the service was compliant with Schedule 3 of the Health and Social Care Act and staff had the necessary checks before commencing employment with the service.

Volunteers were given pre-employment checks and received appropriate training. The site had 17 active volunteers at the time of the inspection. Feedback on volunteers was positive.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff understood the policies and processes for maintaining good infection control. We observed staff were bare below the elbow and followed correct hand hygiene procedures. Staff uniforms were visibly clean, and staff could explain what their role was in infection prevention and control. The location conducted hand hygiene audits and bare below the elbow audits. These showed a good level of staff compliance. Results and any actions to take from the audits were fed back to staff.

The overall clinic environment and the toilets were visibly clean. There was a separate company in charge of the cleaning of the premises who were located at the Nightingale Hospital Exeter. We spoke with staff who said the service was efficient and responsive. Patient feedback often commented on the cleanliness of the environment. We observed cubicle curtains were clean and dated to ensure they were changed regularly. All curtains we checked were within their change date. Hand gel was available in-patient facing areas and consultants had gel on their consultation tables.

The service made sure that medicines and treatments were safe and met people’s needs.

Staff stored and managed all medicines safely. A registered nurse performed a weekly stock check and ordered new supplies as needed from the hospital pharmacy. Medicines we checked on the day were mostly in date with the exception of a couple of items in the buttercup consulting rooms. We showed these to the nurse in charge and they were removed from use.

Medical gases were stored securely. The temperature of medicines requiring refrigeration were monitored. Prescriptions were mostly generated electronically however the Buttercup unit did use FP10 prescription forms. This is a form used in the United Kingdom for prescribing medication. We saw the service kept these in a locked cupboard and recorded the relevant information to ensure safe management of these forms.