Nightingale Hospital Exeter

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This was the first inspection of this service. At this inspection, we rated this key question as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. We rated both partnerships and communities and learning, improvement and innovation as outstanding.

This service scored 82 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The culture of the staff who worked at the outpatient department was positive and innovative. Staff were engaged and passionate about the services they provided and delivering person-centred care. The leadership team were approachable and all staff wanted to deliver patient centred care”.

The Nightingale Hospital Exeter embodied the trust’s mission of ‘Better Together’ and the values, ‘compassion, integrity, inclusion and empowerment’. The service worked collaboratively with patients, teams worked well together, with staff often stating they were most proud of the work their teams carried out. The service worked with its stakeholders and its partners to share what was working well at the hospital with other healthcare providers. Staff from the hospital’s leadership team appreciated the level of investment departmental staff had in contributing to service improvements and strategies.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The Nightingale Hospital Exeter senior leadership team included a lead nurse, divisional director and divisional business manager. They reported to the executives for Royal Devon University Health NHS Foundation Trust. The leadership team were knowledgeable about the services and spoke proudly of their staff and the quality and innovative care provided.

We were told executives visited the site and non-executive directors completed safety visits. There were clear links into the trust and access to central services to support the delivery of care at Nightingale Hospital Exeter.

Staff at all levels told us they had leaders who were visible, approachable and supportive. They described leaders as having an open-door policy and being ready to offer support when needed. Staff told us some senior leaders regularly visited their department to check in with staff and see if their assistance was required.

Leaders understood the challenges to quality and sustainability and could identify the actions needed to address them. They used an inclusive, collaborative, and solution focused approach to make improvements to the service.

The latest feedback from the staff survey highlighted themes about what the service did well. This included, “high standards of clinical services and patient experience, good communication with staff and a supportive leaderships structure”. The staff survey also highlighted good and improving metrics which showed staff enjoyed working and would recommend working at the Nightingale Hospital Exeter as a whole.

Leaders had a good understanding of the service they managed. They had recently recruited a project support officer to the Nightingale leadership team to provide additional support with the communication between the different departments. We were told the impact of this support had seen positive feedback about staff welfare events, regular newsletters, and consistency in information sharing.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies and procedures for staff to encourage a positive culture where people feel they can speak up and their voice would be heard. Staff we spoke with felt confident to raise any concerns with their manager.

Staff could raise any issues both in person and anonymously. There were feedback boxes for staff. These were checked regularly and were discussed as a regular agenda item at the operations meeting.

The lead nurse conducted a weekly safety walk every Wednesday morning. This was also an opportunity for any staff member to speak directly to the lead nurse and raise any concerns.

Patients feedback was valued and used to make improvements to the service.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders worked to create an inclusive working environment. We observed leaders being approachable and supportive to all members of staff. For the reporting period 2024 /2025, for the first time, there was black or minority ethnic staff representation on the non-executive board of the main trust.

The hospital had a multifaith room that could be accessed by staff wanting to pray or have space for quiet reflection.

The Nightingale Hospital Exeter falls under the trust for workforce race equality standard (WRES). The hospital’s workforce race equality standard (WRES) data from 2025 showed ethnic minority staff (24%) were more likely than their white counterparts (19%) to have experienced harassment bullying or abuse from other staff. The data also showed 53% of ethnic minority staff at the hospital believed the trust provided equal opportunities for career progression or promotion. This was lower than white staff (61%). The results compare favourably with other hospital trusts where the figures for abuse are higher and the figures for equal opportunity for career progression are lower. The trust however, has seen a decline across the WRES metrics and are working on an action plan to keep focused on providing a workplace which is inclusive and ensures equity for staff.

Staff said that they felt valued by the leadership team. Staff members were supported to be champions for areas that interested them for example workforce wellbeing and equality networks.

The trust’s 2025 report against the workforce disability equality standards (WDES) showed that the percentage of disabled staff experiencing bullying or harassment from other members of staff had been on an improving trend for the last 3 years, falling from 24% in 2022 to 22% in 2024. However, the report noted a decline in scores across other WDES metrics and the trust have committed to produce an action plan to address the areas of decline.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There were clear structures, processes and systems of accountability to support the delivery of the outpatient service. The service had a meeting structure which gave senior leaders and managers regular opportunities to discuss operational issues. Leaders were clear on the links to trust wide groups and committees to escalate risks and issues. The reporting structure showed how information was fed up from staff and patients.

The governance structure included service multidisciplinary team meetings, weekly senior leadership team meetings, and bi-monthly governance meetings. The location reported into a monthly performance assurance framework which fed into the trust integrated performance report and the 1 devon programme for the system elective recovery board. Nightingale Hospital representation was provided at relevant specialty governance meetings for the trust.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

There were processes to support good information governance standards. There were 9 information governance breaches in the past 6 months in the outpatients departments. There was a trust team to provide help to staff with information governance concerns. Incidents were reviewed for themes and any learning opportunities.

The service had its own risk register and at the time of inspection, did not have any risks which met the criteria for being on the corporate trust risk register. The service used an electronic recording system to record risks. This contained enough information for people to understand the severity of the risk and the level of potential or actual harm to people.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Within the outpatient department, there was excellent partnership and collaboration working. The service shared information and learning with other partners in care and collaborated to improve services. The Nightingale Hospital Exeter was a system asset which aimed to make care and treatment accessible to people, increasing access to the wider population of Devon. It worked across the system with the aim of driving down waiting lists through innovative practices. For example, the Centre of Excellence for Eyes undertook open mornings, where they received visitors from across healthcare services to learn about the pathways that were helping to reduce the number of patient visits to hospitals and drive down the time from referral to diagnosis or discharge. To date, the Centre of Excellence for Eyes had hosted over 56 visitors from over 15 organisations. The medical director of NHS England SW stated, “The new patient glaucoma model shows huge efficiency gains in a very stretched speciality which could be replicated throughout the Southwest and nationally”.

Some of the outpatient services were able to be accessed by other hospital trusts in the Devon area under the leadership of the Royal Devon University Hospital Trust. Staff worked in partnership to ensure these services were delivered smoothly. For example, the health care assistants working in the Buttercup unit could support a range of speciality clinics run by different trusts. We were given an example that there had been service improvements for the breathlessness pathway in part due to co-located diagnostics but also due to the flexible working and good relationships between radiology, respiratory and the buttercup unit team. Health care assistants had been training in performing additional clinical tests for breathlessness which reduced the workload of respiratory physiologists enabling more patients to access the service.

We reviewed the Nightingale experience work plan and saw this had input from various system partners and key stakeholders. For example, the service had collaborated with support groups to enhance patient experience. The Nightingale Hospital Exeter had a direct reporting link to both the trust and the Devon Integrated Care Board. The vision for the next 3 to 5 years for the service was to continue to have collaboration and partnership working at its heart.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The outpatient service has evidenced how the innovative one stop symptom- based pathways in outpatients have positively impacted patients by both reducing the number of visits each patient has to the hospital and reducing the time between the first appointment and diagnosis or discharge. This has also meant more people who were waiting for services could have access to the service because each patient required less hospital visits and so freed up consultant time.

The service continually analysed the data surrounding it’s one stop clinics to identify any learning or improvement opportunities. For example, the service can evidence the waiting list for glaucoma tests has been cut from 807 patients in 2023 to 55 patients in 2024 and has reduced the wait time for these tests from 9 months to under 6 weeks over the same period.

The service is continuing to look to build and continue to develop and embed one-stop models of care that bring together clinical assessment, diagnostics, and treatment planning with a single patient visit. It is looking to expand this service offering to include further musculoskeletal conditions in the immediate future.

Staff said they were able to make suggestions to improve the work of their department. We observed there was a culture where staff opinions mattered. The trust provided the opportunity for staff to attend different levels of quality improvement training.

The location used the trusts patient electronic record system to engage and inform patients about their care journeys. This included tools that provided personalised education and supported shared decision-making and improving outcomes. The electronic record system was being rolled out to the remaining other hospital trust in Devon which will enable the system to have a joint electronic patient recording system. This would help bring equity of experience to all Devon patients. As the service is a joint Devon asset, this would mean services such as patient pathways, clinical documentation and decision support would be enhanced.