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 is the first inspection for this service and this key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients had their health and care needs assessed to make sure the service could meet these. Patients undergoing orthopaedic surgery were assessed in a pre-admission clinic for their suitability. Patients undergoing cataract surgery spoke with ‘Dora’ an Artificial Intelligence (AI) devised chatbot on the telephone where they discussed the surgery and asked health questions. Patients received a call from a consultant if they were considering bilateral cataract surgery.

We reviewed 8 care records during the assessment. Care records were based on the specific pathway for each type of surgery. We found staff had fully completed these and updated them as required.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

The service planned and delivered care in line with national guidance and legislation and staff participated in clinical audit, benchmarking and quality improvement initiatives. For example, The Standard Operating Procedure (SOP) for Ophthalmology was part of their Local Safety Standards for Invasive Procedures (LocSSIP) Guidance. LocSSIPs, are a set of locally developed guidelines that aim to improve safety and reduce errors in invasive medical procedures.

Staff assessed and met patients’ needs for food and drink. Patients undergoing joint replacement surgery were given pre-operative build-up drinks to help reduce the body's stress response to surgery, improve well-being, and potentially speed up recovery.

For patients undergoing orthopaedic surgery, once they have recovered from the anaesthetic, the nurses and therapists managed patient care together making sure patients were safe to mobilise ready for same day or the next day discharge.

Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of the patient group. New staff received an induction programme to enable them to meet the needs of patients. Staff received the necessary specialist training for their roles.

Managers ensured that staff had access to regular team meetings to ensure they were up to date with information about the service. Most staff had received an appraisal. The overall appraisal compliance for the Nightingale Hospital Exeter was 71.2%. The trust average was 66%, and the target was 80%. The appraisal compliance for orthopaedics staff was 84.3% and for ophthalmology staff it was 97.8%.

Managers dealt with poor staff performance promptly and effectively.

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.

Staff collaborated effectively to support patient care. Information was shared during team handovers, and daily safety huddles addressed issues, workloads, and the patients scheduled for the day.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. Staff told us they worked well with all disciplines of staff for example, doctors and other allied health care professionals especially when arranging discharge of orthopaedic patients. Staff also worked closely with staff on other hospital sites operated by the provider if a deteriorating patient required transfer.

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.

Staff supported patients to live healthier lives for example, in pre assessment clinics patients were given advice about stopping smoking and reducing/stopping alcohol intake before surgery. We observed this during a pre assessment clinic.

The website for the Nightingale Hospital Exeter had a selection of videos and written information for patients about each surgical pathway. This included pre- and post-surgery information. Orthopaedic patients were given information on what to expect for example following their surgery such as bruising, as part of the pathway information they took home. It contained pictures on what was normal and when to contact a health care professional for advice.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. Staff told us they knew the procedure to following if a patient required to be transferred to the acute trust.

Staff used technology to support patients effectively for example, all patient records were electronic enabling all staff immediate access to them. Another example of technology was ‘Dora’ the chatbot which was used to contact patients before cataract surgery. Dora was used to chat to patients about the surgery and ask certain questions about lifestyle.

The service regularly reviewed their effectiveness of care and treatment through local and national audit. For example, The National Joint Registry data showed the Nightingale Hospital Exeter was performing in line or better than other providers across all quality measures.

In the NHS, the Referral to Treatment or RTT is specifically the time it takes for a patient to receive consultant led treatment after being referred by their GP or other healthcare professional. The main standard is 92% of patients should start treatment within 18 weeks of referral, as outlined in the NHS Constitution. Following the inspection the trust told us The Nightingale Hospital Exeter does not have RTT data specially for them. For the ophthalmology service they received direct referrals from Devon Referral Service and 99.5% of patients received their care within the 18 weeks’ timescale.

For orthopaedics this doesn't have a specific location waiting list and patients were listed to multiple providers allocated lists. Outcomes continued to be measured against the GiRFT benchmark outcomes and comparable surgical HUBs within Model Hospital.

Readmission rates were also monitored, it was 2.6%, which was in line with the GiRTH recommendations and (The Getting It Right First Time (GiRFT) programme is a national NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change) checked against their peers. The service had reported this was reducing to 1.6%.

The service monitored the number of operations cancelled on the day of surgery. All cancellations were reviewed every month by senior staff at this location for themes and trends.

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

All surgery at the Nightingale Exeter was planned and patients had consented to have surgery. Patients told us they had signed a consent form prior to the surgery and staff checked these were correct prior to their surgery.

Staff received training in assessing mental capacity as well mandatory training in learning disability and autism. The number of staff who had completed this training was above the trust target for mandatory training.