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 there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This is the first assessment for this service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. Staff understood and embraced the provider’s vision of ‘Better Together’ and its core values compassion, integrity, inclusion, and empowerment in their daily work.

Staff in eye theatres and orthopaedics demonstrated a positive, innovative culture. They were passionate, engaged, and committed to person-centred care, supported by an approachable leadership team.

Staff were encouraged to contribute to service strategy, particularly during changes. Senior staff emphasised the importance of inclusive input. For example, feedback led to improved pain relief for orthopaedic patients, helping them mobilise more quickly and safely after surgery.

The service fostered strong teamwork and collaboration with patients and stakeholders. Staff took pride in their teams’ work and actively shared successful practices with other healthcare providers. Leadership valued departmental staff’s commitment to improving services and shaping strategy.

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.

Leaders had the skills, knowledge and experience to perform their roles and leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Staff reported leadership within the service was both visible and accessible, fostering a supportive environment for patients and staff alike. The senior leadership team comprised a Lead Nurse responsible for overseeing clinical care and nursing standards, a Divisional Director providing strategic direction, and a Business Manager handling operational and financial aspects. Additionally, the service had a clinical lead to guide medical practice and ensure high-quality patient outcomes. This multidisciplinary leadership structure contributed to effective communication, accountability, and a clear presence across the service. They reported to the executives from the trust.

Staff survey feedback highlighted high clinical standards, positive patient experiences, strong communication, and supportive leadership. Metrics also showed staff satisfaction and willingness to recommend the hospital as a workplace.

Executives had visited the site, and non-executive directors conducted safety checks. The hospital had strong ties to the trust and access to central services that supported care delivery.

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

Patients and carers were able to provide feedback in ways that suited their individual needs. Feedback cards were available throughout the areas we visited, and responses were overwhelmingly positive.

The service promoted a positive culture by encouraging staff to speak up supported by clear policies. Staff felt confident raising concerns with managers, either directly or anonymously via regularly monitored feedback boxes, which were reviewed in operations meetings. Staff could also access the Freedom to Speak Up Guardian in the trust if they were not able to speak to their manager.

Managers and staff reviewed feedback from patients, carers, and colleagues to drive improvements. For example, we saw 1 patient highlighted inconsistent guidance on the use of crutches following an orthopaedic operation, which senior staff were actively reviewing to resolve.

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

Staff can apply to work flexibly for example, flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. Managers approved reasonable adjustments for staff members to help them effectively carry out their role.

The provider monitored staff diversity to reflect the patient population. The service’s leadership team promoted an inclusive and supportive workplace. In 2024/25, black and minority ethnic staff joined the trust’s non-executive board for the first time. A multifaith room was also made available for prayer and reflection in this location.

In 2025, the trusts overall Workforce Race Equality Standard (WRES) data revealed 24% of ethnic minority staff had experienced harassment, bullying, or abuse from colleagues, compared to 19% of white staff. Additionally, only 53% of ethnic minority staff believed the trust offered equal opportunities for career progression or promotion, while 61% of white staff felt the same. Although these figures compare favourably with other hospital trusts where abuse rates were higher and perceptions of equal opportunity were lower, the trust had seen an overall decline since the last report across WRES metrics. In response, it was developing an action plan to reinforce its commitment to an inclusive and equitable workplace and to monitor any improvements. Similarly, the trust’s 2025 report on the Workforce Disability Equality Standard (WDES) showed a positive trend in reducing bullying and harassment of disabled staff, with rates falling from 24% in 2022 to 22% in 2024. However, other WDES metrics have declined, prompting the trust to commit to a targeted action plan to address these areas and ensure continued progress towards ensuring staff had workplace equality.

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

The governance framework comprised of multidisciplinary team meetings, weekly senior leadership sessions, and bi-monthly governance reviews. Senior staff for the service at this location reported monthly via the performance assurance framework, contributing to the trust's integrated performance report and the One Devon elective recovery programme. This is the local strategy within the One Devon Partnership to reduce NHS waiting lists and recover from the impact of the COVID-19 pandemic on planned (non-emergency) care in the Devon area. Nightingale Hospital Exeter staff provided surgical representatives at relevant specialty governance meetings across the trust.

Staff had implemented recommendations from reviews of deaths, incidents and complaints. The Mortality and Morbidity (M&M) process for the Surgery Care Group aimed to review patient outcomes and improve care quality through systematic evaluation of surgical deaths and complications. Surgeons participated in specialty-based meetings across the trust. Records showed learning from deaths was considered and actions were taken to improve practice. Planned improvements included standardising best practices across all their sites and incorporating nursing care reviews into specialty M&M meetings, following the model used by Northern teams.

Staff at the service undertook or participated in local and national clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

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

Despite established governance processes and support from a dedicated trust team, 7 data breaches occurred in surgery in the past year. These were all rated as minor or minimal harm.

The service kept an electronic risk register, but no entries met the threshold for the corporate trust register at inspection. A divisional risk relating to access was noted due to the lack of onsite parking. Staff used a nearby office car park, while patients used a well-reviewed park and ride. Patient parking at the nearby office car park was not permitted due to safety concerns for patients crossing the road.

One of the challenges faced by orthopaedics included utilisation of theatres however, this was starting to improve. This location relied on other Devon hospital trusts to send consultant and anaesthetist to cover some lists but due to leave these were not always covered. Average theatre utilisation was 80% per week and service leaders stood down 1 to 2 all day lists a week.

The service used streamlined systems to collect ward and directorate data without burdening frontline staff. In orthopaedics, they tracked same-day cancellations, off-pathway transfers, infections, and post-op complications. These were reviewed monthly in a multidisciplinary meeting attended by clinical leads, nursing managers, therapies, and management. Each case was examined, and learning for staff was documented and actioned in a live record accessible by staff.

Staff were equipped with the necessary technology to provide high-level care, including a shared electronic patient record system to support continuity of care. Information governance ensured patient confidentiality was maintained.

The evidence showed an exceptional standard. 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.

The Nightingale Hospital Exeter was set up to reduce waiting lists across Devon for patients who lived in the area. Consultants from Devon hospital trusts worked at this location and once patients had their surgery they were followed up at their host trust.

Senior staff engaged with external stakeholders such as commissioners and other trusts within the Devon area who supported this location.

Patients and staff could meet with members of the provider's senior leadership team to give feedback if requested and this was shared with commissioners.

The orthopaedic and eye centre held regular open sessions for NHS staff, international clinicians, and external stakeholders to share insights and learning from the Nightingale Hospital Exeter model. They also shared their research and outcomes with health care journals.

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

Innovations in the service included single-visit cataract surgery, combining the assessment and procedure to reduce patient hospital visits. The site also performed bilateral cataract surgeries for eligible patients, using outcomes to enhance care and treatment. The results were shared nationally with other trusts.

Staff participated in national audits relevant to the service and learned from them.

Both the eye surgery and orthopaedics were Getting It Right First Time (GIRFT) accredited and senior staff were involved in this programme for assessing other providers for this accreditation. Both teams remained at the forefront of clinical innovation, pioneering best practices through the implementation of GIRFT pathways. Their approach was not only evidence-based but also supported by a growing body of published case studies, which highlight improved patient outcomes, enhanced efficiency, and replicable models of care across both specialties.

Staff felt empowered to suggest improvements within their department, reflecting a culture where their opinions were valued by leaders of the service. The trust supported this by offering staff access to various levels of quality improvement training.

The trust used its electronic patient record system to engage patients in their care journeys, offering personalised education and tools for shared decision-making. The system was being extended to the remaining hospital trust in Devon, creating a unified patient record across the region. As a shared Devon asset, the aim of this was to enhance patient pathways, clinical documentation, and decision support, ensuring a more consistent experience for all patients.