Nuffield Health Warwickshire Hospital

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• 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 reviewed assessing needs, delivering evidence-based care and treatment, how staff, teams and services work together, monitoring and improving outcomes and consent to care and treatment as part of the effective key question. We found effective remained good. Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Staff had access to the hospital’s policies and procedures via their computer system. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

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.

Patients were involved in their planned care and treatment, as well as the next steps of their treatment. Staff made sure patients did not fast for too long before diagnostic procedures such as gastroscopies. Patients were provided with information before fasting for colonoscopy procedures that detailed dietary requirements and how long patients should do this for. Staff took into account patients’ individual needs where food or drinks were necessary following the procedure.

Staff used the World Health Organization best practice guidance to ensure patient care was safe during endoscopy procedures. Patients nutritional and hydration status was assessed by oncology nurses as part of the treatment modified toxicity grading in the care pathway. Staff carried out toxicity and grading assessments and we observed grading score sheets were available and completed. Staff completed assessment documentation for the care and treatment before patients attended for chemotherapy treatment. This included for example, risk of falls, current medicines, baseline observations and allergy status. Staff gave patients information packs during pre-assessment appointments. The packs included contact details for the oncology service, their consultant and the names of the nursing staff. Patients were also given alert cards to carry, which explained that they were at high risk of sepsis, which is a potentially life-threatening condition. The card contained advice for healthcare professionals and the contact details for the service.

There were processes in place for staff to follow in order to assess and meet the needs of patients. The service used clinical tools which were relevant to the patients needs, for example, WHO checklists, mobility and falls risk assessments. Patients undergoing endoscopy procedures were monitored appropriately for signs of clinical deterioration. For example, heart rate, oxygen saturation and blood pressure. Staff checked the patients’ observations frequently and documented them on a chart. Processes were in place to ensure patients received translation and interpretation services to enable them to be involved in the assessment of their needs and to ensure care received was patient centred.

Care, treatment and support were delivered in line with legislation, standards and evidence-based guidance. The service used policies, care and treatment pathways, clinical protocols and standard operating procedures. The endoscopy unit was accredited by Joint Advisory Group (JAG) on Gastrointestinal Endoscopy in March 2023. This meant the team had demonstrated consistent care, quality and safety in line with national standards. From February to June 2024, staff undertook a piece of work around patient reporting of bowel preparation analysis. They looked at 3 types of bowel preparation and respondents were asked if the instructions were easy to follow, if they could easily tolerated them and if they felt the bowel preparation was effective. Responses revealed patients found a certain bowel preparation more effective.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Policies were stored on an online system which all staff had access to. We reviewed 10 policies and found all were within the review date. Updates to policies and tracking of policy review dates, were carried out at corporate level and cascaded to the hospital for implementation. Policies were current and based on professional guidelines, for example, National Institute for Health and Care Excellence (NICE) and Royal College guidelines. The hospital completed a range of audits throughout the year to ensure healthcare was provided in line with their policies, national guidance and standards. Audit results were collated and used to benchmark against the other hospitals of a similar size. From an audit summary from quarter 1 and quarter 2 in 2024, we saw there was an overall compliance of 97.6%.

Staff worked across health care disciplines and with other agencies when required to care for patients. The nursing and pharmacy team had a daily huddle on Milverton suite. Oncology staff said they could raise concerns or ask for advice from consultants at any time and they worked well together to ensure patients were given the best care. We were given an example of an incident which had occurred following the removal of a polyp. The patient phoned the department during the weekend and was sign posted to the emergency department. The colorectal surgeon was informed and the patient was managed appropriately including learning shared.

There was a clinical huddle meeting which we observed during our assessment. This took place every morning and was attended by the senior management team and a representative from each department in the hospital. All staff contributed to provide an overview of the hospital’s activity. Any relevant information was taken back to each department and cascaded to the team. Staff also discussed staffing levels and moved staff to cover areas as required.

There were processes in place to ensure members of the multidisciplinary team (MDT) worked together to ensure the needs of the patients were met. Key governance meetings were attended by members of the MDT which demonstrated an effective and cohesive service. Minutes from various governance and quality meetings revealed meetings were attended by members of the MDT.

Staff gave patients practical support and advice to lead healthier lives. The service had relevant information promoting healthy lifestyles and support. Staff assessed each patient’s health when they attended and provided support for any individual needs to live a healthier lifestyle. The service offered patients an ‘Eating Well’ booklet which provided information on balanced diet and how diet can affect and improve symptoms during and after bowel cancer treatment.

There were processes in place to provide patients with relevant information to support a healthy lifestyle. The hospital’s website had information about health topics. These included highlighting health topics such as back care and bones to joints awareness.

Managers used information from the audits to improve care and treatment. Venous Thromboembolism risk assessments were regularly audited for completion. Staff reduced the length of time patients waited for their first appointments and review appointments by ensuring all clinics were fully utilised. In the event of cancellation, they contacted patients to see if they were able to take the appointment slot. Endoscopy staff used carbon dioxide for colonoscopy procedures to reduce pain and abdominal discomfort and improve patient outcomes.

There were processes in place to monitor and improve outcomes for patients who used the service. There was evidence of regular audits being conducted which included patient reported outcomes. Improvement was checked and monitored. The service participated in quality improvement initiatives such as local and national clinical audits, benchmarking, accreditation schemes, and research. For example, the endoscopy service had achieved JAG accreditation. Staff could give examples of work that had been completed to improve patient outcomes.

The hospital contributed to relevant national audits such as the Cancer Specialty Quality Review, Cancer MDT and documentation audits. Compliance for cancer MDT audit was at 97.6% and documentation audit was at 95.2% in quarter 2 in June 2024. The hospital used audits to benchmark their service against other similar services and develop plans for improvement. Managers and staff carried out a comprehensive programme of repeated audits to check improvement overtime. Managers shared and made sure staff understood information from the audits. The endoscopy service carried out patient satisfaction surveys. We reviewed the results of the February 2024 survey and found 17 out of 18 respondents were given clear written information about their procedure, found their procedure as expected and were fully informed about their care and treatment.

Patients were given information about their procedure both verbally and in writing by the consultants and nursing staff to make an informed decision about their procedure. Patients said staff fully explained their treatment and additional information could be provided if required. We observed staff asking patients’ verbal consent prior to inserting a cannula, observations and delivery of care. Where consent could not be obtained, staff delivered care in the patient’s best interest.

Although staff within endoscopy and oncology did not often care for patients who lacked mental capacity, they were able to describe their responsibilities related to consent, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff followed their internal process for seeking consent from patients when providing care and treatment in line with legislation and guidance and this was clearly recorded. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system they could all update. We observed patient’s consent was obtained in line with hospital policy and documented prior to endoscopy procedures taking place. The consent forms were also checked with the patient as part of pre-procedure checklist. Staff told us the majority of admitted patients had the capacity to make their own decisions. Patients who lacked capacity were identified during the pre-operative assessment process. If a best interest decision had to be made, this would be with the consultant, but these were rare.

There was a hospital policy to ensure staff were meeting their responsibilities under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act, Mental Capacity Act 2005 and the Children Acts 1989 and 2004 and they knew who to contact for advice. Staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards. The service had a compliance rate of 97.5% at the time of our assessment. There were processes in place to ensure staff were supported to make informed decisions about their care and treatment. There were policies and processes which staff were aware of and followed to gain patient consent. Where patients lacked the capacity to make decisions about their care and treatment themselves, there were processes which were in line with national guidance and legislation to ensure consent was gained lawfully. Consent forms we reviewed within the patient records were fully completed and detailed the procedure planned and the risks and benefits of the procedure. The hospital consent forms complied with Department of Health guidance.