Nuffield Health Warwickshire Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed the person-centred care, care provision, Integration, and continuity, providing Information, listening to and involving people, equity in access and planning for the future as part of the responsive key question. We found responsive remained good. The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for their treatment.

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.

Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs. The hospital had a trained psychologist, and patients could be referred where necessary. The hospital had a dementia and learning disability champion. People could access services and appointments in a way and at a time that suited them. There were no waiting lists for the service and staff worked together to facilitate rapid access to services. A multi-faith and spirituality box which included multiple religious texts and icons, a prayer mat with compass, holding crosses, affirmation stones and healing crystals was available on site. Staff advised patients this could calm their minds during their treatment.

Most patients who attended the hospital were privately funded or insured patients. Results of the Nuffield Health Patient Satisfaction Survey published in June 2024 showed treatment for 72% of patients who attended was paid by their insurance, 21% was privately funded and 7% were NHS referrals. If during pre-admission assessment staff identified the service could not meet the patient’s needs, staff would not treat the patient at the hospital and refer the patient to an alternative health care provider who could support the patient. The hospital did not have the facilities to support the care of patients with high complex needs. Therefore, this patient group was not admitted to the hospital. The Milverton Suite ran one-stop breast clinics on Thursdays. They accepted self-referrals in diagnostics clinics which was run by clinical nurse specialists who were supported by consultants. Managers made sure staff, patients and carers could access interpreters or signers when needed. Information on interpreting services was readily available.

Nurses gave patients detailed explanations about their procedure and treatment in addition to written information. We observed clear explanations being given during pre-assessment appointments and reassurance being given to patients who were anxious about their care treatment.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

All staff had access, through secure logins, to the organisation's intranet to gain information relating to policies, procedures, national guidance and e-learning. All staff we spoke with were able to demonstrate the use of the system and retrieve information. The endoscopy unit had introduced a 30-day patient follow up post endoscopy procedure. Staff asked patients if they had seen their GP for reasons related to the procedure, had taken any antibiotics following their procedure or had been hospitalised for reasons linked to the procedure.

The service had policies and processes in place to ensure the information which patients received met their needs and where adjustments were required, these were made. There were arrangements to ensure data or notifications were submitted to external bodies as required. There were also arrangements (including internal and external validation) to ensure the availability, integrity and confidentiality of identifiable data, records and data management systems, in line with data security standards. Staff shared information with the Private Healthcare Information Network (PHIN). PHIN is an independent, government-mandated organisation responsible for publishing performance about private consultants and hospitals. Medical staff completed a gastrointestinal clinical coding discharge summary following endoscopy procedures where complications resulted in extra treatment, the length of stay was extended, or the patient returned to theatre. Lessons were learned when there were data security breaches. The information used in reporting, performance management and delivering quality care was consistently found to be accurate, valid, reliable, timely and relevant. The service had an electronic quality management system, which monitored the performance of the service through data collection on all aspects of the service including incidents, complaints, mandatory training and audits.

‘The Pink Ribbon Club’ had been established to empower people following their breast cancer operation. This was a rolling programme which comprised of a physiotherapy-led exercise class with a social forum where all participants joined when they were medically fit. Patients, relatives and carers knew how to complain or raise concerns. Information on how to make a complaint was available at the service. Patients told us they felt involved in their care and staff spoke in a way they could understand. Patients we interviewed told us doctors and nurses informed them of their care and treatment, including future plans. A patient told us; ‘I find the chairs in the waiting areas quite low for people with back problems’. They felt comfortable to provide this feedback to staff.

All staff we spoke with were aware of the complaint procedure. Clinical staff told us they always tried to resolve any issues or complaints at the time they were raised. Staff said learning from complaints and concerns was communicated to them mainly at handovers, team meetings, emails and notice boards. Complaints were also discussed at the daily communication meeting. Staff told us on the back of ‘you said we did’, the hospital had dedicated two car park spaces for patients attending to receive chemotherapy. All patients who required chemotherapy had a new patient assessment prior to their appointment. The service was open Monday to Friday from 8.30am to 4.30pm. The endoscopy unit was open Monday to Friday from 7:30am to 6:00pm. The service performed 50 to 60 procedures per month. A Nuffield wide interpreter service was available for patients who did not speak English.

There were policies and processes in place to support patients who wanted to raise concerns and complaints about their care and treatment. During the onsite assessment, we saw posters and leaflets which informed patients on how they could raise their concerns. Staff knew how to acknowledge complaints. Staff understood the complaints policy. Staff were trained to resolve minor concerns as part of an approach to meeting individual expectations and avoid minor issues escalating into a formal complaint. There were no complaints in the previous 3 months prior to our assessment. The service received 22 compliments in the same reporting period.

The hospital participated in the NHS e-referral service for certain procedures. Through this service, NHS patients who required an appointment or a procedure were able to choose both the hospital they attended and the time and date of their treatment. The service offered free NHS care under the patient choice government initiative. Patients could either book an appointment through their GP, through the NHS e-referral service website, NHS e-referral service line or by calling the Nuffield Health e-referral team. Patients could phone or email the booking team if they wanted to cancel or rearrange their appointment. Relatives and visitors were offered hot and cold drinks and could use the hospital’s restaurant.

Managers monitored waiting times and made sure patients could access planned procedures when needed and received treatment within agreed timeframes and national targets. There was limited endoscopy service in the hospital and waiting times were therefore generally quick. The service was responsive to patients in the admission criteria. Patients mostly had their procedures within 2 weeks of being booked. Patients had to be over 16 years old to be able to receive chemotherapy at Milverton suite. Any patient requiring chemotherapy treatment for over 12 hours would not be treated in this hospital. Information shared following our assessment showed turnaround time to start treatment after receiving consultant referral and accompanying paperwork was 10 working days.

There were process and policies in place to ensure that people were able to access care and treatment when they needed it and in a way that promoted equality.

Staff tailored the care and treatment they provided to meet the experience of patients. Following endoscopy procedures, patients and their GPs were provided with a copy of report detailing immediate findings and whether biopsies were taken. All patients attending for either endoscopy procedures or oncology used private en-suite rooms during their stay.

There were processes in place to engage with the local population and to ensure care was tailored to their needs. The processes and policies in place within the service ensured patients were treated in line with requirements under legal and human rights.

Staff ensured patient records were updated after each appointment, this was to ensure that any discussions between the patient and staff were recorded and any actions that had been agreed were all logged. Patients attending for chemotherapy told us they were kept informed about future appointments. They felt staff had given them all information they required.

Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. During our assessment, we observed effective multidisciplinary working between different teams involved in patient care and treatment. There was clear communication between staff and we observed safe and effective coordination of care between oncology staff and the pharmacy team. Staff had access to relevant information to assist them to provide effective care to patients admitted to the unit.

There were pathways in place to follow for patients who attended the service. Where planning for the future was required, additional staff were invited to attend appointments to support staff. This was particularly for patients who had to attend for different cycles of chemotherapy. Consultants worked in close collaboration with nurses and pharmacists to ensure the right treatment was received. An endoscopy referral to cancer services pathway was in place for patients with suspected cancer. Staff contacted the Milverton Suite’s cancer services clinical nurse specialist (CNS) team for nursing support. The CNS supported the consultant with breaking bad news and provided patients with supportive literature tailored to their individual needs.