Nuffield Health Warwickshire Hospital

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

The service completed assessments and followed patient pathways which were nationally recognised and evidence based. Assessments were up-to-date and staff understood people’s current needs. Managers used information from audits to improve care and treatment for patients. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

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 given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally.

Staff completed risk assessments for each patient on admission and reviewed this regularly. They had standardised patient pathway booklets which prompted staff to update risk assessments daily following surgery. Nursing staff used nationally recognised tools to assess patient’s risk of developing pressure ulcers, malnutrition, falls, as well as risks associated with moving and handling. Patients identified at risk were placed on care plans and were monitored more frequently by staff to reduce the risk of harm. We reviewed 5 sets of notes and found all risk assessments had been completed and reviewed regularly. Staff ensured patients were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. Staff assessed patient communication needs in pre-operative assessment and planned for assistance if required. The pre-operative assessment team met with the anaesthetist on a weekly basis to ensure all patients were suitable for surgery at the hospital.

People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood. Theatre and the ward audited patient notes. We saw 3 theatre notes audits January to March 2024. January and February 2024 audits were not clear. It was difficult to ascertain how many notes had been assessed, what the results were and what needed to improve. March 2024 audit showed the 8 notes assessed were completed poorly with some areas achieving only 12.5% compliance. There was no action plan with the audit. The ward’s most recent audit for care records showed a compliance of 84.1% and risk assessments was 75%; there was a clear associated action plan with some actions complete. Outstanding actions had a review date.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Policies seen contained current national guidelines and were in line with evidence-based practice. Policies were stored on an online system which all staff had access to. The service used NICE guidelines to ensure care was evidence-based. Policies, processes, and other supporting documentation were based upon national guidance and standards. Staff followed guidance regarding the records and management of medical implants, such as hip implants. Patients signed a consent form agreeing they were satisfied for their details to be stored on the central database.

All new policies were highlighted to staff in theatre via email and they had to vote to say they had read it. They were also discussed in team meetings. There was a process in place to record all implants. Paperwork was completed at the time of insertion of an implant and was documented on the National Joint Register (NJR) by theatre staff. The service also participated in the breast registry. Staff used surgical pathways which were in line with national guidance. This included integrated care pathways specific for a day case procedure. National Safety Standards for Invasive Procedures (NatSSIPS) were available in the theatre department. NatSSIPS provide a framework to produce Local Safety Standards for Invasive Procedures (LocSSIPS). We saw the service had a LocSSIP for the safe standards for invasive procedures had been created for the Nuffield Health group. It had been recently updated in line with 2023 guidelines.

A patient told us they had been seen by physiotherapist and nursing staff who prepared them for what to expect post-operatively and when they returned home.

Staff worked well together and with other teams. They had good links with all the departments within the hospital. Theatre staff told us they worked well with the ward and appreciated each other’s job roles. They told us they helped each other out where needed. There was a daily huddle for all heads of departments and the senior management team to share and risks with their service. Staff had a good relationship with the consultants and anaesthetists and were able to call them for advice when required. There were pathways that staff followed to ensure patients received the care they required. Some of these pathways involved transitioning between different services if a patient needed transferring out for example. Staff were aware of how to appropriately hand patients over and refer to different services. The anaesthetists had created a consortium of 15 of them and ensured every day there was someone on call to assist within the hospital if required. Service leads told us learning was shared between the hospital and external services such as GPs and other NHS hospitals. They held monthly meetings with the NHS providers and produced quarterly reports detailing learnings, outcomes, and establishment updates.

We observed good working relationships between the preassessment team and anaesthetist. They held multidisciplinary team meetings to discuss patients’ suitability for surgery and considered options to keep patients safe from harm. There was an effective MDT working between the physiotherapists and other health professionals involved with patients undergoing surgery. The teams worked together to prepare patients for what to expect post-operatively and when they returned home.

Patients attended pre-operative assessment appointments where their suitability for surgery was checked. This included the completion of a health questionnaire, and an opportunity for the nurse to provide advice or refer patients on to other appropriate services if they required these services. We saw posters relating to bereavement care, sepsis, and questions relating to cancer, and diabetes information.

Staff assessed each patient’s health and provided support and advice to help patients lead healthier lives. Patients attended a pre-operative assessment appointment where their fitness for surgery was checked. Staff asked patients a series of questions about their lifestyle such as smoking and drinking. Patients were given advice about smoking cessation when required.

Managers and staff carried out a programme of repeated audits to check improvement over time. Managers told us they used information from the audits to improve care and treatment and they shared and made sure staff understood information from the audits. We saw that audits were discussed with staff at team meetings and actions were created. Staff we spoke to were able to tell us about audits and changes needed. Consultants we spoke to told us the theatres were very efficient. It was staff with high quality staff and enabled a good turnover of patients.

The audit programme ensured different aspects of care and treatment within the service were checked during each audit. Audits included medical records, infection prevention and control, WHO safety surgical checklists and medication audits. Audit results were discussed at governance meetings, where all clinical leads were present. However, not all audits we reviewed had clear action plans which meant there were not always clear improvements made from the audits. There was a VTE audit which showed compliance of 97.5%; there was an associated action plan. It included actions such as the consultants not completing the forms; all the notes we checked were completed by the consultants. The managers completed a NEWS2 audit bi-monthly. Compliance was consistently above the 90% target. Staff checked patients’ temperature prior to their operation and continuously throughout to ensure they did not get too cold. If their operation lasted longer than 45 minutes, a warming blanket was used. We observed staff asking patients their pain score when they woke up and administering pain relief promptly where patients had pain.

The service participated in relevant national clinical audits, which they generally performed well in. Managers used the results to improve services further. The service had an effective system to regularly assess and monitor the quality of its services to ensure patient outcomes were monitored and measured. Outcomes for patients were positive, consistent and were in line with national standards. Clinical audits and risk assessments were carried out to facilitate this. The hospital participated in some national audits to monitor patient outcomes including the elective surgery Patient Reported Outcome Measures (PROMs) programme and the National Joint Registry (NJR). The NJR data for 2020/2021 to 2022/2023 showed a total of 8,702 primary and revision hip, knee, elbow and shoulder procedures were undertaken. The consent rate for the reporting period 2022/2023 was at 97.55% which was better than the national average of 93.36%. PROMS data was collected for patients who underwent shoulder surgery using the oxford shoulder scores tool. The Nuffield Health average was 29 in 2022 and was based on 12 months data from the previous calendar year. From July 2023 to June 2024, there were 2 unplanned return to theatres, 13 unplanned transfers to the local NHS trust ward and 12 readmissions to the ward. The service had a low SSI rate with only 7 recorded SSI’s within the last 12 months. Staff carried out a full root cause analysis for all readmission and return to theatre and discussed these during the infection prevention and control committee. There was a surgical safety champion in theatre who completed quarterly WHO audits. Results for May 2024 were 93.8%. There was no action plan with the audit. There were points for staff to discuss such as “please fill in an incident for late finishes” and “a few brief sheets coming through without all the information being filled in”. Staff told us they were fed back results in the team meetings.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff worked in line with the provider’s consent policy. Staff used consent forms and records showed signed consent forms were documented in the patients’ records. Staff gained consent for the surgical procedure and for the use of anaesthesia.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Patients were given information about their proposed treatment both verbally and written, to enable them to make an informed decision about their procedure. Each patient file contained a consent form which showed staff had discussed the risks and benefits of treatment with patients prior to any procedures being undertaken. Staff clearly recorded consent in the patients’ records. There was also a checklist within the pathway to ensure the consent form was checked prior to surgery going ahead; this was completed in all notes we checked. We also observed a patient being taken to theatre and they were asked about their consent form prior to leaving the ward and then again in the anaesthetic room. We looked at 5 sets of patient notes and saw consent was recorded in all these records. Staff were given the appropriate skills and knowledge to seek verbal and written informed consent before providing care and treatment to their patients. Staff were aware of the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberties Safeguards (DoLS). Data showed 93% of staff had completed consent to examination or treatment training and 95% had completed MCA and DoLS training.

There was a consent policy. When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions. They would involve the patients representative and other healthcare professionals. Staff told us most patients admitted had the capacity to make their own decisions. Patients who lacked capacity were identified during the pre-operative assessment process, where it was determined whether they could be admitted for treatment at the hospital. Staff had training on the MCA 2005; 95% of staff were compliant with this training. Managers audited the consent forms. The most recent audit showed they were 99.3% compliant. There was an associated action plan to improve compliance.