Nuffield Health Warwickshire Hospital

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

Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and all staff were committed to improving services continually.

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 mostly felt respected, supported, and valued. They were focused on the needs of patients receiving treatment and worked well together to ensure they achieved good outcomes for patients. Staff were positive and proud to work in the organisation. The culture was centred on the needs and experience of people who used services. Staff told us they felt involved in decisions in the theatre and pre-assessment department and most staff we spoke to felt really happy at work. Staff described the culture in theatre as “very friendly” and “we are a close-knit family”. There was mostly a positive, compassionate, and listening culture within the service. Almost all staff we spoke to told us this. Staff on the ward attended an informal meeting called a ‘huddle’. Ward staff had monthly meetings on the first Monday of each month. Most staff across various areas had a good relationship with each other and were not afraid to raise concerns. However, some staff told us that they felt there was a blame culture at times within the senior management team and this had a negative impact on staff well-being.

There was a theatre mission statement which was displayed on entry to the theatre. It included statements such as “We plan to deliver safe and effective individualised care. Act as patient advocates throughout the patient journey, treating them with dignity and respect.” The theatre manager had a vision for the service which included extending it further to bring in bowel surgery and have an extended recovery or high dependency unit. They found endoscopy was underutilised and wanted to use this for minor operations.

There was a clear management structure with clear lines of responsibility and accountability. However, there had been a lack of stability within the leadership team, and they had recently had a new leader. The senior leadership team consisted of the health systems director, director of clinical services and operations director. Each head of department reported into 1 of the senior managers and there was a monthly heads of department meeting. Staff told us leaders were well respected, visible, approachable, and supportive. Departmental managers worked clinically and provided cover for sickness when required. Ward and theatre staff worked together effectively. We were told managers were approachable at all levels and were mostly helpful. The consultants we spoke with felt the hospital was well run and efficient, and the managers were responsive. All staff received clinical supervision to support them cope with a recent incident. A psychologist was available to provide emotional support to staff as required. There was an Employee Assistance Programme in place which offered counselling and mental well-being support sessions to staff who required it.

There was a leadership structure in place for the service. The service had processes in place to ensure staff were recruited fairly and for roles they were competent in. Where new leaders were recruited, there were processes in place to ensure they were supported. There was a process in place for leaders to meet and discuss issues and cascade information back down to the staff in the service. The minutes from the governance meetings showed leaders were knowledgeable about their issues and priorities in their services.

Leaders fostered a positive culture where most people felt they could speak up and their voice would be heard. Staff and leaders mostly acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. A Freedom to Speak Up board with information about how to speak up was available in the staff room on the ward. The ward manager told us that this was beneficial to those who needed to offload. There was a freedom to speak up guardian in the hospital. We were told they had emailed the staff recently to remind them of their role and they were there to support them. Mostly, when concerns were raised, leaders investigated sensitively, and lessons were shared and acted upon. Most staff we spoke to were confident their voices were being heard and felt able to raise any issues. However, a few staff told us they were not confident to speak up due to the blame culture from the leadership team. Following our assessment, the health system director arranged for the head of safety culture, head of inclusion and employee engagement to visit the hospital and undertake an independent review of the leadership, culture and team working.

There was a freedom to speak up policy and a whistleblowing policy and staff were aware of this. The service had contact details in place for staff to access if they needed to speak up about concerns which impacted the care delivery and environment which staff experienced. The service had a quarterly staff survey where comments were anonymous. This allowed staff to voice any concerns. Results of the April 2024 staff peakon engagement score showed 7.8 engagement core outcome. This engagement level was in line with the benchmark of 7.8.

The service promoted equality and diversity in daily work and provided opportunities for career development. For example, staff observing Ramadan were allowed flexible working shifts. A prayer room was available on the ward, and a staff nurse did not work on Sundays as they were training to become a pastor. ‘Belonging – Equity, Diversity and Inclusion’ training was part of staff’s mandatory training programme; 98% of theatre staff had completed this.

Policies and processes in place to ensure the service were inclusive and fair in the way they operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

All levels of governance and management functioned effectively and interacted with each other. Staff at all levels were clear about their roles and understood what they were accountable for, and to whom. Staff told us there were governance, management, and accountability arrangements in place, and that they understood their role and responsibilities, what they were accountable for, and to whom. The hospital’s governance framework was supported by a medical advisory committee (MAC) meeting and a clinical quality and safety meeting. They held risk forum meetings which fed into these meetings such as clinical heads of department monthly meeting, infection prevention and control, medical devices and medicines management. We saw standard agenda items for discussion included clinical incidents, complaints, audits and risks. There was evidence of action taken to address compliance within the surgical service. Staff told us they received feedback from meetings. There was an ongoing theatre action log from their team meetings. It was displayed on the notice board for all staff to see. We saw actions were completed promptly and chased when required. Completed actions included HCA training for collecting patients and prayer room allocated on the ward for staff. We reviewed monthly ward and theatre team meeting minutes which kept staff informed. They followed a standing agenda to ensure the most important updates were always provided. Staff held a pre-assessment patient safety meeting on the day of our assessment. They reviewed 15 sets of notes to determine eligibility for surgery. Healthcare assistants undertook pre-assessments for patients receiving local anaesthesia and staff nurses undertook pre-assessments for patients having their procedures under general anaesthesia.

There was a clear management structure. Leaders monitored quality and operational processes and had systems to identify where action should be taken. There were a range of other systems which supported the delivery of safe and high-quality care. These included daily management huddles and daily walk arounds by leadership team to most clinical areas. The service had a clear governance structure with various committees. We reviewed 4 sets of minutes which showed action plans were discussed and improvements were made. Learning was shared with staff using several avenues. We reviewed ward and theatre meeting minutes which showed staff were kept informed. There were arrangements for identifying, recording, and managing risks, issues, and mitigating actions. The surgical division had departmental risk registers, which highlighted the main risks for each area. The departmental risk registers were incorporated into the hospital risk register to allow oversight at all levels. Risk registers were reviewed regularly and updated quarterly. We saw the top 3 risks displayed on the theatre notice board for staff. There was a MAC meeting which occurred quarterly. The MAC were responsible for providing assurance and advice to the senior management team on medical and operational matters. It was attended by a consultant representative from each specialty. We reviewed 2 sets of minutes and saw actions were taken to make improvements. Consultants we spoke to told us their representatives fed back information that was relevant from the meetings. Preassessment processes seemed robust. The preassessment team worked collaboratively with anaesthetists and held patient safety meetings to ensure patients were suitable for their procedures.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

All staff were committed to continually learning and improving services. They had a good understanding of how to make improvements happen. Leaders encouraged staff to speak up with ideas for improvement and actively invested time to listen and engage. Staff in theatre told us the senior management team had recently had an afternoon where staff could go and talk to them about anything. We were told there were queues of staff waiting to speak to them and they found them willing to listen. Staff told us they were encouraged to develop and were proud of the service. Staff told us about their innovative ‘Mako’ robot in theatre which they had used since August 2023. Consultants used this for completing certain operations including total knee and hip replacements. We were told they had great outcomes for patients. They required CT scans to be completed prior to the operation. This meant they were able to order the exact size prosthesis required. A ‘hello and welcome’ pack including an induction folder was available for students from a neighbouring university. There was also an induction pack for healthcare assistants and staff nurses. A buddy system was available for new health care assistants. A students led innovative practice was in place on the ward which allowed students look for areas which could be improved and research on. We saw examples of work done around waste management, ‘sodium on the podium’ and a review of fluid balance charts which entailed a review of non-recording of fluid balance or lack of compliance. Students presented these and received an innovative practice certificate following a successful presentation.

There was a focus on continuously learning in the department. The theatre leadership team arranged monthly training for staff on topics of their choice. Staff felt they could ask for extra learning if they needed more support in a certain area. In theatres, there were 2 HCA’s who started as apprentices and had been supported to complete up to their level 3. The theatre manager was passionate about helping staff to progress.