QUALITY REPORT 2013
INCORPORATING NHS QUALITY ACCOUNT 2013/14
CONTENTS
Page:
Group Chief Executive Statement on Quality
1
Board of Governors Statement on Accuracy
2
Statement on Priorities for Quality Improvement
3
Background information and summary of Internal & External Audit
5
Section 1: Nuffield Health report on Safety
7
Section 2: Nuffield Health report on Effectiveness
12
Section 3: Nuffield Health report on Caring
18
Section 4: Nuffield Health report on Responsiveness
21
Section 5: Nuffield Health report on Leadership/Well-led
23
Looking forward to 2014/15
27
Appendices
Appendix 1 NHS Quality Account 2013/14
28
Appendix 2 Membership of Board Integrated Governance Committee
37
Appendix 3 Independent Expert Advisors to Nuffield Health
37
Appendix 4 Regulatory and Quality Assessment Frameworks
38
Appendix 5 Bibliography including references and internet links
39
Note: underlined text throughout the report denotes hyperlinks
to relevant documents and as summarised in Appendix 5.
Group Chief Executive Statement on Quality
As Group Chief Executive of Nuffield Health, I am delighted to present our seventh, Annual Quality Report for
2013, and as a companion publication to the Annual Report of the Financial Statements. The report reflects the
quality of our health and wellbeing provision, and the commitment to excellence by everyone across Nuffield
Health. It is consistent with the values of the organisation, which place the customer at the centre of everything
we do and as we seek to continually improve what we offer to those who use our services.
The report is published annually and is available to the public via our website, which supports the open and
transparent culture in Nuffield Health. During 2013 there has been considerable focus on transparency and
Nuffield Health aims to be at the forefront of this agenda. As Group Chief Executive, I welcomed the Competition
Commission’s proposed measures which included the requirement for the collection and publication of information
on the performance of private hospitals and individual consultants. Nuffield Health is a member of the Private
Healthcare Information Network (PHIN) and provides information for publication on the PHIN website that allows
the public to compare and contrast private healthcare providers including, where provided, for NHS procedures.
Nuffield Health has continued to lead the way in assuring the entire pathway of care for our patients. In the summer
of 2013 we launched the Nuffield Promise which provides our customers with guarantees that the package they
sign up to, including follow-up care, will be totally transparent with no hidden surprises. This approach goes to
the heart of Nuffield Health values and we continue to be independent and enterprising in demonstrating how
passionate we are about care.
We believe that the warm and empathetic way that Nuffield Health staff engage with customers makes our
organisation different. In spring 2013, we appointed a new Chief Nurse, Professor Dickon Weir-Hughes to lead
the Nuffield Health Way of Caring. This approach will continue to ensure that our customers are cared for as they
would want to be – Health as it should be.
Nuffield Health continues to be responsive to customer needs and has continued to make access to high quality
care easier in 2013. In October 2013 we opened the Nuffield Health Bristol Hospital – The Chesterfield which is a
blend of tradition, retaining the Grade II listed ‘Clifton Court’ frontage, and technological advances in healthcare
including three digital theatres, critical care and intensive care all built within an entirely new hospital on the site.
We have invested in customer facing technology to support our Physiotherapy Network, the largest outside the
NHS. This new system allows secure on-line booking of physiotherapy appointments and customers can easily
search for appointments within an area that they specify. We continue to reach out to the wider population
reinforcing important messages about maintaining personal wellbeing. The Nuffield HealthScoreTM online tool
was launched in 2013, helping more people to monitor their health and wellbeing anytime, anywhere. As well as
tracking exercise, body measurements and eating behaviours, it also provides insight into emotional wellbeing
thereby providing people with a more holistic picture of general health.
Nuffield Health has continued to develop its products and services throughout 2013 and I am grateful for the
scrutiny that the Board Integrated Governance Committee (BIGC) provides by way of assurance that our processes
are Safe, Effective, Caring, Responsive and Well-led. I would like to take this opportunity to thank Ms Jane Wesson,
Governor and outgoing chair of BIGC.
David Mobbs
Group Chief Executive
Nuffield Health Annual Quality Report 2013
Page 1
Board of Governors Statement on Accuracy
As Chair of the Board Integrated Governance Committee (BIGC), I am confident that the information in this report
is accurate. In 2013 there have been four meetings of BIGC, the formal quality sub-committee of the Nuffield
Health Board, which mirrors the arrangements for financial governance provided by the Audit Committee. These
arrangements for financial and quality governance are aligned with the guidance provided by the NHS Leadership
Academy on the Principles for Good Governance for Boards. The members of the Committee are given in appendix
2 and the membership is also consistent with good quality governance as there is input from people with quality
expertise and those with responsibility for frontline clinical leadership. BIGC provides the scrutiny to ensure
that required standards are achieved and that action is taken where sub-standard performance is identified. In
addition, it provides assurance that the organisational systems and processes in relation to quality are robust and
well-embedded, so that priority is given to identifying and managing risks to the quality of care of customers and
welfare of staff and visitors.
External scrutiny of the care and wellbeing quality system is provided by the relevant healthcare regulators
including, but not limited to, the Care Quality Commission (CQC), as well as other regulators such as the Health
and Safety Executive. In addition, external quality certification schemes provide scrutiny in respect to the
management systems for Health and Safety, Occupational Health, Information Security, Medical Devices, Medical
Laboratories and for Environment Standards for people living with cancer.
There have been various responses to the Francis Report during 2013. At the beginning of year came the Initial
Government Response to the Report of Mid-Staffordshire NHS Foundation Trust Public Inquiry, Patients First and
Foremost and at the end of the year came the further response to the public inquiry, Hard Truths, The Journey to
Putting Patients First. These responses, and key messages from related external reports, have been reviewed
as part of the BIGC cycle of activity during 2013 to ensure that Nuffield Health is embedding any relevant lessons
learned into the programme of continual improvement. In particular BIGC acknowledged the ambition identified in
Professor Sir Bruce Keogh’s report that boards need rapid access to accurate, insightful and easy to use data and
other intelligence for the ‘forensic pursuit of quality improvement’.
In the summer of 2013 Nuffield Health responded to the consultation on the changes to the way the CQC regulates,
inspects and monitors care – A new start. Nuffield Health welcomed the proposals whilst recognising there is
work to do in aligning NHS and independent sector reporting to support comparable ratings across the health and
care sector. To support our internal ‘intelligent monitoring’ processes, BIGC changed the reporting frameworks
to align with the five questions proposed in the ‘new start’ documents. Therefore, the scrutiny applied by BIGC is
consistent with the ‘balanced scorecard’ of the CQC five questions and this report is similarly configured to show
how Nuffield Health meets CQC requirements to be:
Safe – ensuring people are protected from abuse and avoidable harm
Effective – promoting a good quality of life and achieving good evidenced based outcomes
Caring – involving people and treating them with compassion, kindness, dignity and respect
Responsive –organising products and services to provide wide access to meet people’s needs
Well-led – promoting high quality person-centred care through strong leadership
I am confident that BIGC will maintain its high level of scrutiny as the quality sub-committee of the Board and
will meet the new ‘fit and proper’ requirements for strengthening corporate accountability when the regulations
come into force in 2014. As my term as a Governor comes to a close and I step down from Chair of BIGC, I am assured
that the new chair, Mrs Joanne Shaw, will lead the Committee in developing evermore insightful intelligence about
the quality of the products and services provided by Nuffield Health to its customers.
Jane Wesson
Governor and Chair of the
Board Integrated Governance Committee
Nuffield Health Annual Quality Report 2013
Page 2
Statement on Priorities for Quality Improvement:
I was very pleased to take up the role of Group Quality Systems Director during 2013, having worked in Nuffield
Health since 2001 as Group Chief Pharmacist. The focus of the new role is to help build on the strong foundation
Nuffield Health already has in the approach taken to implement policy into practice, monitor performance and in
taking prompt action where any shortfalls are found. This approach has been developed over a number of years
as part of the process towards Nuffield Health achieving NHS Litigation Authority (NHSLA) at level 3. Nuffield
Health remains the only independent organisation to have been successfully assessed at the highest level of
accreditation against the NHSLA risk management standards.
The influence of the various reports referred to in the section above, and the associated changes in the regulatory
frameworks such as CQC and Monitor, will necessarily focus certain areas as priorities for quality improvement,
including always seeking to improve:
Openness: enabling concerns to be raised and disclosed freely without fear and questions to be answered
Transparency: allowing accurate information about performance and outcomes to be shared with staff,
patients and the public
Candour: ensuring that patients harmed by a healthcare service are informed of the fact and that an
appropriate remedy is offered, whether or not a complaint has been made or a question asked about it.
Nuffield Health provides an increasingly wide range of health and wellbeing products and services to customers.
The regulatory framework varies across Hospitals, Fitness & Wellbeing, Corporate Wellbeing and Physiotherapy.
For this reason, coupled with the NHSLA no longer providing assessments against the risk management
standards, in 2014 Nuffield Health is piloting the processes for certification against the international standard
for Quality Management System (ISO9001). This continual improvement framework will require Nuffield Health to
demonstrate, across the range of products and services, its ability to:
consistently provide products and services that meets customer needs together with applicable statutory
and regulatory requirements, and
enhance customer satisfaction through the effective application of the system, including processes
for continual improvement of the system and the assurance of conformity to customer and applicable
statutory and regulatory requirements.
On successful completion of the pilot, the objective is to apply for certification against the new ISO9001:2015
standard when launched in the autumn of 2015. In the interim the continual quality improvement programme is
based on quality objectives taken from our purpose, vision, mission, values and beliefs. Nuffield Health aims to be:
Safe because we believe in doing the right thing, in openness and transparency and not putting commercial
gain before clinical need,
Effective because evidenced–based knowledge and education are the cornerstone of our approach and we
believe in providing the best outcomes for all,
Caring because our values are at the core of our brand and by acting as the consumer advocate and leading
public debate and the policy agenda,
Responsive because we improve the scope and affordability of our services to ensure they become widely
accessible and we believe in putting the needs of the consumer first and in consumer choice,
Well-led because we believe in striving to be the best we can and in empowering people to take control.
It is our mission to train, develop and motivate our people and others, as well as to seek other like-minded
organisations and people to always deliver health as it should be.
As part of our quality governance continual improvement process the following areas have been identified as
areas for improvement of our products and services to customers. There is an underlying theme of improving
our ‘intelligent monitoring’ in order to provide information to our customers on the quality of the products and
services we provide. This in turn will better support customers to be able to make informed choices about their
care and wellbeing options. Progress on achieving these improvements will be managed in the operating divisions
and will be monitored, measured and reported through the relevant management boards, with oversight from the
quality governance committees.
Nuffield Health Annual Quality Report 2013
Page 3
Improving safety:
As demonstrated in this report, Nuffield Health aims to provide safe products and services to its customers.
We recognise that we not only need to have safe systems and processes in place, but we need to be able to
benchmark our safety indicators, including with NHS services where relevant. We are working to align our
systems and reporting so that we can contribute to the National Reporting and Learning System (NRLS)
to support benchmarking in adverse event monitoring. As part of this improvement process we will also be
monitoring whether there are any outliers in adverse event reporting (high/low), whether adverse events
are being consistently investigated at the right level and whether there is any correlation with claims.
Improving Effectiveness:
Nuffield Health provides effective products and services in order to meet the desired outcome for
customers. We recognise that outcomes need to be measured more consistently across Nuffield Health
and evidence based-systems used to support stakeholders, for example including electronic records and
electronic prescribing. We are working to develop and integrate electronic systems to improve quality and
access to outcome data that can be used to support customer choice. This will be associated with improved
access to clinical audit information that will support choice of professional providing products and services.
Improving Care:
Satisfaction with Nuffield Health products and services is very high as shown later in this report. However,
we need to improve our processes for monitoring satisfaction and to ensure that this is analysed in
conjunction with complaints in order to better understand holistic customer feedback. As part of the
Nuffield way of caring we will also review how both customer and staff satisfaction influence the outcome
of care.
Improving Responsiveness:
Nuffield Health continues to invest significant resources in developing easier ways for current and
prospective customers to access our products and services through our Customer Relationship Management
(CRM) system and digital platforms, which include Nuffield HealthScoreTM. We are aware that we need to
improve our processes for customers where we are less responsive, for example following cancellation
of procedures. Therefore, we will focus on reducing cancellations and on improving our measurement of
follow-up bookings so that we can demonstrate we have improved in this area.
Improving leadership:
Nuffield Health has an extensive leadership programme and training courses delivered through the Nuffield
Health Academy supported by a Learning Management System (LMS). As part of the continual improvement
process we need to constantly update the training needs analysis to ensure our people are competent to
deliver our products and services. We are also aware that some of the people we engage with to deliver our
products and services find it less easy to access our development programmes. We will focus on improving
how we induct and orientate temporary staff and how we work with Consultants to ensure that they are
fully engaged with our strategy for joined-up health.
Karen Harrowing
Group Quality Systems Director
Nuffield Health Annual Quality Report 2013
Page 4
Background information and summary of internal and external audit:
Nuffield Health is a provider of health and wellbeing solutions for customers, which cover the landscape of
needs from ‘improving and maintaining health’ to ‘treating health problems’. These ‘prevent’ and ‘cure’ ends of
the landscape are brought together through how we ‘assess and contain’ health risks. Together these elements
provide an inter-relationship towards Joined-up Healthcare. Nuffield Health’s 7th Annual Quality Report provides
an overview of how the quality of service provision is monitored and, where required, improved. Given the range
and diversity of Nuffield Health’s products and services, it is not straightforward to find comparable metrics and
therefore external comparison is not always possible. As part of the continual improvement process, relevant
external benchmarks are being developed. The Quality Account for specific NHS activity for the year 2013/14 can
be found in Appendix 1.
Improve and maintain
health
Hospitals
Beds
Assess and contain
health risks
Treat
health problems
2011
2012
2013
31
31
31
% change
from
2011 - 13
1,411
1,401
1,435
Patients treated in Hospitals
265,156
281,375
282,414
7%
Hip and other Orthopaedics Procedures
46,800
50,668
55,045
18%
General Surgical Procedures
30,900
31,855
31,706
3%
Ophthalmic Procedures
14,500
16,255
16,401
13%
Outpatients Visits
317,350
339,784
345,393
9%
MRI and CT Scans
59,543
63,398
66,345
11%
Radiological Examinations
153,665
132,762
128,193
-17%
Consumer Wellbeing Centres
53
65
65
Medical Centres
8
6
6
193
198
200
Corporate Wellbeing Centres
Members of Corporate Centres
98,000
99,975
102,000
4%
Consumer Fitness Members
134,000
190,941
183,340
37%
Physiotherapy Sessions
460,000
555,897
474,516
3%
82,000
102,090
98,651
20%
Health MOTs
The assurance framework in Nuffield Health comprises:
Internal Audit
External Audit
Internal audit in subject specific risk, safety and quality management processes, operates across the organisation
with feedback loops to ensure lessons are learned as part of our continual improvement methodology. Internal
audit supports external audit. Nuffield Health undertakes external audits of suppliers to ensure that the products
and services provided are of the desired quality to be used or associated with Nuffield Health.
External audit includes verification against compliance to regulation and certification against standards by
relevant bodies. There are numerous relevant regulatory bodies whose requirements we meet and links are
provided in Appendix 4. The regulator in England that undertakes external regulatory assessment across
Hospitals (29) and Wellbeing centres (18 including mobile mammography units) is the Care Quality Commission. In
Nuffield Health Annual Quality Report 2013
Page 5
the majority of areas Nuffield Health demonstrated 100% compliance, performing better than the overall score
in both the NHS and independent sector hospitals. The areas that were considered by the CQC not to be fully met
(1 outcome in Hospitals and 2 in Wellbeing centres) were subject to review, action planning and implementation of
improvements. Two facilities have since been re-inspected by the CQC (2014) and found to be fully compliant. The
final outstanding action from the 2013 CQC inspection programme has been completed at the local centre and
confirmation of compliance is awaited from the CQC. The Nuffield Health hospitals in Wales (1 + clinic) and Scotland
(1) are subject to inspection by Health Inspectorate Wales and Health Improvement Scotland respectively, and are
fully compliant.
Nuffield Health maintains a number of certifications for quality standards that are subject to external audit by
bodies who are themselves subject to external accreditation, usually by the United Kingdom Accreditation Service
(UKAS). These include:
SEQOHS: Safe, Effective Quality Occupational Health Service - new for 2013 having demonstrated good
governance across 51 standards of occupational health. Special recognition was given for several areas,
including clinical governance, robust policies and procedures (particularly regarding confidentiality and
consent), staff and client satisfaction and the quality of our written information leaflets. Operated by the
Royal College of Physicians on behalf of the Faculty of Occupational Medicine.
OHSAS 18001: Occupational health and safety management best practice standard for customers and
staff in health and safety.
ISO 27001: Information security management system accreditation and full compliance with the NHS
Information Governance Toolkit.
CPA/ISO 15189: Pathology/Medical Laboratory accreditation scheme across all pathology laboratories.
ISO 9001/ISO 13485: Quality Management System and Medical Device Management for sterile surgical
instruments to support compliance to European Directives.
MQEM: Macmillan Quality Environment Mark for standards of environment for people living with cancer
(scheme assessed by DNV {Det Norske Veritas}).
Nuffield Health continues to work towards the Joint Advisory Group (JAG) accreditation for GI Endoscopy, ISO
14001 on Environmental Management System, ISO 22301 on Business Continuity Management and attains high
levels of compliance to PLACE (Patient-led assessments of the care environment).
Nuffield Health was named:
Best Workplace Wellbeing Provider at the 2013 Health Insurance Awards. The Health Insurance Awards are
judged by a panel of senior independent figures and voted for by insurers and intermediaries.
Nuffield Health Annual Quality Report 2013
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1. Nuffield Health report on safety: Protecting people from abuse and avoidable harm
The safety of our customers, staff and visitors is paramount. Health and Safety risks have the potential to
impact anyone who comes into contact with Nuffield Health premises. Nuffield Health has continued to
implement lessons learned following Health and Safety adverse events, including training and developing
individuals and teams to the required NEBOSH or IOSH standards. Nuffield Health has a rigorous programme
of Health and Safety management and the external certification we maintain in respect to our Occupational
Health and Safety Management System (OHSAS 18001) provides assurance that Nuffield Health maintains a
safe environment.
Graham Cowan, Group Health, Safety and Environmental Director
The information in this section is provided to align, where possible, with the indicators being used by the Care
Quality Commission (CQC) as part of the process of ‘intelligent monitoring’.
1.1.
Avoidable Infections:
Our hygiene and infection prevention standards are subject to internal and external scrutiny and have been
verified by our customers during unannounced inspections from the CQC. This is demonstrated in the CQC reports
on Nuffield Health, Tunbridge Wells Hospital in November 2013 and on Nuffield Health Bromley Fitness and
Wellbeing Centre in September 2013:
….. pleased with the quality of the care that they received. Comments we heard included, “very very
good”….One patient said,” medical care is excellent … always washing their hands”
…..complimentary of the health assessments undertaken, including the cleanliness of the clinic. People’s
comments included “very thorough and professional”, “nice and clean”, and “I am happy with the service I
received”.
Nuffield Health has an excellent record with respect to the management of avoidable infections (Healthcare
Associated Infections or HCAI). There is a well-established infection prevention programme which includes
reporting, monitoring, auditing and embedding lessons learned into training and development. Nuffield Health
participates in the Public Health England National Mandatory Surveillance of HCAIs and, as shown below, our very
low levels of HCAI have decreased in 2013 including:
Zero cases MRSA Blood Stream Infections (BSI) for 34 consecutive months
Nuffield Health Annual Quality Report 2013
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In the rare cases where an avoidable infection is identified a full root cause analysis is undertaken. Lessons learned
and potential trends are reviewed at the Group Infection Prevention Committee and where necessary, action
taken at a local or group level. At the time of writing there is no Public Health England (PHE) report that provides
a direct comparison between the independent sector and the NHS. However, within the independent sector (IS),
Nuffield Health performs very well against other similar organisations and consistently performs better than the
‘overall independent sector (IS) rate’ for HCAIs:
1.2.
Adverse events including ‘Never Events’:
As stated in the section on continual improvement, the plan is for Nuffield Health to benchmark against the NHS,
and the independent sector, with respect to safety incidents. The NHS has stated it will provide the independent
sector with access to the National Reporting and Learning System (NRLS) in 2014. The data available in the NHS
Quarterly Data Summary (QDS) reports set out the number of patient safety incidents reported to the NRLS by
NHS organisations in England and Wales. The figure below is taken directly from the latest NHS report and is
titled ‘chart 1’, as per the NRLS website. The associated NHS England news release stated: “The trend of increased
incident reporting reflects that work over recent years, and our continuing focus on reporting and learning in a
culture of openness and honesty.”
Nuffield Health Annual Quality Report 2013
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Nuffield Health has seen a similar growth in reporting of adverse events (shown in the figure below) which can
be attributed to improving the knowledge within teams about the benefits of reporting all adverse events.
We welcome the recommendations in the Berwick Report that a culture must be maintained and developed to
manage the risks inherent in all healthcare systems. All those engaged in providing healthcare and wellbeing
seek ‘to do no harm’. The development of ‘intelligent monitoring’ by the CQC across the NHS and the independent
sector, including the potential to be able to identify under reporting of safety incidents, will support an open and
transparent culture.
In Nuffield Health the open reporting culture is well developed in the Hospital Division and reporting and
monitoring is being developed to align with the NHS. Nuffield Health is a diverse organisation and the reporting in
the Wellbeing Division is developing from different foundations (fitness industry – see ‘members/clients’ below).
System integration developments will be required in order for the business to be able to report consistently
across all divisions and other industry benchmarks will need to be sought for the non-clinical adverse events
across Nuffield Health.
Nuffield Health Annual Quality Report 2013
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Nuffield Health has been working to align reporting systems with the NHS for ‘adverse events affecting patients’
and during 2012 introduced a harm level of ‘no harm - prevented’, across the organisation. As shown below in
2013, the majority (69%) of adverse events caused ‘no harm’ and within the ‘no harm category’ the majority (75%),
were events that were prevented, for example an error or omission in prescribing where there was intervention
prior to the medication being administered. It is important that lessons are learned from these ‘near miss’ events
so that systems and processes can be continually improved.
Nuffield Health has continued to improve adverse event reporting and monitoring through the internal Datix risk
management system. This has included reviewing categories and levels of harm against NHS terminology. Whilst
the year on year continual improvement is a positive factor, it does mean that there is an impact on year to year
trend information. The figure below shows the total of ‘all harm levels’ against ‘no harm’ for ‘all’ adverse events
and then for ‘patient events’. In addition, the position in the NHS over a three year period is shown (2013 not yet
available from NHS). As Nuffield Health develops criteria to support reporting into the external NRLS, then a more
consistent picture of reporting will develop and improvement can be more effectively targeted.
Nuffield Health Annual Quality Report 2013
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The percentages of adverse events that are classified as severe or above are very small (0.5-0.6%) and these
are similar to the NHS, as shown below. There were 4 unexpected deaths across the Nuffield Health in 2013 and,
following full root cause analysis, there were no concerns identified from internal investigation or by the relevant
coroner.
There were 5 Never Events in the Nuffield Health Hospital Division in 2013, one less than in 2012. Never events are
serious, largely preventable patient safety incidents that should not occur if the available preventative measures
have been implemented. These events resulted in a level of ‘moderate’ harm, since follow-up was required (and
undertaken) in each case. Each event was subject to root cause analysis and implementation and sharing of
lessons learned.
3 events related to wrong implant (2 x ophthalmic lens and 1 x orthopaedic)
1 event related to wrong site surgery (level of disc replacement)
1 event related to a retained foreign object post procedure (fragment of microfracture pick)
The term ‘Never Event’ has been restricted to those events defined by NHS England. In 2014 the Wellbeing Division
will be reporting on events that should not occur if preventative measures have been implemented and these will
be termed Significant Preventable Events.
1.3.
Venous Thromboembolism:
Venous Thromboembolism (VTE) is a significant patient safety issue in hospital. The first step in preventing an
adverse event from VTE is to identify those at risk so that preventative treatments can be used. Nuffield Health
(Hospital Division only) has a very low incidence of VTE as a percentage of activity and a high percentage of
patients undergo risk assessment. As part of the drive for continual improvement, the goal for admitted patients
to be risk assessed will be increased to 95% for 2014.
Nuffield Health Annual Quality Report 2013
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2.
Nuffield Health report on effectiveness: Promoting a good quality of life and achieving good outcomes.
Nuffield Health champions healthy lifestyles. We believe that the more active people are, the better their
quality of life will be and the lower their risk of ill health. We believe this because we see evidence every day
in our Fitness & Wellbeing Centres. Our research shows that once the good habit of regular exercise is made,
it stays with you for life. Therefore, it is important to encourage parents, schools, health professionals and
anyone working with children to help them gain experience of different types of exercise and with it a lifelong
love of activity. This would help to reverse the trend of more people at a younger age being diagnosed with
type 2 diabetes. In October 2013 Nuffield Health opened a new community fitness suite at Piggott School,
Wokingham. At the opening the Head Teacher stated that ‘accessing Nuffield Health’s expertise will have a
positive impact on both our students and the wider community’. The education sector is a key area for Nuffield
Health. We are currently working with 18 schools and colleges across the country implementing programmes
to help students live healthy active lives.
Dr Davina Deniszczyc, Medical Director Wellbeing
Nuffield Health’s approach to wellbeing is industry leading and therefore there are very few areas for comparison
and benchmarking. Our approach is to define the evidence base by engaging in research and reviews. In May
2013, Nuffield Health published research in conjunction with the London School of Economics, 12 minutes
more, highlighting the importance of physical activity, sports and exercise, in order to improve health, personal
finances and the pressures on the NHS. The research showed that the average person in the UK does well below
the recommended amount of exercise. However, those who do take part in physical activity have better mental
and physical health, lower cholesterol and blood pressure, are less likely to have cardiovascular disease or Type
2 diabetes and are more likely to be a healthy weight. The research also shows that achieving this need not be
difficult and recommends that each person only needs to undertake an additional 12 minutes of physical activity
each day to make a difference. For that to be sustainable it must be in an environment that is friendly and meets
the needs of the individual.
2.1.
Wellbeing outcomes and audit – Health Assessments and Fitness
Nuffield Health offers four types of Health Assessment designed to address specific concerns of people at
different stages and ages to help them understand their individual needs for health and wellbeing improvement.
Our customers confirm the benefits, for example as during unannounced inspections from the Care Quality
Commission (CQC). This is demonstrated in the CQC report on Nuffield Health London City Fitness and Wellbeing
Centre in August 2013:
Everyone we spoke with was happy with the service. One person told us, “they make me feel relaxed, you
are always a little anxious about this type of thing, but they put you at your ease.” Another person wrote in
the satisfaction survey, “a really wonderful experience. I left in a good frame of mind of how I was physically
and mentally. I have goals for my next appointment.” People told us that assessments and tests were
explained at every step and they were always asked if they were happy to go ahead with any procedures.
In 2013 we continued to collate information on abnormal tests from Health Assessments. This shows that we
continue to diagnose issues that require early follow-up. From 2014 we are aiming to benchmark this information
and to see where we can follow-up the customer journey in order to review longer term outcomes of the service.
Nuffield Health ensures that people undertaking exercise within its Fitness & Wellbeing Centres have the
opportunity to tailor their exercise programme to their individual needs. Health MOTs are offered to all members
free. The outcomes show that this is an important first step to an enhanced programme of exercise. As shown
below nearly 100,000 Health MOT’s were undertaken in 2013. 62% of members required a modified/moderated
programme of exercise after MOT. More significantly 4% of members required referral to a GP after having a
Health MOT and prior to starting exercise. This percentage has been consistent in the last three years. Outcomes
from members’ personalised gym programmes demonstrate improvement as a ‘population’. The aim for 2014 is to
look at how outcomes for individuals can be reported and reviewed over time.
Nuffield Health Annual Quality Report 2013
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2.2.
Wellbeing outcomes and audit – Physiotherapy
Nuffield Health is the largest provider of physiotherapy services across the UK, outside the NHS. The service
offers a wide range of treatments to keep people active, from managing muscular aches and pains through to
long term rehabilitation after serious injury. 70% of patients recover in 5 sessions or less and the average number
of sessions has been consistent over the past 3 years (4.8). The efficiency of the service has improved over the
last 3 years with the ‘Did Not Attend (DNA)’ rate falling from 8% to 3.6%. The percentage of ‘good outcomes’ has
been fairly consistent since 2011 with an average score of 91.8%. A ‘good outcome’ means patients reporting
improvement of 30% and above at the point of discharge. As part of the continual improvement programme a
new target for ‘excellent’ outcomes will be established for 2014.
Nuffield Health Annual Quality Report 2013
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2.3.
Wellbeing outcomes and audit – Mammography
During 2013 a review was undertaken of the latest evidence for breast screening mammography in asymptomatic
women over the age of 40 years. This was to ensure that our mammography service provided benefit, over any
potential risks from screening. The review led to the following improvements to the service in line with the
evidence base:
Introduction of initial eligibility criteria checks followed by a ‘Lifetime’ risk assessment prior to appointment
booking.
Introduction of risk based client pathways for those assessed as low, moderate and high risk, whereby only
women at high risk would be recommended a mammogram on the basis of benefit outweighing any risks.
Women considered low risk would be supported with surveillance techniques and those at moderate risk
offered further testing and risk assessment.
Patient information to be aligned with NHS information, with particular reference to those aged 40-50, to
ensure they have all the information required to make informed decisions.
Doctors engaged in obtaining patient consent during Health Assessments to undertake training and
development relating to the new evidence base, including relevant risk assessments.
The quality of mammograms is subject to peer review audit and the trend below identifies that the number of
sites providing good or perfect images has improved year on year. The grey areas indicate sites that were unable
to perform the peer review against the quarterly audit programme timeline, either due to staff changes or
low qualifying numbers of mammograms. A continual quality improvement plan has been put in place which is
overseen by the Group Radiology Manager.
2.4.
Hospital outcomes and audit – unplanned readmission/transfer/return to theatre
The majority of Nuffield Health Hospitals’ activity is elective surgery. It is important to monitor areas of the
pathway of care that are not planned since this may be an indication that quality and safety could be impacted by
unplanned activity. The figure below shows a positive trend, with unplanned transfers to another provider having
fallen. However, unplanned returns to the theatre and unplanned readmissions have increased year on year in
actual numbers and as a percentage of activity. Although the percentages are small, we are investigating this
trend and external benchmarks. Key lines of enquiry include changes in patient mix, for example chemotherapy
re-admissions.
Nuffield Health Annual Quality Report 2013
Page 14
2.5.
Hospitals outcomes and audit – national clinical audit and registries
The activity in the Hospital Division is predominantly elective surgery, and of that over 55,000 (30%) are
orthopaedic procedures. This activity has therefore driven the collection of outcome measures and is the key
focus of this section, where the National Joint Registry (NJR) defines the benchmark for both the NHS and the
independent sector. As stated in the opening section of this report Nuffield Health is a member of the Private
Healthcare Information Network (PHIN) and the programme of future development of comparable outcomes
is provided on their website. The PHIN publication tab also provides information on hip and knee replacement
surgery carried out by the independent sector for the NHS.
The latest National Joint Registry report to be published is the NJR 2013 10th Annual Report which includes surgical
data to December 2012. The overall position in Nuffield Health is very good, however, the following outliers are
identified in the report:
3 Nuffield Health Hospitals are identified as outliers in respect to increased rate of hip revisions. The
adjacent NHS hospitals are also seen as outliers. This issue relates to the complications with Metal on Metal
hip implants. Nuffield Health is following national guidance with regard to the management of patients as
stated in the information on the NHS Choices website.
2 Nuffield Health Hospitals are identified as outliers in respect to ensuring that there is consent obtained
from the patient for information to be submitted to NJR. Where consent is not positively identified then the
NJR will not process information on the patient. The two hospitals have undertaken a review of procedures
to ensure improvement in NJR consent rates.
As shown in the figure below overall compliance in obtaining consent to share patient information with the NJR is
good. The details in the 2013 NJR report show that the range in Nuffield Health is between 60% and 100%. This
indicates that lessons can be learned across the hospitals in order to improve the position and this will be followed
up in 2014. The ability to link episodes of care is reliant on the provision of the NHS number and the figure below
identifies good compliance overall for Nuffield Health. However, there is a range in compliance from 83% to 99%.
The NJR report comments that 100% can be achieved for these compliance metrics and therefore the target for
Nuffield Health Hospitals is 95% in 2014 and 100% in 2015.
Nuffield Health Annual Quality Report 2013
Page 15
As stated in the quality improvement section at the front of this report, the focus for 2014 is to review where
submission into other national clinical audit and registries would be applicable in Nuffield Health (as defined by the
Healthcare Quality Improvement Partnership {HQIP}).
2.6.
Hospital outcomes and audit – surgical site infection (SSI)
Infection can occur as an unwanted complication of surgery and may result in a poor outcome or even further
surgery. For example the NJR report referred to above states that in orthopaedic revision surgery the cause is due
to infection in 12% of hip revisions and 22% of knee revisions. It is therefore essential that surgical site infections
are monitored and any issues or trends identified. The Surveillance of Surgical Site Infections is undertaken by
Public Health England and monitoring of infection rates in orthopaedic procedures became mandatory in the
NHS in 2004. As stated in the ‘safety’ section, Nuffield Health has high standards of hygiene and continues to
implement improvements by lessons learned from root cause analysis into surgical site infections, for example,
in improving monitoring of intra-operative temperature of patients and in improving staff training on surgical
site infection surveillance to ensure data collection and reporting is robust. As shown below the rates of surgical
site infections in hip and knee replacement in Nuffield Health are very low. The NHS rate has been included as an
indicative benchmark. The Nuffield Health rates are not fully comparable with the NHS due to the potential for
more readmissions into the NHS and the higher ASA* scores of patients treated in the NHS.
*ASA score is the American Society of Anaesthesiologist scoring classification of a patient’s pre-operative physical status on a scale from one to five, with
higher scores indicating severe systemic disease.
Nuffield Health Annual Quality Report 2013
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2.7.
Hospital outcomes and audit – Patient Reported Outcome Measures
Patient Reported Outcome Measures (PROMs) are standardised validated question sets to measure patients’
perception of health and functional status and their health-related quality of life. Nuffield Health invites all
patients (private and NHS) undergoing hip or knee replacement, groin hernia surgery, or varicose vein surgery
to complete a PROMs questionnaire. There is a national programme for all NHS patients (whether treated in the
NHS or the independent sector) and therefore reporting can be compared between the NHS and the independent
sector, where the volume of patients meets the thresholds. Information on NHS PROMs is available on the
NHS Choices PROMs website. The Private Healthcare Information Network (PHIN) also publishes PROMs for hip
and knee replacement surgery against individual hospitals for NHS patients treated in the independent sector.
The details of the NHS PROMs results for Nuffield Health are reported in the NHS Quality Account as a supplement
to this report. PROMs for NHS patients treated in Nuffield Health show similar outcomes to PROMs in the NHS.
PROMs for private patients are voluntary and are not collected by a national programme and therefore there
are currently no independent sector benchmarks. During 2014 PHIN plans to collate and publish private patient
PROMS, where they are available. Nuffield Health does offer private patients, undergoing one of the four relevant
procedures, the opportunity to be involved in PROMs and the results over three years are shown below. The
percentage of patients reporting improvement is similar to NHS results, with the exception of varicose vein
surgery. The results for varicose vein surgery are being reviewed as the procedure may be for cosmetic purposes
and the perception of improvement, given the potential discomfort, may be lower. A review of patient information
outlining the risks and benefits of the procedure using the various techniques for varicose vein surgery is
underway. Comparative PROMs information on varicose vein surgery may be limited going forward as fewer
eligible procedures will be undertaken in the NHS in 2014.
Nuffield Health patients are informed about the risks and benefits of the procedures undertaken. This is verified
during unannounced inspections from the Care Quality Commission (CQC) and demonstrated in the CQC report on
Nuffield Health York Hospital in December 2013 and Nuffield Health Taunton Hospital in March 2013:
People we spoke with said they felt fully informed about their care and treatment. They had been able
to ask questions and gain written information about their condition. A person we spoke with said “I have
always received the most detailed of explanations. Everyone is very explicit.”
From patient records and our conversations with patients we found that people were always asked for
their consent before they received any care or treatment. Patients told us “All the risks were fully explained
and I was given a consent form to sign” and “I was given a consent form to look at and information to take
home and read”. Patients told us they were very happy with the care and treatment they received. We
were told “Nothing was too much trouble for the staff”. One patient had been an inpatient at the hospital
previously and was now returning for another treatment, they said “I’ve come back for more. That says it all.
I have no concerns”. Another patient told us they had been nervous before admission but said their hospital
stay “had been an excellent experience”. All patients spoken with said they felt safe and “in good hands”
during their stay at the hospital.
Nuffield Health Annual Quality Report 2013
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3.
Nuffield Health report on caring: Involving people and treating them with compassion,
kindness, dignity and respect
Nuffield Health is committed to devising and implementing initiatives which will improve the quality of the care
we provide. Patients receive focussed individualised and holistic care, based on evidence, best practice and
innovation. Involving people and treating them with compassion, kindness, dignity and respect are fundamental
to our values and this caring approach is seen throughout our workforce and across the Hospital and Wellbeing
divisions. The approach to leadership as defined in the ‘Well-led’ section below is pivotal to the Nuffield Way of
Caring.
Professor Dickon Weir-Hughes, Chief Nurse
3.1.
Customer Satisfaction:
Nuffield Health works to enhance customer satisfaction through reviewing customer feedback. Customer
satisfaction surveys vary across the organisation and have been adapted over time in response to operational
feedback. There are a limited number of survey questions that can be used to compare services within Nuffield
Health and there are also differences between surveys used in the NHS and the rest of the independent sector.
A review of industry best practice and regulatory requirements is planned for early 2014, in order to improve
the opportunities for benchmarking and have a more consistent use of the Net Promoter Score (NPS) to drive
improvement. The NPS is the difference between the percentage of users who would recommend Nuffield Health
minus the percentage of users who would not. In the interim, the specific details from NHS patients are reported
in the NHS Quality Account as a supplement to this report. A summary of the results from responses of customers
across Nuffield Health are provided below showing consistently high levels of overall satisfaction and ‘would
recommend to friends and family’.
In addition to formal satisfaction survey feedback, Nuffield Health draws assurances about the high level of
customer satisfaction through a number of informal routes, for example verbal and written compliments. The
feedback our customers provide during unannounced inspections from the Care Quality Commission (CQC)
is extremely positive, as identified throughout this report. The feedback on our caring culture in Hospitals is
demonstrated in the CQC report for the Nuffield Health Leeds Hospital in November 2013 and Nuffield Health
Manor Hospital, Oxford in March 2013:
All the patients we spoke with spoke highly about the care and treatment they received from staff.
Comments patients made included, “All the nurses have been lovely. I was in a lot of pain last night but they
gave me all the medication they could when I asked for it” and, “I am so lucky to be here in this hospital. I can’t
speak highly enough of them.”
Nuffield Health Annual Quality Report 2013
Page 18
One person said “The doctors explain everything and the nurses tell you what they are going to do.”
We spoke to two patients about their experience of the care provided. Patients described their care
as “Excellent”, “Attentive” and “10 out of 10.” Patients were able to describe a full assessment of their
care needs and were asked if there were any individual preferences they had. This meant that care was
individualised and met the needs of the person.
The feedback from customers on the management of privacy and in exceeding expectations is also demonstrated
in the CQC reports in Wellbeing for the Nuffield Health Wellbeing Centre Manchester in April 2013 and Nuffield
Health Reading Fitness and Wellbeing Centre in January 2013:
“They respect my privacy.” ….”My experience has been amazing and I would recommend them to anyone, I
can’t speak highly enough of them.” “They always explain what they are doing and ask if I have any questions
about my treatment.” “They offer time to recover or use the facilities before I leave.”
People told us they were pleased with the care provided by the physiologists and doctors at the Nuffield
Health Reading Fitness & Wellbeing Centre. They said staff were professional and knowledgeable. One
person told us that her experience “exceeded expectations.”
3.2.
Customer Complaints:
Nuffield Health reviews complaints to establish where lessons can be learned. The aim is to manage all complaints
as close to the customer as possible, and within the area where they occur (stage 1). During 2013 a review of
the complaints process was undertaken to ensure that complaints were classified more consistently across
Nuffield Health. The areas below in the Wellbeing Division showing a sudden increase in complaints are related to
alignment of measurement process rather than any actual increase in complaints.
Complaints escalated to divisional level (stage 2) are monitored to understand why they were not resolved locally.
During 2013 Nuffield Health reviewed the management of complaints at stage 2 and those requiring external
adjudication (stage 3), and following publication of the updated code by the Independent Sector Complaints
Adjudication Service (ISCAS), the following improvements were initiated in 2013 and are due to completed in early
2014:
ISCAS - extend code to cover all clinical complaints across Nuffield Health, including Wellbeing.
Customer information – review Nuffield Health leaflet and website to improve communication on how
to complain and how to escalate complaints when the customer is not satisfied. In addition, to improve
alignment with the principles of the Parliamentary and Health Service Ombudsman in order to improve
communication on the different complaint processes available for NHS patients.
Reporting – improve reporting and analysis of complaints from ‘point of care to board’ and integrate
satisfaction and complaint reporting to improve learning on customer expectations.
Nuffield Health Annual Quality Report 2013
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The position on stage 2 and stage 3 complaints is shown below (only available for Hospitals to the end 2013). Of 5
complaints escalated to independent adjudication (stage 3) 1 was upheld, 1 was not upheld with 3 partially upheld.
The increase in stage 3 complaints has highlighted issues at stage 2 and the process has now been standardised
within the Hospital Division.
In late 2013 a review of on-line customer and patient feedback about Nuffield Health was undertaken, including
NHS Choices and Patient Opinion, both of which are also reviewed by CQC as part of their intelligent monitoring. An
improvement plan was developed for implementation in early 2014, which will support Nuffield Health managers
on how to effectively manage on-line feedback sites.
Nuffield Health Annual Quality Report 2013
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4.
Nuffield Health report on responsiveness: Organising products and services to provide wide access to meet people’s needs
Freedom to access information about our health and wellbeing should be a given. The more we know about our
wellbeing the quicker and better our improvement will be. With Nuffield HealthScore™ we’re allowing access
to data that in the past has not been readily available and enables our members and patients to see and keep
track of their personal data in a quantified way. If we can help someone to make just one positive, healthrelated change to their lifestyle, we are helping to prevent long term chronic disease, ill health and possibly
premature death.
Rebecca McCheyne, Group Digital Services Director
4.1.
Responsive – access to innovative products and services
Nuffield Health can demonstrate how it is organising products and services to provide wide access to meet
customer needs including, but not limited to;
Through 31 Hospitals, 65 Wellbeing Centres, 6 Medical Centres and 200 Corporate Wellbeing Centres.
In June 2013 Nuffield Health announced a three year partnership with the Ministry of Defence to undertake
fitness tests of prospective new recruits for the Royal Navy, Royal Marines and Royal Air Force.
During 2013 Nuffield HealthScoreTM continued to develop as an online and mobile fitness/lifestyle tool
allowing customers to monitor their health and wellbeing anytime.
In summer 2013 Nuffield Health responded to identified unmet needs of customers by introducing the
Nuffield Health Promise which included promises in relation to price, treatment and follow-up.
Nuffield Health is committed to providing new products and services across the health landscape. Innovation will
continue to play a pivotal role in all aspects of clinical and wellbeing services, including measurement of their
efficacy and cost effectiveness. We have continued to collaborate with academic and research organisations,
for example in recruiting participants to clinical research. Our approach recognises that a strong evidence base
is important and drives clinical and academic research including recruitment of participants to the ADON study,
a possible new treatment for Acute Demyelinating Optic Neuritis, and the introduction of new services and
procedures such as a genetic counselling and screening service, risk screening for kidney stones, enzymatic
vitreolysis in ophthalmology, and left atrial appendage exclusion for cardiac patients.
Our responsive and accessible services are subject to external scrutiny and have been verified by our customers
during unannounced inspections from the CQC. This is demonstrated in the CQC reports on Nuffield Health
Surbiton Fitness and Wellbeing Centre in February 2013 and Nuffield Health Newcastle Hospital in November
2013:
They had been consulted throughout and felt fully informed about the procedures. We were told that “the
doctor was excellent, probably the best that they’d had.” Information is available for people who attend the
centre. We found a variety of leaflets in the waiting room and treatment rooms. These informed people
about the various tests that were available. We also saw lifestyle leaflets regarding alcohol, smoking and
diet.
Care and treatment was planned and delivered in a way that was intended to ensure people’s safety
and welfare. One patient said;” I’ve been so impressed with the care, I’ll come back for other treatment
depending on the cost.” Another said;” I knew how good the Nuffield was even before I was admitted, as
people had told me.”
Nuffield Health Annual Quality Report 2013
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4.2.
Responsive – access to comparative indicators
Due to the highly diversified products in the Wellbeing Division, there are no comparable benchmarks and new
‘responsive/access’ measures are being developed for 2014. For the Hospital Division many of the acute NHS
indicators relate to access to emergency treatment. The proportion of patients whose elective operation was
cancelled is an indicator that can be benchmarked against the NHS and will be able to benchmarked across the
independent sector through the Private Healthcare Information Network (PHIN) in the future. As shown below
the 2013 position in Nuffield Health has improved from 2012. As part of the continual quality improvement
programme understanding how we have met customer needs through re-booking cancelled procedures will be a
focus for 2014.
Nuffield Health will be working with the CQC during 2014 to develop indicators in this and other areas that will
support intelligent monitoring within the independent sector.
4.3.
Responsive – management of personal information
Nuffield Health has the capability to respond to new ways of managing personal data, given the established
controls it has in place in relation to information security. Throughout 2013 Nuffield Health has continued to
demonstrate a responsible approach towards the safe and secure management of data, ensuring that confidential
health information is handled in accordance with Caldicott Principles, requirements of the 1998 Data Protection
Act and International Standards for Information Security. Nuffield Health has held the Information Security
Management Standard ISO27001:2005 since 2007, and in January 2013 underwent a full re-certification process
in line with the 3 yearly review cycle, achieving continued certification. In addition, Nuffield Health completes an
annual NHS Information Governance Toolkit, and meets the required level, exceeding the required level in 23 out
of 29 individual requirements and attaining an overall score of 93%.
Nuffield Health Annual Quality Report 2013
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5.
Nuffield Health report on leadership/ well-led: Promoting high quality person-centred care through strong leadership
Nuffield Health prides itself on being a values-led organisation; that is, an organisation whose values dictate
everything that it does. The core value upheld by Nuffield Health is to do right by the patient, and this permeates
at all levels of the organisation. From frontline staff to the Chief Executive, practice is informed by what the
organisation and its members believe to be important. It is crucial that employees working directly with patients
share the values of the organisation, and draw on them as they operate on a daily basis. Applying these values
on a moment-by-moment basis can make the working day more demanding; but following prescriptive rules
can remove a sense of understanding of what the right thing to do is, and take away individual responsibility
for doing just that.
Marcus Powell, Group Organisation Development/HR Director
5.1.
Leadership - Staff Surveys and other feedback
Nuffield Health develops and motivates people to take control and to strive to be the best they can. They
demonstrate this when dealing with customers, as verified during unannounced inspections from the CQC. This
is highlighted in the CQC reports on Nuffield Health Plymouth Hospital in February 2013 and on Nuffield Health
Birmingham Fitness and Wellbeing Centre in October 2013:
One member of staff told us “It isn’t difficult, it’s about involving people and making sure they know what’s
going on.” We spoke with four people who had used the service and they all told us how their care and
treatment had been delivered in line with their individual care plan. “I knew what was going to happen and
why, and that’s what’s happened.” one person told us….They all confirmed that they had been treated with
respect and dignity. “You’re a person, not a number here” one person said.
We saw and staff told us that they felt supported to deliver care and treatment which met people’s needs.
We found that the provider had robust systems in place to monitor the quality of services they delivered to
people who used Nuffield Health Birmingham Fitness & Wellbeing Centre. We spoke with three people who
used the service on the day of our inspection. They all confirmed their satisfaction with the service. One
person told us, “All the staff have been very polite, helpful and professional.”
The ‘Leadership MOT’ provides an opportunity for staff to provide feedback on how the organisation is managed
and a key question is whether staff would recommend Nuffield Health to friends and family, known as the staff
Friends and Family Test (FFT):
Nuffield Health Annual Quality Report 2013
Page 23
The results in the figure above show that 92% of staff in Nuffield Health Hospitals Division and 91% in the Nuffield
Health Wellbeing Division would recommend Nuffield Health’s products and services to a friend or relative. These
results are comparable to the NHS Staff Survey Results from the highest performing NHS Trusts (those in the 4th
quartile) where the average score in the top quartile in the NHS is 84%. Staff satisfaction levels are closely linked
to the quality of healthcare provided and in 2014 we aim to increase the number of staff indicators that can be
benchmarked externally. In addition, within the Hospitals Division the Consultants who work in our hospitals are
happy to recommend both patients and other Consultants colleagues to Nuffield Health. As can be seen in the
figure below the score has improved in 2013:
5.2.
Leadership - Development and Training
Nuffield Health continues to attract and develop new leaders through the Development and Leadership
Programmes at every level of the organisation. These include our “discovering leadership” programme where
attendees are given an insight into the qualities that make for good leadership; a programme to help those in
managerial roles further develop their skills by interacting with and learning from leaders across the organisation;
and a programme for senior management, run in conjunction with Ashridge Business School, to identify the
future needs of Nuffield Health and how these can best be met. In 2013 a new programme “Brand Leadership”
was introduced, which is intended to highlight what is different about values driven leadership and why it’s
important we develop leaders who have the capacity to take the lead and do the right thing in whatever context
they find themselves. This has been very well received by all 300 people who have been through the programme.
Nuffield Health continues to deliver mandatory training across the workforce supported by e learning through
a Learning Management System (LMS). In 2013 a review of the LMS was initiated as modules had become ‘tired’,
‘user acceptability’ had declined and there were difficulties in reporting compliance with the increasing number
of accounts being established. Following implementation of improvements planned for 2014, new targets for
mandatory training compliance will be established across the business.
Nuffield Health Annual Quality Report 2013
Page 24
In June 2013 the Nuffield Health The Manor Hospital Oxford announced a partnership with Oxford University
to offer a surgical scholarship to complete MSc in Surgical Science and Practice in the area of Orthopaedic,
Neurosurgical or Cardiovascular practice. In 2014 Nuffield Health will be looking for more collaboration with
academic institutions as it is recognised that this will improve our approach to life-long learning, which in turn
underpins programmes such as the Nuffield Way of Caring.
5.3.
Employee Wellbeing and Performance Excellence
Nuffield Health is the largest provider of employee wellbeing services in the country and has been awarded
the Best Provider of Workplace Wellbeing Services again in 2013. Our approach to Wellbeing in the Workplace
is underpinned by research and the relationship between ‘happy staff and happy customers’ continues to be
investigated, as referred to above. Throughout 2013 Nuffield Health continued to embed the learning gained as
a provider of workplace wellbeing services into the organisation. In December 2013 the head office moved from
New Malden to Epsom and the new support centre was designed with employee wellbeing in mind. Our staff
are supported with a safe, effective quality Occupational Health service through the SEQOHS certification which
is managed by the Royal College of Physicians. Nuffield Health continues to provide an Employee Assistance
Programme (EAP) that can be accessed in a variety of ways as indicated in the figure below. The methods of
access have changed over the last three years and there has been a decline in volumes from 545 cases in 2011 to
297 in 2013.
Nuffield Health is a diverse organisation and has a number of legacy systems that impact our ability to provide
consistent trend information within Nuffield Health and with external benchmarks. The transition to an integrated
HR system has begun and consistent denominators are being developed. As shown below the Hospital staff
sickness absence has been flat over three years and this information is reliable. However, the other data points
may reflect ‘counting’ changes rather than changes in sickness.
Nuffield Health Annual Quality Report 2013
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The information on staff turnover shows a marked difference between the two divisions reflecting the different
norms in the industry whereby fitness staff are more mobile in their roles than hospital professionals. Industry
benchmarks will be developed for comparison in 2014.
The competence and capability of our people is vital to delivery of our strategy and underpinning operational
objectives. Nuffield Health recognises the importance of engaging with employees in an open and transparent
manner about their performance. In 2013 we started to introduce an approach based on on-going reviews and
support with feedback and coaching, all linked to our brand values and centred around honest conversations Performance Excellence. As stated above more HR indicators are being developed that can be benchmarked
within, and external to Nuffield Health. These will include measures of staff support, staffing ratios and the
proportion of staff for whom appraisals are undertaken. We have begun analysing information on appraisals for
doctors as part of the requirements for revalidation. These are currently low numbers, however, the process will
extend in 2014 for doctors who work mainly with Nuffield Health and are engaged through Practising Privileges.
2014/15 will also see many more healthcare professionals requiring a formal process to assess their fitness to
practice.
Nuffield Health Annual Quality Report 2013
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Looking forward to 2014/15
As we look forward to 2014/15 there will be significant changes in the way that healthcare is regulated when the
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 come into force on 1st October 2014.
Nuffield Health is committed to meeting and exceeding the requirements of these Fundamental Standards and will
strive to ensure that systems continue to be safe, effective, caring, responsive and well-led for all our customers
and staff, and that we are able to demonstrate this through external benchmarking and ratings. The introduction
of the Health and Social Care Act 2008 (Duty of Candour) Regulations 2014 in October 2014 will ensure there
is a consistency in the way information is reported when things go wrong and this will support customers in
making informed choices about the providers they choose to deliver high quality products and services. Nuffield
Health’s aim is to be the provider of choice based on the quality of service provision and this will be supported by
programmes of quality improvement including the Nuffield Way of Caring.
Nuffield Health is confident that the extensive programme that has been developed and implemented through
Leading the Nuffield Health Way will ensure that we will be fully compliant with the new ‘fit and proper person
requirement’ (FPPR). This new requirement comes under the Health and Social Care Act 2008 (Regulation of
Regulated Activities) (Amendment) Regulations 2014, which will come into force immediately after the regulations
for the ‘Fundamental Standards’. The new FPPR will apply to managers in individual hospitals and fitness and
wellbeing centres, as well as to the members of the respective boards. Nuffield Health will also apply the spirit
of these new regulations in areas of the business that are not subject to the same regulatory framework. The
quality governance framework will be achieved through a combination of structures and processes (e.g. quality
and safety committees at and below board level) which lead on the Nuffield Health wide quality performance
including:
Ensuring required standards are achieved;
Investigating and taking action on sub-standard performance;
Planning and driving continual improvement;
Identifying, sharing and ensuring delivery of best-practice; and
Identifying and managing risks to quality of care.
Nuffield Health will ensure that the quality governance framework is subject to scrutiny ‘through the line’ during
management reviews in accordance with the requirements of the international standard for Quality Management
Systems (ISO9001). This will include ensuring that the management review focuses on planned inputs and outputs
of the review including:
Customer feedback review – both satisfaction and complaints
Customer outcomes review – the effectiveness of the products and services against the planned pathway
Audit results review – risk based approach to internal audit and results of external audit
Status of preventative and corrective actions review
Approving improvements to the products and services that relate to customer requirements
Approving improvements to the quality management systems and processes
Approving resources required to meet the improvement plans.
At the end of 2013 we simplified the Wellbeing structure into
one division. This will ensure we keep on track with our vision
of integrated health and it is a fantastic opportunity for us to
deliver exciting and innovative products through clinicians,
fitness professionals and client services teams to our corporate,
private medical insurance and consumer customers. We have
a new Wellbeing leadership team organised to support our
four key service lines in consumer fitness, corporate fitness,
physiotherapy and primary preventive health. This is an exciting
journey and part of the long term vision for Nuffield Health to
offer joined up health and wellbeing. It is this integration that
will set us apart as an innovative provider of quality products
and services.
Our focus for 2014 is to refine the Hospital strategy, enter
new markets and accelerate integration with Wellbeing,
ensuring our hospitals’ proposition becomes fully
differentiated to improve access. This is an exciting time
for Nuffield Health and its staff, who are pivotal to driving
forward the agenda. In March 2014 we were delighted to
announce the appointment of Consultant Orthopaedic
Surgeon, Mr Geoff Graham, as Medical Director, Hospitals.
Mr Graham will be working with the business and our
Consultant colleagues to support the integration and
customer proposition. In addition, this appointment
augments the existing strong clinical leadership provided
by the Chief Nurse and his team.
Dr Andrew Jones, Managing Director, Wellbeing
KP Doyle, Deputy CEO and Managing Director, Hospitals
Nuffield Health Annual Quality Report 2013
Page 27
Appendix 1
Appendix 1 – NHS Quality Account 2013/14
Introduction
A Quality Account is a report on the quality of NHS healthcare provided under the NHS standard contract or
otherwise commissioned by Clinical Commissioning Groups (CCGs). The format is specified in regulation and more
information on the purpose and content of quality accounts can be found at the webpages for NHS Choices
Quality Accounts. The entire Quality Report is published on the NHS Choices Quality Account website as well as
on the Nuffield Health Reports section of our website.
Scope and content of this Quality Account
The Quality Account appendix of the Nuffield Health Quality Report only applies to NHS services provided from
the Hospital Division of Nuffield Health. This appendix includes NHS information for the reporting period April
2013 to March 2014 in order to align with NHS requirements. The information in the body of this report is for the
year 2013 and is aligned with the Nuffield Health Annual Report and Financial Statements.
As part of changes to regulations regarding NHS providers, Nuffield Health applied for and was granted a Monitor
licence on 1st April 2014. This is the first year that Nuffield Health has published a separate NHS report as a provider
in this format and certain information is not available, for example a comparison with 2012/13 improvement
plan for NHS activity. In addition, NHS services are not provided at all Nuffield Health Hospitals and/or numbers
of procedures can be low. Therefore, the reporting in the ‘prescribed’ statements is incomplete in some cases.
Furthermore, the data sets used in the independent sector and the NHS are not equivalent in all circumstances
at the time of publishing and the nearest equivalent information has been provided where this is available. The
information in this quality account is for Nuffield Health as a provider and the detailed information for individual
hospitals can be found with other relevant NHS information on our website.
Part 1: Statements on Quality
As stated in the background section of the body of this report, Nuffield Health is a provider of health and wellbeing
solutions for customers, which cover the landscape of needs from ‘improving and maintaining health’ to ‘treating
health problems’. Our integrated approach extends to our NHS activity and NHS service provision is included in
the overarching governance framework within Nuffield Health. The Group Chief Executive statement on Quality,
which is at the front of this report, applies to the NHS information provided. Nuffield Health is the only hospital
group outside of the NHS to have been awarded NHS Litigation Authority Level 3 accreditation for our governance
policies and processes. This is an important endorsement of the high quality of our clinical care.
Part 2: Priorities for improvement and statements on Assurance from the Board
The Board of Governors statement of assurance is provided towards the front of this report and it details the
approach to internal and external scrutiny of quality and safety across Nuffield Health.
As part of Nuffield Health’s quality governance our priorities for continual improvement are outlined in the body of
the report. The improvement plans encompass elements that are important to the way Nuffield Health provides
services to the NHS, namely;
Improving safety: We are working to align our systems and reporting so that we can contribute to the
National Reporting and Learning System (NRLS) to support benchmarking in adverse event monitoring
with the NHS and to improve safety. A link with NRLS is anticipated to be launched by 4th quarter 2014/15.
Improving effectiveness: We are developing electronic systems to improve quality and access to outcome
data and clinical audit information that can be used to support patient choice. Where possible, these
developments will include links to NHS and this will be initiated in 4th quarter 2014/15.
Improving care: We are improving the management of our complaints to ensure patient feedback is
analysed in conjunction with satisfaction reporting so that we can learn lessons more effectively on
improving care. Website development, including improved signposting to the Ombudsman for NHS
patients, is planned for 2nd quarter 2014/15.
Improving responsiveness: We are focussing particularly on putting things right quickly where things
have not gone according to planned procedure, for example cancelled surgery. We will be improving
the measurement of following up cancelled procedures and then implementing improvement plans for
hospitals to achieve by 3rd quarter 2014/15.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
I mproving leadership: In addition to the specific learning and development improvements referred
in the body of the report, we are also aligning our leadership development with the Monitor Well-Led
Framework. The CQC well-led framework key lines of enquiry (KLOE) and the NHS TDA/Monitor wellled framework key questions are outlined in a joint Statement of Intent and Nuffield Health plans to
implement the integrated approach by 3rd quarter 2014/15.
Progress on achieving these improvements will be managed in the operating divisions and will be monitored,
measured and reported through the relevant management boards, with oversight from the quality governance
committees and ultimately by the Board. During 2013/14 a gap analysis was undertaken against the Monitor
Quality Governance Framework and during 2014/15 the oversight and scrutiny committees will be aligned with
the four domains of Monitor’s framework, namely;
Strategy
Capabilities and culture
Processes and structure
Measurement.
Core NHS Quality Account Indicators
As stated in the introduction, this is the first year that Nuffield Health has presented NHS core quality account
indicators separately from other quality reporting and therefore the information below is provided only for the
reporting period 2013/14. The body of the report shows data and information over a three year reporting period
(where available) to provide assurance of Nuffield Health’s quality of care. The core set of indicators provided
below are those prescribed by NHS England for 2013/14 that are most relevant to the services provided by
Nuffield Health.
Prescribed Information
Nuffield Health Statement
The data made available to the provider with regard to: Nuffield Health is an independent sector provider and
does not currently use the Trust SHMI indicator.
(a) The value and banding of the summary hospitallevel mortality indicator (“SHMI”) for the trust for • Nil (0) NHS patients died in the reporting period
the reporting period; and
• Palliative care is N/A as no NHS patients were referred
(b) The percentage of patient deaths with palliative
by NHS for palliative care in 2013/14
care coded at either diagnosis or specialty level for
Nuffield Health considers that this data is as described
the trust for the reporting period.
due to the appropriate management of the elective
care pathway that prevent people from dying
prematurely. Nuffield Health intends to take the
following action, and so the quality of its services, by
the continual improvement of the pathway of care for
all patients.
The data made available with regard to the provider’s Nuffield Health patient reported outcome measures
patient reported outcome measures score, during the (PROMs) score for:
reporting period, for (i) groin hernia surgery:
•
groin hernia surgery is 0.1003 (EQ-5D adjusted
average health gain)
Nuffield Health considers that this data is as described
because we continue to help people recover from
episodes of ill health by application of clinical best
practice, delivered by well trained staff in a clinically
safe environment. Nuffield Health intends to take
the following action to improve the score, and so the
quality of its services, by the continual improvement
of clinical practice and by engaging with patients in
new ways to improve the percentage of patients
responding to groin hernia repair PROMs.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
The data made available with regard to the provider’s Nuffield Health patient reported outcome measures
patient reported outcome measures score, during the (PROMs) score for:
reporting period, for (ii) varicose vein surgery
•
varicose vein surgery is not applicable as there
is insufficient NHS activity in Nuffield Health to
derive results.
The data made available with regard to the provider’s Nuffield Health patient reported outcome measures
patient reported outcome measures score, during the (PROMs) score for:
reporting period, for (iii) hip replacement surgery:
• hip replacement surgery 22.186 (Oxford Hip score
adjusted average health gain)
Nuffield Health considers that this data is as described
because we continue to help people recover from
episodes of ill health by application of clinical best
practice and patient safety, delivered by well trained
staff in a clinically safe environment. Nuffield Health
intends to take the following action to improve the
score, and so the quality of its services, by the continual
improvement of clinical practice and by engaging with
patients in new ways to improve the percentage of
patients responding to hip replacement PROMs
The data made available with regard to the provider’s Nuffield Health patient reported outcome measures
patient reported outcome measures score, during the (PROMs) score for:
reporting period, for (iv) knee replacement surgery:
• knee replacement surgery 16.59 (Oxford Knee score
adjusted average health gain)
Nuffield Health considers that this data is as described
because we continue to help people recover from
episodes of ill health by application of clinical best
practice and patient safety, delivered by well trained
staff in a clinically safe environment. Nuffield Health
intends to take the following action to improve the
score, and so the quality of its services, by the continual
improvement of clinical practice and by engaging with
patients in new ways to improve the percentage of
patients responding to knee replacement PROMs
The data made available with regard to the percentage
of patients readmitted to a hospital which forms part
of the provider within 28 days of being discharged from
a hospital which forms part of the provider, during the
reporting period, for patients aged —
(i) 0 to 15; and
(ii) 16 or over
The percentage of NHS patients readmitted to a
Nuffield Health hospital within 28 days of being
discharged from a Nuffield Health hospital for the
reporting period was:
• 0 to 15 – not applicable
• 16 or over – 0.06%
Nuffield Health considers that this data is as described
because readmission to hospital within 28 days to a
Nuffield Hospital is very low. Nuffield Health intends
to take the following action to improve the way people
recover from episodes on ill health, and so the quality of
its services, by ensuring that data can be triangulated
from other sources e.g. where patients are readmitted
to another hospital.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
The data made available with regard to the provider’s Nuffield Health’s Patient Satisfaction Survey (PSS)
responsiveness to the personal needs of its patients measures the responsiveness to the personal needs
during the reporting period.
of our patients and the score was:
• 100% for overall care for the reporting period.
Nuffield Health considers that this data is as described
because Nuffield Health continues to provide people
with a positive experience of care. Nuffield Health
intends to take the following action to improve the
measurement, and so the quality of its services,
by implementing more consistent measures of
patient experience that will support improvement in
benchmarking within the independent sector and with
the NHS.
The data made available with regard to the percentage Nuffield Health undertook VTE risk assessments on:
of patients who were admitted to hospital and who
•
98.6% of NHS patients who were admitted to
were risk assessed for venous thromboembolism
hospital during the reporting period.
(VTE) during the reporting period.
Nuffield Health considers that this data is as described
because we treat and care for people in a safe
environment and protect them from avoidable harm.
Nuffield Health intends to take the following action to
improve this 98.6%, and so the quality of its services,
by consistently recording risk assessment information
to ensure all qualifying patients are included in the
measurement.
The data made available with regard to the rate per Nuffield Health rate of cases of C. difficile infection is
100,000 bed days of cases of C difficile infection
• 2.47 per 100,000 bed days.
reported within the provider amongst patients aged 2
or over during the reporting period.
Nuffield Health considers that this data is as described
because we treat and care for people in a safe
The latest available data for all NHS Trusts shows an
environment and protect them from avoidable harm.
average rate of 17.3 per 100,000 bed days
Nuffield Health intends to take the following action to
improve this rate of 2.47 per 100,000 days, and so the
quality of its services, by continual improvement of our,
already very high, standards on infection prevention
and control.
The data made available with regard to the number
and, where available, rate of patient safety incidents
reported within the provider during the reporting
period, and the number and percentage of such patient
safety incidents that resulted in severe harm or death.
Nuffield Health had the following patient safety incidents
relating to NHS patients during the reporting period:
• Number of all patient safety incidents = 2151
• Rate (percentage of episodes) = 3.42%
• Number resulting in severe harm/death = 11
• Rate (percentage severe harm/death) = 0.51%.
Nuffield Health considers that this data is as described
because we treat and care for people in a safe
environment and protect them from avoidable harm.
Nuffield Health intends to take the following action to
improve the rate 0.51% of incidents resulting in severe
harm or death, and so the quality of its services, by
continual improvement in patient safety. This will
include ‘signing up to safety’ with regard to the five
campaign pledges which will be publically endorsed by
our Group Chief Executive
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
The data made available with regard to the percentage Nuffield Health undertook a staff survey in 2013/14
of staff employed by, or under contract to, the provider which included an approved Friends and Family Test
during the reporting period who would recommend (FFT) question, relevant to the provider.
the provider to their family or friends.
• Nuffield Health Staff FFT = 92%
Nuffield Health considers that this data is as described
because Nuffield Health continues to provide people
with a positive experience of care. Nuffield Health
intends to take the following action to improve the
score of 92%, and so the quality of its services, by
continual improvement of the leadership development
programmes ‘Leading the Nuffield Health Way’ and the
‘Nuffield Health Way of Caring’.
The data made available during the reporting period
with regard to patients who would positively promote
the provider to their family or friends if they needed
similar care or treatment.
Nuffield Health has a specific patient Friends and
Family Test that is consistent with the question asked
of all NHS patients. At the end of the 2013/14 reporting
period (March 2014)
• Nuffield Health Patient FFT = 93
Nuffield Health considers that this data is as described
because Nuffield Health continues to provide people
with a positive experience of care. Nuffield Health
intends to take the following action to improve the
score of 93, and so the quality of its services, by
continual improvement of the leadership development
programmes ‘Leading the Nuffield Health Way’ and the
‘Nuffield Health Way of Caring’.
Additional NHS Quality Account Indicators
Prescribed Information
Nuffield Health Statement
The number of different types of relevant health During 2013-14 Nuffield Health provided:
services provided during the reporting period, specified
• 245 relevant health services to NHS Commissioners
under the contracts, agreements or arrangements
through Choose & Book and
under which those services are provided.
• 6000 plus episodes of care for 60 NHS Trust hospitals
through direct contracting.
The number of relevant health services to which the Nuffield Health has reviewed all the data available
provider has reviewed all data available to it on the to them on the quality of care in all of these health
quality of care provided during the reporting period.
services through the board to ward governance
processes.
The percentage that the income generated by the The income generated by the relevant health services
relevant health services represents of the total income reviewed in 2013/14 represents 24 per cent of the
for the provider for the reporting period.
total income generated from the provision of relevant
health services by Nuffield Health for 2013/14.
The number of national clinical audits and national
confidential enquiries which collected data during the
reporting period and which covered the relevant health
services that the provider provides or sub-contracts.
During 2013/14 there were 4 national clinical audits
and nil national confidential enquiries (as not eligible
for period 2013/14) covering relevant health services
that Nuffield Health provides.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
The number, as a percentage, of national clinical audits
and national confidential enquiries, identified under
entry 2, that the provider participated in during the
reporting period.
During 2013/14 Nuffield Health participated in 50%
of national clinical audits which it was eligible to
participate in on the terms of entry criteria, however
eligible patient numbers for 2 audits were too low to be
relevant. Nuffield Health was not eligible to participate
in any national confidential enquiries.
A list of the national clinical audits identified above The national clinical audits that Nuffield Health was
that the provider was eligible to participate in.
eligible to participate in during 2013/14 are as follows:
• National Joint Registry (NJR)
• Patient Reported Outcome Measures (PROMs)
• National Blood Transfusion Audit
• Cardiac Arrest Audit
Numbers of transfusions and cardiac arrests at
individual sites are very low, however, registration
with the national blood transfusion and cardiac arrest
audit bodies is planned from 2014/15.
A list of the national clinical audits identified above, The national clinical audits that Nuffield Health
that the provider participated in.
participated in during 2013-14 are as follows:
• National Joint Registry (NJR)
• Patient Reported Outcome Measures (PROMs).
A list of each national clinical audit that the provider
participated in, and which data collection was
completed for during the reporting period, alongside
the number of cases submitted to each audit, as a
percentage of the number required by the terms of the
audit or enquiry.
The national clinical audits that Nuffield Health
participated in, and for which data collection was
completed during 2013/14, are listed below alongside
the number of cases submitted to each audit or
enquiry as a percentage of the number of registered
cases required by the terms of that audit or enquiry.
• National Joint Registry (NJR) – 96.1%
•
Patient Reported Outcome Measures (PROMs)
– 80.2%.
The number of national clinical audit reports published The latest relevant national clinical audit reports to be
during the reporting period that were reviewed by the published are:
provider during the reporting period.
• National Joint Registry (NJR) – The 10th Annual Report
of the National Joint Registry for England, Wales and
Northern Ireland is the formal public report for the
period 1 April 2012 to 31 March 2013.
•
Patient Reported Outcome Measures (PROMs)
– Report data April 2013 to December 2013.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
A description of the action the provider intends to take For the audits that were reviewed in 2013-14, Nuffield
to improve the quality of health care following the Health intends to take the following actions to improve
review of reports identified above.
the quality of healthcare provided
• National Joint Registry (NJR) - Individual hospitals
reviewed reports applicable to services or parts of
services they provide and defined improvement
where required. Nationally, results for gaining
patients consent for sharing information with the
NJR (93%) and provision of the NHS number to enable
linkage between records (95%) was found to be
good. However, the NJR report comments that 100%
can be achieved for these compliance metrics and
therefore the target for Nuffield Health Hospitals is
95% in 2014 and 100% in 2015.
• Patient Reported Outcome Measures (PROMs) – the
main focus for quality improvement is in increasing
the rate of return from patients.
The number of local clinical audit reports that were Individual Hospitals undertake a programme of local
reviewed by the provider during the reporting period. clinical audit carried out either monthly or quarterly
depending on risk assessments. These cover a wide
range of areas including infection prevention and
medicines management as well as audits of pathology,
radiology and other clinical services. As stated within
the body of the report Nuffield Health also has
external certification in a number of areas, for example
information security.
A description of the action the provider intends to Individual hospitals have action plans in place to
take to improve the quality of healthcare following the improve the quality of healthcare based on the local
review of reports.
findings. Collated results identify areas for further
enquiry either locally or across some or all of Nuffield
Health hospitals. Examples of work in progress include
improvements in compliance to the WHO surgical
checklist and monitoring of normothermia in the
perioperative phase of surgical treatment.
The number of patients receiving relevant health
services provided or sub-contracted by the provider
during the reporting period that were recruited
during that period to participate in research approved
by a research ethics committee within the National
Research Ethics Service
The number of patients receiving relevant health
services provided or sub-contracted by Nuffield Health
in 2013/14 that were recruited during that period to
participate in research approved by a research ethics
committee
nil. None were recruited as this is not
included the Nuffield Health contractual arrangements
with the NHS.
Whether or not a proportion of the provider’s income
during the reporting period was conditional on
achieving quality improvement and innovation goals
under the Commissioning for Quality and Innovation
payment framework agreed between the provider and
any person or body they have entered into a contract,
agreement or arrangement with for the provision of
relevant health services.
A proportion of Nuffield Health income in 2013/14
was conditional on achieving quality improvement
and innovation goals agreed with Nuffield Health for
the provision of relevant health services, through the
Commissioning for Quality and Innovation payment
framework. Further details of the agreed goals for
2013-14 and for the following 12 month period are
available from each individual hospital upon request.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
Whether or not the provider is required to register with Nuffield Health is required to register with the Care
the CQC under section 10 of the Health and Social Care Quality Commission and its current registration status
Act 2008.
is: Nuffield Health is registered in respect of the
following regulated activities (number of hospitals in
brackets to which activity applies):
• Treatment of Disease or Injury (29)
• Surgical Procedures (29)
• Diagnostic & Screening Procedures (29)
• Family Planning (16 )
• Maternity & Midwifery Services ( 1 )
Nuffield Health has no conditions of registration
and has not taken part in any special reviews or
investigations by the CQC at any time including the
reporting period 2013/14.
Whether the CQC has taken enforcement action The Care Quality Commission has not taken
against the provider during the reporting period.
enforcement action against Nuffield Health during
2013/14 (or previous years – see external audit
information on page 5 of body of report).
Whether or not during the reporting period the
provider submitted records to the Secondary Uses
service for inclusion in the Hospital Episode Statistics
which are included in the latest version of those
statistics published prior to publication of the relevant
document by the provider.
Nuffield Health submitted records during 2013/14
to the Secondary Uses service for inclusion in the
Hospital Episode Statistics which are included in the
latest published data.
If the provider submitted records to the Secondary The percentage of records in the published data which
Uses service for inclusion in the Hospital Episodes included the patient’s valid NHS number was:
Statistics which are included in the latest published
• 100% for admitted patient care;
data:
• 100% for outpatient care; and
(a) the percentage of records relating to admitted
patient care which include the patient’s —
• not applicable for accident and emergency care.
(i) valid NHS number; and
(ii) General Medical Practice Code;
which included the patient’s valid General Medical
Practice Code was:
• 99% for admitted patient care;
(b) the percentage of records relating to outpatient
care which included the patient’s —
• 99% for outpatient care; and
(i) valid NHS number; and
• not applicable for accident and emergency care.
(ii) General Medical Practice Code;
(c) the percentage of records relating to accident and
emergency care which included the patient’s —
(i) valid NHS number; and
(ii) General Medical Practice Code.
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
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Appendix 1
Prescribed Information
Nuffield Health Statement
The provider’s Information Governance Assessment Nuffield Health Information Governance Assessment
Report overall score for the reporting period as a Report overall score for 2013/14 was:
percentage and as a colour according to the IGT
• 93% and was graded GREEN.
Grading scheme.
Whether or not the provider was subject to the Nuffield Health was subject to the Payment by Results
Payment by Results clinical coding audit at any time clinical coding audit during the reporting period by the
during the reporting period by the Audit Commission. Audit Commission and the error rates reported in the
latest published audit for that period for diagnoses
and treatment coding (clinical coding) were
• 97.5% accuracy for Primary Diagnosis,
• 90.9% accuracy for Secondary Diagnosis,
• 97.5% accuracy for Primary Procedure and
• 83.9% accuracy for Secondary Procedure codes.
The action taken by the provider to improve data Nuffield Health’s continual improvement plan for
quality.
data quality includes monitoring monthly Secondary
Uses Service (SUS) submissions at a local level using
a group-wide data quality benchmark tool. This
benchmark tool allows us to identify any sites where
SUS data submissions are of poor quality on a monthly
basis. Where issues arise Nuffield Health investigates
and provides support to improve e.g. process review,
system training and escalation to operational directors.
A minimum of 3 sites will be externally audited during
2014/15 to monitor clinical coding quality.
Appendix 1 – NHS Quality Account 2013/14: Bibliography
NHS Choices Quality Accounts:
http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/quality-accounts/Pages/
about-quality-accounts.aspx
Nuffield Health Reports:
http://www.nuffieldhealth.com/about-us/financial-reports
Nuffield Health Annual Report and Financial Statements:
http://www.nuffieldhealth.com/sites/default/files/inline/1112_Annual_Report_2013_for%2520web_V3.pdf
Nuffield Health Monitor Licence:
https://licensing-gateway.monitor.gov.uk/sites/monitor/documents/Licence_200060_1.pdf
Monitor Well-Led Framework:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/312988/well_led_
framework_governance_reviews_1_.pdf
Monitor/NHS TDA/CQC Statement of Intent on Well-Led Framework:
http://www.cqc.org.uk/sites/default/files/Well-led%20framework%20statement%20of%20intent%20
FINAL.pdf
Monitor Quality Governance Framework:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284262/
ToPublishQualityGovGuide22April13FINAL.pdf
Nuffield Health NHS Information:
http://www.nuffieldhealth.com/nhsinformation
Nuffield Health Annual Quality Report 2013 - Appendix 1 NHS Quality Account 2013-14
Page 36
Appendix 2 – Membership of the Board Integrated Governance Committee 2013/14
Jane Wesson (Chairman) - Governor
Guy McCracken - Governor
Joanne Shaw - Governor
Luke Talbutt (Secretary) - General Counsel and Company Secretary
Graham Cowan - Group Health, Safety & Environmental Director
Dr Davina Deniszczyc - Medical Director, Wellbeing
Mr Geoff Graham - Medical Director, Hospitals
Karen Harrowing - Group Quality Systems Director/Group Chief Pharmacist
Professor Dickon Weir-Hughes - Chief Nurse
Appendix 3 – External Advisors:
Nuffield Health is grateful for the support of the following external advisors who are subject matter experts and
advise and/or attend the relevant committees and forums:
Dr Ishmail Badr
QA Physicist, Radiation Protection and Laser Protection Advisor
Mr Ian Clements
Managing Director (Quadriga), Health & Safety Advisor
Dr Matthew Dryden
Consultant Microbiologist, Infection Prevention & Control Advisor
Professor Laurence Jacobs
Chief Scientist (AK Research GmbH), Nuffield HealthScoreTM Advisor
Dr Alban Killingback
Physicist, Ultrasound Protection Advisor
Professor Iain Lyburn
Consultant Radiologist & Radiology Advisor
Dr Pixie McKenna
Private GP and Media Doctor, Nuffield HealthScoreTM Ambassador
Dr Steve McVittie
Consultant in Occupational Health (OH) Medicine, OH Advisor
Dr Rak Nandwani
Consultant, Genitourinary Medicine, Sexual Health Advisor
Dr Hafiz Qureshi
Consultant Haematologist, Blood Transfusion Advisor
Dr Marc Rea
Physicist/Engineer, Magnetic Resonance Safety Advisor
Dr Sethsiri Wijeratne
Consultant Chemical Pathologist
Nuffield Health Annual Quality Report 2013
Page 37
Appendix 4 – Regulation, inspection and external audit:
Regulators of health and care professionals, products and services:
Professional Standards Authority – oversight of regulators of health and social care professionals in UK
Health and Safety Executive (HSE) – Regulator to reduce work-related death and serious injury in Great
Britain
Local Authority/Food Standards Agency – Environmental Health Officers inspection of food quality and
hygiene
Care Quality Commission (CQC) – Inspection of health and care services in England
Healthcare Improvement Scotland (HIS) – Inspection of healthcare in Scotland
Healthcare Inspectorate Wales (HIW) – Inspection of healthcare in Wales
Medicines and Healthcare Regulatory Agency (MHRA) – Registration of Medical Devices
Human Fertilisation and Embryology Authority (HFEA) – Licensing and monitoring of UK fertility clinics
General Pharmaceutical Council (GPhC) – Regulator for pharmacy premises in Great Britain
Office for Standards in Education, Children’s Services and Skills (Ofsted) – Regulator of care/education (e.g.
Nuffield Health crèche facilities)
Additional information on quality assurance not already included in this report:
The Radiological Protection Centre (RPC) continues to independently assure that Nuffield Health uses
ionising and non-ionising radiation safely in order to protect the wellbeing and safety of patients and staff.
All Nuffield Health pathology facilities are accredited by Clinical Pathology Accreditation (CPA) and are also
all compliant with Blood Safety Quality Regulations (BSQR).
All six HSSUs remain registered with the UK Competent Authority (MHRA) and continue to be audited by
the Notified Body SGS Ltd. This registration provides evidence of compliance with Medical Devices Directive
93/42/EEC (and its amendment 2007/47/EC) as well as a robust quality management system (QMS) based
on ISO 9001:2008 and ISO 13485:2012.
Nuffield Health Annual Quality Report 2013
Page 38
Appendix 5: Bibliography:
This report can be accessed as both hard copy and also on-line. There are many links to internet pages (denoted by
underlining) used throughout this report to support the text and these links haven been expanded below under
each of the section headings used in the report.
Group Chief Executive Statement on Quality:
Competition Commission:
http://www.competition-commission.org.uk/media-centre/latest-news/2014/Jan/cc-sets-out-changes-forprivate-healthcare
Private Healthcare Information Network:
http://www.phin.org.uk/About.aspx
Nuffield Health Promise providing guarantees:
http://www.nuffieldhealth.com/hospitals/promise
Nuffield Health values:
http://www.nuffieldhealth.com/about-us
Nuffield Health Bristol Hospital – The Chesterfield:
https://www.nuffieldhealth.com/hospitals/bristol
Physiotherapy Network for on-line booking:
https://nuffieldhealth.secure.force.com/cp_BookingStep1
Nuffield HealthScoreTM:
https://nuffieldhealthscore.com/
Board of Governors Statement on Accuracy:
NHS Leadership Academy: The Healthy NHS Board 2013: Principles for Good Governance:
http://www.leadershipacademy.nhs.uk/wp-content/uploads/2013/06/NHSLeadershipHealthyNHSBoard-2013.pdf
Francis Report - Final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry:
http://www.midstaffspublicinquiry.com/report
Department of Health. Patients First and Foremost: The Initial Government Response to the Report of The Mid
Staffordshire NHS Foundation Trust Public Inquiry March 2013:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170701/Patients_First_
and_Foremost.pdf
Hard Truths: the journey to putting patients first. The government’s further response to Robert Francis QC’s
report on the Mid Staffordshire NHS Foundation Trust public inquiry:
https://www.gov.uk/government/publications/mid-staffordshire-nhs-ft-public-inquiry-government-response
NHS England. NHS Review into quality of care and treatment provided by 14 hospital trusts in England: overview
report, Professor Sir Bruce Keogh. 2013:
http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf
CQC A new start - Consultation on changes to the way we inspect, regulate and monitor care services:
http://www.cqc.org.uk/public/sharing-your-experience/consultations/consultation-changes-way-we-inspectregulate-and-monito
Corporate accountability in health and social care - fit and proper person regulations:
http://consultations.dh.gov.uk/fit-and-proper-persons/corporate-accountability-in-health-and-social-care
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Statement on Priorities for Quality Improvement
CQC - Consultation on how we regulate, inspect and rate services:
http://www.cqc.org.uk/public/get-involved/consultations/consultation-how-we-regulate-inspect-and-rateservices
Monitor - All providers of health care services for the purposes of the NHS need an NHS provider licence from
April 2014:
http://www.monitor.gov.uk/regulating-health-care-providers-commissioners/licensing-providers/who-needsa-licence
Nuffield Health – Hospitals:
http://www.nuffieldhealth.com/hospitals
Nuffield Health - Fitness and Wellbeing:
http://www.nuffieldhealth.com/fitness-and-wellbeing
Nuffield Health – Corporate Wellbeing:
http://www.nuffieldhealth.com/corporate-wellbeing
Nuffield Health – Physiotherapy:
http://www.nuffieldhealth.com/physiotherapy
International Organisation for Standardization – ISO 9001:
http://www.iso.org/iso/home/standards/management-standards/iso_9000.htm
Background information and summary of Internal & External Audit:
Care Quality Commission – Nuffield Health Summary:
http://www.cqc.org.uk/directory/1-102643516
United Kingdom Accreditation Services:
http://www.ukas.com/about-accreditation/about-ukas/
Patient-led assessments of the care environment (PLACE):
http://www.england.nhs.uk/ourwork/qual-clin-lead/place/
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Section 1 - Nuffield Health report on safety:
National Advisory Group on the Safety of Patients in England. A promise to learn – a commitment to act:
Improving the safety of patients in England, Professor Don Berwick. 2013:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.
pdf
CQC Inspection Report: Nuffield Health Tunbridge Wells Hospital – November 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-115574778_Nuffield_Health_Tunbridge_Wells_
Hospital_INS1-630512136_Scheduled_16-01-2014.pdf
CQC Inspection Report: Nuffield Health Bromley Fitness and Wellbeing – September 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-239064230_Nuffield_Health_Bromley_Fitness_
and_Wellbeing_Centre_INS1-940524719_Scheduled_08-10-2013.pdf
Public Health England: Healthcare Association Infections (HCAI):
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/
NHS news: Six-monthly patient safety incident data published:
http://www.england.nhs.uk/2013/09/25/pat-safe-data/
Never Events – serious, largely preventable patient safety incidents:
http://www.england.nhs.uk/ourwork/patientsafety/never-events/
Section 2 - Nuffield Health report on effectiveness:
Opening of the new community fitness suite at Piggott School - October 2013:
http://www.nuffieldhealth.com/fitness-and-wellbeing/news/nuffield-health-opens-new-community-fitnesssuite-piggott-school
Nuffield Health and the London School of Economics. 12 minutes more: The importance of physical activity,
sports and exercise, in order to improve health, personal finances and the pressures on the NHS:
http://www.nuffieldhealth.com/sites/default/files/inline/Nuffield%20Health_%20LSE_Low-Fitness_Report.
pdf
CQC Inspection Report: Nuffield Health London City Fitness and Wellbeing Centre – August 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-239085011_Nuffield_Health_Fitness_and_
Wellbeing_Centre_INS1-566394760_Scheduled_06-09-2013.pdf
National Joint Registry:
http://www.njrcentre.org.uk/njrcentre/default.aspx
National Joint Registry for England, Wales and Northern Ireland. 2013 10th Annual Report – Surgical Data to
December 2012:
http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%20
10th%20Annual%20Report%202013%20B.pdf
Metal on Metal – NHS Choices information for patients:
http://www.nhs.uk/Conditions/Hip-replacement/Pages/Metal-on-metalimplants.aspx
Private Healthcare Information Network (PHIN) – Publications:
http://www.phin.org.uk/Publications.aspx
Healthcare Quality Improvement Partnership:
http://www.hqip.org.uk/national-clinical-audit-registries/ Surveillance of Surgical Site Infections in NHS Hospitals in England 2012/13:
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140455019
CQC Inspection Report: Nuffield Health York Hospital – December 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-115574877_Nuffield_Health_York_Hospital_INS1557610358_Scheduled_08-01-2014.pdf
CQC Inspection Report: Nuffield Health Taunton Hospital – March 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-102643516_Nuffield_Health_1-115574698_
Nuffield_Health_Taunton_Hospital_20130416.pdf
Nuffield Health Annual Quality Report 2013
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Section 3 - Nuffield Health report on caring:
CQC Inspection Report: Nuffield Health Leeds Hospital – November 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-115574578_Nuffield_Health_Leeds_Hospital_
INS1-658811841_Scheduled_07-12-2013.pdf
CQC Inspection Report: Nuffield Health Manor Hospital Oxford – March 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-102643516_Nuffield_Health_1-115574757_
Nuffield_Health_The_Manor_Hospital_Oxford_20130423.pdf
CQC Inspection Report: Nuffield Health Wellbeing Centre, Manchester – April 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-102643516_Nuffield_Health_1-115574916_
Nuffield_Health_Wellbeing_Centre_Manchester_20130501.pdf
CQC Inspection Report: Nuffield Health Reading Fitness and Wellbeing Centre – January 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-102643516_Nuffield_Health_1-245361963_
Nuffield_Health_Reading_Fitness_and_Wellbeing_Centre_20130306.pdf
Independent Sector Complaints Adjudication Service (ISCAS):
http://www.independenthealthcare.org.uk/independent-sector-complaints-adjudication-service/how-iscasworks/menu-id-651
Parliamentary and Health Service Ombudsman:
http://www.ombudsman.org.uk/improving-public-service/ombudsmansprinciples/ombudsmans-introductionto-the-principles
NHS Choices – on-line patient feedback:
http://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/nhs-friends-and-family-test.aspx
Patient Opinion – on-line patient feedback:
https://www.patientopinion.org.uk/
Section 4 - Nuffield Health report on responsiveness:
The Nuffield Health Promise:
http://www.nuffieldhealth.com/hospitals/promise
Nuffield HealthScoreTM
http://info.nuffieldhealthscore.com/what-is-healthscore?utm_source=NHCOM&utm_medium=COMMS&utm_
content=HEALTHSCORE&utm_campaign=OBESITY
Ministry of Defence – fitness tests:
http://www.nuffieldhealth.com/fitness-and-wellbeing/news/MOD-and-Nuffield-Health-announce-fitnesstesting-partnership
CQC Inspection Report: Nuffield Health Newcastle Hospital – November 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-115574618_Nuffield_Health_Newcastle-uponTyne_Hospital_INS1-641927922_Scheduled_27-11-2013.pdf
CQC Inspection Report: Nuffield Health Surbiton Fitness and Wellbeing Centre – February 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-238816928_Nuffield_Health_Surbiton_Fitness_
and_Wellbeing_Centre_INS1-576721381_Scheduled_22-06-2013.pdf
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Section 5 - Nuffield Health report on leadership/well-led:
CQC Inspection Report: Nuffield Health Plymouth Hospital – February 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-102643516_Nuffield_Health_1-115574658_
Nuffield_Health_Plymouth_Hospital_20130321.pdf
CQC Inspection Report: Nuffield Health Birmingham Fitness and Wellbeing Centre – October 2013:
http://www.cqc.org.uk/sites/default/files/media/reports/1-572333982_Nuffield_Health_Birmingham_
Fitness_and_Wellbeing_Centre_INS1-574162152_Scheduled_30-10-2013.pdf
NHS Staff Survey Results – Friends and Family Test:
http://www.nhsstaffsurveys.com/Page/1006/Latest-Results/2013-Results/
Nuffield Health Development and Leadership Programmes:
http://www.nuffieldhealthcareers.com/why-work-for-us/development-and-leadership-programmes-.aspx
Brand Leadership Programme:
http://www.nuffieldhealth.com/performance-excellence/brand-behaviours
Nuffield Health Manor Hospital – Scholarship in Surgical Science and Practice:
http://www.nuffieldhealth.com/hospitals/news/nuffield-health-manor-hospital-announce-partnership-oxforduniversity-offer-surgical
Nuffield Health – Best Provider of Workplace Wellbeing Services 2013:
http://www.nuffieldhealth.com/corporate-wellbeing/news/nuffield-health-wins-best-provider-workplacewellbeing-services-2013-health-insurance
Nuffield Health – Wellbeing in the Workplace:
http://www.nuffieldhealth.com/corporate-wellbeing/our-approach/workplace-wellbeing
Staff satisfaction and quality of patient care - Imperial College London:
http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_21-2-2013-10-43-14
Nuffield Health – Move to Epsom:
http://www.nuffieldhealth.com/about-us/news/nuffield-health-announces-move-to-epsom
SEQOHS - Safe, Effective, Quality Occupational Health Service:
https://www.seqohs.org/
Performance Excellence approach:
http://www.nuffieldhealth.com/performance-excellence
Nuffield Health Annual Quality Report 2013
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Contact details:
Nuffield Health
Epsom Gateway
Ashley Avenue
Epsom
Surrey
KT18 5AL
Telephone: 0370 218 7041
Web site: www.nuffieldhealth.com
Publication date: May 2014
Nuffield Health Annual Quality Report 2013
Page 44
Registered Office, Nuffield Health, Epsom Gateway, Ashley Avenue, Epsom, Surrey, KT18 5AL
A Registered Charity Number: 205533 (England & Wales), a Charity Registered in Scotland Number: SC041793
and a Company Limited by Guarantee Registered in England Number 576970