Nuffield Orthopaedic Centre

Updated 7 June 2019

The Nuffield Orthopaedic Centre has been treating patients with bone and joint problems for more than 80 years. The hospital also undertakes specialist services such as the treatment of bone infection and bone tumours, limb reconstruction and the rehabilitation of those with limb amputation or complex neurological disabilities. Departments and services include orthopaedics, rheumatology, radiology, rehabilitation, OxSport, metabolic medicine, therapy services, Hydrotherapy pool and gym and day surgery unit.

The Oxford Centre for Enablement (OCE) at the Nuffield Orthopaedic Centre is the Wessex regional enablement centre and is commissioned by NHS England (NHSE) to provide specialist neurological rehabilitation for up to 26 patients. The area covers a wide area from Oxfordshire, Buckinghamshire, Berkshire, Hampshire, Isle of Wight and Dorset.

The Oxford Centre for Enablement (OCE) specialises in all aspects of disability and rehabilitation: clinical, education, research, and policy. It aims to help patients, other clinicians and clinical services, researchers, educationalists, commissioners and anyone involved in designing or developing rehabilitation services.

Updated 7 June 2019

Our rating of services stayed the same. We rated it as good because:

• People were protected from harm. Lessons were learned and communicated widely to support improvement in other areas where relevant, as well as services that are directly affected.

• People have good outcomes because they received effective care and treatment that met their needs. Up to date information about effectiveness was shared, and used to improve care and treatment and people’s outcomes.
• When people received care from a range of different staff, teams or services, it was co-ordinated. All relevant teams were involved in assessing, planning and delivering people’s care and treatment. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.
• Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded.
• People were supported, treated with dignity and respect and were involved as partners in their care. People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff were positive.
• People’s needs were met through the way services were organised and delivered. Reasonable adjustments were made and action taken to remove barriers when people find it hard to access or use services.
• Leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.
• There was an effective and comprehensive process to identify, understand, monitor and address future and current risk.

However

• The service provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
• There was a gap in the management and support arrangements for staff. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff. The medicine division had developed actions to address the gap in compliance, and action plans were in place at directorate level.

• The trust’s responses to complaints were not always completed in a timely manner. The trust did not have a target for closing complex complaints, which some of these complaints may have been.

• A proportion of patients did experience a delay when medically fit with their transfer from hospital.
• To keep patients safe, eight beds were closed which had impacted on the waiting list and finances. There was an average wait of two weeks for admission to the Oxford Centre for Enablement (OCE).

Updated 7 June 2019

Our rating of this service stayed the same. We rated it as good because:

• People were protected from harm. Lessons were learned and communicated widely to support improvement in other areas where relevant, as well as services that are directly affected.

• People have good outcomes because they received effective care and treatment that met their needs. Up to date information about effectiveness was shared, and used to improve care and treatment and people’s outcomes.
• When people received care from a range of different staff, teams or services, it is co-ordinated. All relevant staff, teams it was co-ordinated. All relevant teams were involved in assessing, planning and delivering people’s care and treatment. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.
• Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded.
• People were supported, treated with dignity and respect and were involved as partners in their care. People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff are positive.
• People’s needs were met through the way services were organised and delivered. Reasonable adjustments were made and action taken to remove barriers when people find it hard to access or use services.
• Leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.
• There was an effective and comprehensive process to identify, understand, monitor and address future and current risk.

However

• The service provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
• There was a gap in the management and support arrangements for staff. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff. The medicine division had developed actions to address the gap in compliance, and action plans were in place at directorate level.

• The trust’s responses to complaints were not always completed in a timely manner. The trust did not have a target for closing complex complaints, which some of these complaints may have been.

• A proportion of patients did experience a delay when medically fit with their transfer from hospital.
• To keep patients safe, eight beds were closed which had impacted on the waiting list and finances. There was an average wait of two weeks for admission to the Oxford Centre for Enablement (OCE).

Updated 14 May 2014

The hospital had a good safety record, with only one serious incident reported in the last 12 months. There was evidence that this incident, which resulted in the death of a patient, had been thoroughly investigated and learning had been identified. Although, the trust had formal processes in place to disseminate learning from incidents, this was not effective because staff were not clear about the learning from this incident.

All of the patients we spoke with were effusive in their praise for the staff at the hospital, with comments including: “nothing is too much trouble” and “this is the best hospital I have been in”. Staff were caring, dedicated, and proud to work at the hospital. It was considered a good place to work by many staff, who felt well supported by senior clinicians and local management. Staffing shortages for nurses and healthcare assistants presented an ongoing challenge and there was regular use of temporary staff. Staff expressed frustration about patients’ discharge being delayed because of a lack of suitable alternative hospital beds or support in the community. This sometimes led to ‘bed blockages’ and cancelled operations. Despite these challenges, staff believed that they provided a good quality of patient care and discharge arrangements were proactively and effectively planned.

There was significant discontent among the consultant body, who were concerned about the culture and the management style of senior management. There was unhappiness about a lack of engagement with clinicians and a belief that decisions were being taken without consultation with clinicians, for financial reasons, and which were detrimental to patient care. Some senior staff felt they could not speak out or did not feel that they were listened to.