Background to this inspection
Updated
6 November 2018
Dorset County Hospital NHS Foundation Trust provides acute services from Dorset County Hospital, a hospital which was completed in 1997. It provides a full range of district general services, which include accident and emergency services and critical care. The hospital has around 400 beds (including 32 maternity beds and eight critical care beds), seven main operating theatres and two day-surgery theatres.
The trust provides services in the community through links with five community hospitals in Weymouth, Portland, Bridport, Blandford Forum and Sherbourne.
Acute hospital services are provided to a population of around 250,000 people, living within Weymouth and Portland, West Dorset, North Dorset and Purbeck. Alongside this, the trust provides renal services for patients throughout Dorset and South Somerset, serving a total population of around 850,000 people.
The wide geographical spread of the community means the trust providers services including outpatients, day surgery, and renal dialysis at five other NHS locations. It serves an area with a higher than average elderly population and lower than average proportion of school-aged children.
The trust employs around 2,800 staff.
Updated
6 November 2018
Effective, caring, responsive and well-led were rated as good and safe as requires improvement. Apart from safe, for which the rating stayed as requires improvement and caring which remained good, the other key questions improved from requires improvement to good. We took all ratings into account in deciding overall ratings other than those for diagnostic imaging which we do not include in the overall ratings.
- We rated well-led at the trust as good. There was effective, experienced and skilled leadership, a strong vision for the organisation, and embedded values. The leadership had the capacity and capability to deliver high-quality sustainable care. Leaders understood the challenges to quality and sustainability and they were visible and approachable. There was a clear vision for the trust and strong values. The strategic plans fitted with local integration plans for Dorset county, and the strategy was aligned to the wider health and social care economy. Staff felt valued and supported and positive and proud to work for the organisation. There were cooperative and supportive relationships throughout the trust. There was good governance and structures to assess the care provided and give assurance around quality. There were processes for managing risk, issues and performance. Information and data was of good quality. The views of people using the service were considered, as were those of staff and stakeholders. The trust was strong on continuous improvement and innovations. However, the trust needed to review and improve how it gave assurance around learning from preventable deaths. The arrangements for the Freedom to Speak-up Guardian did not reflect the recommendations of the National Guardian’s office. The responses to complaints and how the trust demonstrated to those who complained that it learned from their issues needed improvement.
- Urgent and emergency services (alternatively known as accident and emergency services or A&E) improved from requires improvement overall at our last inspection in 2016 to good in 2018. At our previous inspection, safe and well-led were requires improvement with the other key questions rated as good. Safe remained this time as requires improvement with issues with patient triage times, paediatric nursing levels, some mandatory training, and completion of records. There were also some unresolved issues with the room used for assessment of mental health patients. However, staff protected patients from avoidable harm, most areas were being kept clean, incidents were addressed, and there were good staffing levels and skill mix in the nursing teams. The other key questions were rated as good, with well-led improving from requires improvement to good. There were strengthened arrangements for leadership, priorities were well understood, and there was a strong culture. However, there were some issues with governance of risks, some need for improvement in IT systems, and a lack of engagement with the public around the way services were designed and run.
- Maternity services were rated as good. We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. Safe was rated as requires improvement with all the other key questions rated as good. In safe we found not all staff had updated their mandatory training, not all equipment was cleaned correctly, medicines were not always managed well, and there were issues with the levels of nitrous oxide, which had not been addressed since our previous inspection. There was an inconsistent approach to the use of safety guidelines and there were some issues with emergency planning and untoward events. However, incidents were well managed, there were good staffing levels, patients were protected from avoidable harm, there were comprehensive birth plans for women, and staff were given time to undertake specialist midwifery training. The other key questions were rated as good.
- End of life care was rated overall as good. This improved from a rating of requires improvement at our last inspection. Safe improved to good, effective remained requires improvement, caring and responsive stayed as good, and well-led improved significantly from inadequate to good. In effective, resuscitation decisions or mental capacity assessment and decisions were not always well recorded, and care planning was not always completed as required. However, otherwise, the service provided care in line with national guidance, staff were competent and there was good multidisciplinary working.
- Outpatients was rated as good overall. We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. Safe was rated as good. Effective we do not rate. Caring and responsive were good, although well-led was rated as requires improvement. In well-led the governance systems were not always effective for assurance purposes, and there was no coordinated approach to service improvement. We had some concerns about infection control at the physiotherapy clinic in Weymouth Community Hospital, and clinic letters were significantly delayed. Neither of these areas had improved since our last inspection. However, the services had good managers, there was a positive culture, and good engagement with patients, the public and staff.
- Diagnostic imaging was rated as good overall. We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings. Safe, effective, caring and well-led were rated as good. Responsive was rated as requires improvement. In responsive, handovers were not as good as they should be, and reporting times for patients attending A&E were poor. However, the service met the individual needs of patients and some reporting times were good.
- On this inspection we did not inspect medical care, surgery, critical care, or services for children and young people. The ratings we gave to these services on the previous inspection in 2016 are part of the overall rating awarded to the trust this time.
- Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.