Poole Hospital

Updated 14 September 2023

We inspected the Maternity service at Poole Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the Maternity service, looking only at the safe and well led key questions.

Maternity services at Poole Hospital are provided by University Hospitals Dorset NHS Foundation trust. This was the first time we rated maternity services at Poole Hospital since Poole Hospital NHS Foundation Trust and The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust merged on 1 October 2020. The maternity ratings inherited from the previous provider at the last inspection in January 2020 was good overall.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 31 January 2020

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

• Staff understood how to protect patients from abuse and managed their safety. The service controlled infection risk. Staff assessed risks to patients, acted on them. They managed medicines well. The service managed safety incidents and learned lessons from them. Staff collected safety information and used it to improve the service.
• Patient records were not being stored securely at our last inspection meaning unauthorised people may have had access. At this inspection we found the majority patient records were stored securely.
• Safety checks on resuscitation and emergency equipment were following trust policy to make sure they were ready for use. This was an improvement from our last inspection.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could mostly access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not make sure all staff completed mandatory training updates in key skills, although this was against a high benchmark at this trust.
• On two wards the resuscitation equipment was stored behind locked doors meaning there could be a delay in accessing this in an emergency.
• Staff did not always complete the patient’s first assessment of risks to their health and safety.
• Detailed records of patients’ nursing care and treatment were not continually maintained. Records were not always clear. However, they were mostly up-to-date, stored securely and easily available to all staff providing care.
• Nurse and medical staffing remained a challenge and a known risk to the trust. At our last inspection we found nurse staffing levels were not safe. At this inspection, we found a number of initiatives had been implemented to address the shortfall.
• At our last inspection staff did not always involve all patients in their care, by explaining next steps and involving them in decisions about their care. At this inspection we received similar feedback from some patients and their relatives who did not feel involved.
• Staff did not always provide emotional support to patients, families and carers.
• Demand on the medical care services continued to be a challenge for the trust. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
• Staff did not always complete patients’ fluid and nutrition charts. This was identified as a concern at our last inspection.
• There was variable performance for all wards in the audit data around patients being assessed for malnutrition within 24 hours of admission as per trust protocol.
• Staff appraisal rates were not meeting trust targets.
• Minutes of governance meetings were hand written which meant they were not very clear and difficult to read.

Updated 26 January 2018

Our rating of this service improved. We rated it it as good because:

• There was openness and transparency about safety, and continual learning was encouraged. Staff were supported to report incidents, including near misses. Both units were secured both day and night.
• Staff were clear about their safeguarding responsibilities and if there was a concern about a child’s wellbeing safeguarding procedures were followed and understood. We saw evidence all staff had completed the appropriate level of training in safeguarding.
• Care was planned and delivered in line with evidence based guidance, standards and best practice and the individual needs of the child and family were met through the careful care planning. Staff followed care pathways and used multidisciplinary records to support practice.
• Staff used a paediatric early warning system for the early detection of any deterioration in a child’s condition, and we observed children and young people’s pain effectively assessed and treated.
• Staff received annual appraisals and new staff were supported when completing their competency assessments, helping to maintain and further develop their skills and experience.
• Services were provided seven days a week by medical and nursing staff. There was good multidisciplinary working evident across both units.
• Parents and children gave feedback about the care and kindness received from staff, which was very positive. Staff worked in partnership with parents, children and young people in their care.
• For children and young people at the end of their life staff worked with parents to provide outstanding emotional and compassionate support and developed the end of life unit - Gully’s place.
• Inpatient services were tailored to meet the needs of individual children and young people. Access and flow through both departments was very good and complaints were dealt with in a timely manner. Staff listened to feedback and complaints and responded to them in a timely manner.
• Play staff ensured that children and their families were supported during their hospital stay and their interventions during procedures reduced the anxiety and worry for the children for example during blood tests.
• Area’s outside of the children’s unit and neonatal unit (NNU) for example radiology, provided specific ‘child friendly’ environments for children to wait and undergo investigations and worked closely with the play therapist team to reduce stress and anxiety during those procedures.
• Staff at all levels of the children’s unit and NNU were proud of their work and were familiar with the Poole approach of being compassionate, open, respectful, accountable and safe.
• Poole hospital NNU is the first and only unit in the United Kingdom to utilise a two-tier model of consultants and advanced neonatal nurse practitioners.

However:

• There was not always enough medical staff with the right skill mix. Staffing levels had been reviewed, but changes to staffing levels identified as necessary from the reviews had not been fully implemented at the time of the inspection to meet the facing the future standards.

• There was a risk children would be exposed to inappropriate adult conversation in the ear nose and throat (ENT) and fracture outpatient’s clinics as they were treated alongside adult patients.
• Adult trained nurses who had not completed competencies to work with children were seeing children and young people in the adult preoperative clerking department.
• The epilepsy and diabetes service had reduced capacity due to understaffing, which meant that some children might not receive the support they needed at the right time. The service was aware of this risk and business cases were being submitted for additional staff.

Updated 26 January 2018

Our rating of this service improved. We rated it it as good because:

• The intensive care unit provided care and treatment in line with national guidance and the Royal College guidelines these to meet patient’s needs.
• Patients’ care was planned and took account the needs of people in vulnerable circumstances and their needs were supported while receiving care.
• There were effective assessment processes for assessing patients’ risks and their safety was monitored. The intensive care team worked cohesively and regularly reviewed and responded to patients’ risks.
• The trust had invested in the unit to ensure that patients had access to appropriate bathroom facilities.
• The intensive care team worked closely with the outreach team in the identification and early intervention to support deteriorating patients across the other wards and units. Patients were escalated to the unit as required to ensure that critically care patients received early input and the most appropriate care and support.
• The unit was fully engaged in research activities and supported the National Institute for Health Research (NIHR) studies.
• Staff provided kind and compassionate care.

However

• Not all nursing staff had received an appraisal of their work as appraisal rates were 84% which was below the trust target of 95%.
• Aspects of the environment did not support robust infection prevention and control.
• Medicines were not always stored safely and securely.

We were not fully assured that mixed sex breaches were always being reported in line with national guidance.

Updated 31 January 2020

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

• Safe care was provided across the end of life care service. Staff had processes they used to assess and respond to patient risk. Patient safety incidents were reported and investigated to ensure learning and change.  
• Staff provided effective care within the end of life care service. The service provided care and treatment based on national guidance and evidence-based practice. The effectiveness of care and treatment was monitored, and findings used to make improvements. Staff were competent for their roles. Staff supported patients to make informed decisions about their care and treatment and provide consent.  
• We saw effective multidisciplinary team working. There was a presence of the multidisciplinary team within the end of life care team, reaching out across the directorates and a truly holistic approach to assessing, planning and delivering care.  
• Staff gave truly person-centred care. As much emphasis was placed upon the emotional needs of those close to the patients as the patients themselves. Staff treated patients with compassion, dignity and respect, took account of their individual needs, and helped them understand their planned care. 
• The service was inclusive and took account of patients’ individual needs and preferences, and treated concerns and complaints seriously to investigate and share learning.  
• The service provided consistent and high‑quality care. The leadership team understood and managed the priorities of the service, and there was a clear vision and strategy of ‘one chance to get it right’.
• Staff felt respected, supported and valued, and there was an evident multi-professional and collaborative culture within the division. There were effective governance processes and management of performance and risk, with further governance improvements planned. Staff were committed to learning and improving services.

Updated 10 March 2023

Updated 10 March 2023

Updated 25 May 2016

We rated the service in the emergency department (ED) as good for safe, effective, caring, responsive and well-led. We saw a high standard of care and treatment delivered by competent, caring and compassionate staff.

The department had a culture of safety where incidents were reported. Learning was shared and changes made as a result of this. The department was visibly clean. Staff adhered to infection control procedures. Equipment was available, fit for purpose and clean. However, medicines were not always appropriately managed and stored.

The department had appropriate medical staffing levels that included a consultant present for 12 hours a day and senior medical cover for 24 hours per day. There was an appropriate number of suitable trained and skilled nurses in the department. There was a lead nurse for the unit, as well as skill mix of emergency nurse practitioners, advanced nurse practitioners and children’s nurses. There were a low number of nursing vacancies within the department. Agency staff were seldom used as staff worked flexibly to provide appropriate skill mix and staffing levels. Recruitment to a small number of vacancies was ongoing.

The safeguarding requirements for children, young people and vulnerable adults were understood, and there were appropriate checks and monitoring in place. However, there was no flagging system to identify patients with a learning disability.

The department provided effective care that followed national guidance and this was delivered to a high standard. Pain relief was offered appropriately and the effectiveness of this was checked. Multi-disciplinary work was in evidence and the department ran its services seven days a week.

Patients gave positive comments about the care they received, the attitude of the staff. Patients and relatives told us they were treated with compassion, dignity and respect, and staff were observed treating them with kindness and courtesy. Patients’ were kept informed of treatment options and were involved in decisions about their care.

The service had some improvement to make in consistently meeting the 4 hour emergency access target of 95%. The hospital was not consistently meeting the national emergency access target of 95% of patients who required hospital admission to be transferred to a ward or discharged from ED within four hours. However, this target was achieved in 5 months in the last year, and was above 90% for a further 5 months.. Patients were however, assessed and treated within standard times. There was good support provided for patients with a mental health condition and patients living with dementia.

The ED was well led by senior nurses and doctors, and the departmental strategy and vision was recognised by staff. The culture within the department was one of accessible leadership with mutual trust and respect, leading to the maintenance of an effective team. There was appropriate monitoring of incidents, quality and performance by senior staff.