Poole Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment, this key question was rated as requires improvement. At this assessment, the rating has remained as requires improvement. This meant there were some shortfalls in service leadership, leaders did not always assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to the governance of the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had developed a vision and strategy for their values, this was underpinned by a strategy referred to as ‘Patient First.’ The strategy was based on the mission statement that they aimed to achieve ‘provide excellent health care for our patients and be a great place to work, now and for future generations.’ The goals of this strategy were: all patients to receive quality care; to be rated the safest trust in the country; to maximise value for money; to be a great place to work in; and to consistently deliver timely, appropriate, and accessible care to patients. This was supported by the trust values of we are caring, we are one team, we are listening to understand, we are open and honest, we are always improving, and we are inclusive.

During inspection both senior leaders and some staff spoke about the strategy and the Patient First process. All staff described how they were motivated to give the best care possible to their patients. Leaders said the surgical care group was involved in the process to formulate the strategic goals and objectives for the Patient First process. These were then disseminated through the care group to directorates to ensure consistency of approach.

Most staff commented positively about the culture at a local level, describing it as supportive, with lovely colleagues and supportive managers. However, this was not the same in all areas. Staff in some of the smaller surgical services described that there was not a good working culture which had resulted in some medical staff leaving employment from the service.

Some staff spoke about a low morale in theatres. Although well supported by local leaders, there was uncertainty and concerns about the implications on staff due to the transformation of services. Some staff felt senior management lacked empathy and people skills and failed to recognise the impact the transformation of services may and was having on some staff.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness, and honesty.

The Trust had an overarching executive leadership team. The Trust managed its services through care groups. Most of the surgical services were in the Surgical care group with gyneacology in the Women’s, Children, cancer and support services care group. The care groups covered the services both at Poole Hospital and The Royal Bournemouth Hospital. Each care group was led by a group director of operations, group director of nursing and a group medical director, supported by a head of nursing and professions and a deputy director of operations who were responsible for all staff and clinical performance. The surgical care group was divided into 5 directorates: Surgical directorate; trauma and orthopaedic directorate, Head and neck directorate, anaesthetic directorate and Private health. Each of the directorates was led by a general manager, clinical director and senior matron.

All staff spoke positively about the local leadership and told us they had good working relationships. On the wards and units we visited during the inspection we saw there was strong clinical leadership from the ward managers and the lead nurses. Most staff said the senior leadership team was visible and supportive. However, some staff commented they felt senior leaders did not always fully understand or acknowledge the impact the transformation of services had on them.

The service fostered a positive culture where staff felt they could speak up and their voice would be heard.

The trust had the freedom to speak of policy that gave staff guidance about how to speak up/raise concerns about anything that got in the way of patient care or affected their working life. Staff we spoke with knew about the Freedom to Speak Up process and how to contact the Freedom to Speak Up team. They said they were encouraged to speak up and were not afraid to speak up.

Information provided by the service showed staff used to Freedom Speak Up service. The top themes of concerns raised with the Freedom to Speak Up team included attitudes and behaviours of staff, policies and procedures, and workers safety and well-being. In response to things from the surgical care group and the other care groups a University Hospitals Dorset behaviour charter was being developed.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had an Equality, Diversity and Inclusion policy that set out the trust’s commitment to diversity and inclusion in their services for patients, visitors, and staff. The trust monitored and reported on gender, ethnicity and disability pay gaps. There was a programme to support internationally trained staff, which commenced prior to the member of staff arriving in the UK. The programme included practical and pastoral support as well as clinical support. The trust had also been awarded the NHS Pastoral Care Quality Award. This recognised the trust’s work in international recruitment and their commitment to providing high quality pastoral care to international educated nurses and midwives during the recruitment processes and their employment.

At the service group level, internationally educated nurses spoke positively about the support they received both when they initially commenced employment and with their ongoing development. Staff reported that improvements had been made, and internationally trained and ethnically diverse staff were now empowered to progress their careers. Some staff spoke about how they had been supported, with reasonable adaptations, to return to work after long term sickness.

Staff had access to several staff network groups. These included networks for staff with physical disabilities, long-term health conditions, special needs, and mental health challenges, for ethnically diverse staff, for LGBTQ+ and for international doctors.

Lack of auditing and oversight information meant staff did not always have the best information about risks, performance and outcomes.

There was lack of process to gather information to gain assurance that staff were delivering safe and effective care and treatment that followed national and local guidance and policy. A lack of monitoring and audits meant there was reduced oversight of some areas of the service. There were no service led audits of the safety or appropriateness of the environments. There were no audits undertaken in the surgical services about the management of suspected sepsis. There was no oversight or monitoring of whether staff used personal protective equipment correctly as per policy and national guidance. There was no auditing about whether staff used the care planning process effectively. There was lack of oversight about whether staff followed consent processes correctly. There were minimal audits about safe medicine management. Many of these deficiencies would be addressed by the effective use of the matron walk abouts which were yet to be fully embedded into the surgical services.

However, the service did take part in national clinical audits which enabled them to have oversight of clinical performance and outcomes in these specific areas.

There was a governance structure with lines of accountability through wards/departments, the directorates to care group governance and through to the trust board. Each directorate had a governance lead.

Records of governance meetings at care group, directorate and ward/department levels demonstrated the quality, performance and safety of the service were monitored and reviewed. This included monitoring of referral to treatment times, monitoring of cancellation on day of surgery rates, review and learning from incidents, appraisal rates and review of the risk register.

Our review of the risk register showed risks described by staff were included on the risk register. This included staff vacancies in theatres, shortages in maxillofacial consultants and lack of uninterrupted power supply in theatres. Detail on the risk register evidenced leaders regularly reviewed the risks and actions were taken to lessen the risks.

Staff followed process to ensure all patient records were held securely and only accessed by authorised personnel.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff share information and learning with partners and collaborate for improvement.

The service provided examples of how they were collaborating with partners to support and improve the healthcare experience of patients. The surgical care group was a partner in the Clinical Acute Network Dorset. This consisted of partners in the integrated care system and was overseen by the Integrated Care Board. The service worked with a nearby acute NHS trust in the Dorset Urology Network Steering Board. This board had the aim to develop recommendations for the design and delivery of urology surgical services within the scope of the network. The service was also working in collaboration with another neighbouring acute NHS trust to develop a clinical strategy for delivering upper gastrointestinal services. across Wessex in an integrated model.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

The trust was using the patient first strategy to have a structured quality improvement process. At the time of the inspection not all wards had received training about the patent first process, this was being rolled out across the trust. There were only a few surgical wards who had received this training.

However, there was an ethos of improving their services across wards and departments and there were examples of improvements made by the service. Many of these were focused on releasing theatre time and reducing waiting lists. This included the hand hub, which released main theatre capacity and supported the four hour safety standard by pulling patients from the emergency department for treatment in the hand hub. The ambulatory arthroplasty project was reducing patient length of stay in hospital. A pilot for ultrasound guided foot and ankle injections, meant patients were removed from theatre waiting lists.

Other examples included those based around developing the skills of staff so to improve the patient experience. In the preoperative assessment service, the matron had worked with a neighbouring acute trust to develop a preoperative assessment foundation course for nurses.