Dorset County Hospital

Updated 30 June 2026

Date of assessment: 20 to 21 January 2026. Dorset County Hospital provides a range of NHS hospital services. This assessment looked at medical care and urgent and emergency care services due to the age of the rating, which we rated as good overall. The rating of medicine and urgent and emergency care has been combined with the ratings of the other services from the last inspections. See our previous reports to get a full picture of all the other services at Dorset County Hospital. The rating of Dorset County Hospital remains good.

Updated 4 September 2025

We carried out this 2-day assessment on 20 and 21 January 2026.

Medical care at Dorset County Hospital is provided by Dorset County Hospital NHS Foundation Trust. Acute and planned medical treatment and care includes endoscopy, older persons services, acute stroke care and outpatient services, all of which are supported by allied health professionals and diagnostics, including a; fully accredited pathology, liquid-based cytology, CT scanning, MRI scanning, ultrasound, cardiac angiography and interventional radiology. There is an Acute Hospital at Home service that is staffed and governed by the trust, working in close collaboration with Dorset Healthcare, which enables patients to be treated in their own homes.

The population served has a proportion of older patients much greater than the national average (over 65 years representing 30% of the total population vs 19% for England and Wales). Dorset continues to experience an increasing total population, with 0.4% per annum forecast in the coming years, and the older population growing around 2% per annum. The population served is in large part rural or coastal and has areas of marked deprivation, particularly in Weymouth and Portland.

This was a comprehensive assessment and was carried out because the service had not been inspected since 2016. We assessed 5 key questions; safe, effective, caring, responsive and well led.

We rated medical care as good overall because:

There was a good learning culture where staff and people using the service could raise concerns. Incidents were reported and investigated, and learning was shared with staff. People were kept safe and protected from any possible risks. Staffing levels were managed to ensure there were enough staff with the right skills, qualifications, and experience. Staff received training and had the opportunity to receive feedback on their performance and identify any additional development needs.

People were involved in assessments of their needs and given information which helped them to make decisions about their care. Staff completed and reviewed assessments taking account of people’s individual wishes and needs. Treatment and care was based on latest evidence and good clinical practice. There was a multidisciplinary approach to the delivery of care, including working with other agencies to ensure the best outcomes for people. Staff made sure people understood their treatment and care so they could give informed consent. Information was provided in a range of ways to ensure people could understand.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Most leaders were visible, knowledgeable, and supportive. Staff were treated equally and understood their roles and responsibilities. There was a culture of continuous improvement and providing the best standards of care to people who used the service.

However, patient flow through the service was often a challenge, which resulted in a poor experience for some patients.

Updated 4 September 2025

We carried out this 2-day assessment on 20 and 21 January 2026. Urgent and Emergency care at Dorset County Hospital is provided by Dorset County Hospital NHS Foundation Trust. This service was originally built to accommodate 22,000 attendances in the 1990s. In response to national guidance during the COVID-19 pandemic in 2020, the trust expanded the footprint of the emergency department (ED) to manage infection prevention and control risks. To support this, the trust secured additional funding which was used to double ED capacity while longer-term improvement works progressed. By 2024/25, demand had risen significantly, with the service accommodating 52,000 attendances yearly. At the time of our inspection, significant capital improvement works were underway, funded through the New Hospital Programme (NHP). These works were intended to substantially increase capacity and were scheduled for completion in 2027.

This was a comprehensive assessment and was carried out because the service had not been inspected since 2018.

We rated the service as good. The service had made improvements and was no longer in breach of regulations for safe staffing and premises and equipment. Mandatory training compliance had improved. Mental health risks were now well managed and mitigated. Ligature points had been removed since the last inspection, along with other items posing a potential risk to peoples’ safety.

During the inspection, we identified concerns around the clinical oversight of the walk-in emergency department waiting room. Additionally, do not attempt cardiopulmonary resuscitation decisions were not always made by medical or nursing staff with the correct level of seniority and training in line with trust policy. However, there were clear responsibilities, roles and systems of accountability.

Updated 13 April 2025

Date of assessment: 20 May 2025.

This was a follow up assessment following a section 29a Warning Notice issued in June 2023. We carried out an on-site visit, completed virtual interviews and reviewed data provided by the trust.

Dorset County Hospital provides maternity services to the population of West and North Dorset, including Dorchester, Weymouth and Portland, the Purbecks, Bridport and Lyme Regis, as well as South Somerset. Dorset County Hospital is operated by Dorset County Hospital NHS Foundation Trust.

We refer to women in this report, but we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues

Maternity services included low and acute care during the antenatal, intrapartum and postnatal period, as well as community care. Maternity services were based in one ward separated into different areas. This included a day assessment and triage area, antenatal and postnatal area, a co-located midwife-led birth centre, delivery suite, and 1 maternity theatre. All elective and emergency caesarean sections were completed in the maternity theatre. If there was a need to use a second theatre the service would use main theatres.

The maternity service had around 1,750 births a year. Approximately 8% of babies are born at home.

Around 8.7% of local pregnant women lived within the top quarter for poverty. Only 9% of women using Dorset County Hospital maternity services were from a black, Asian and ethnic minority background.

We assessed 13 quality statements across the safe and well-led key questions. Scores from the assessment were combined with ratings and scores from previous inspections to give the rating of Good.

Staff were kind, caring and compassionate. Women could access care and treatment when they needed it. The department and staff were well-led by the maternity senior leadership team, who embodied the cultures and values of their workforce.

There was a good safety culture where events were investigated, and learning was embedded to promote good practice. Staff provided safe care and treatment.

The maternity service had core staff within the day assessment and triage. To ensure staffing levels met the needs of women, leaders had introduced assigning staff to their designated maternity area at the start of each shift.

The maternity service could demonstrate it had improved governance processes and introduced a clear audit programme and updated guidelines.

During the assessment we found there was no evidence safeguarding alerts were recorded and child protection checks had been completed in women's records and no evidence to show safeguarding alerts were added to the electronic records.

Staff did not always make sure equipment, facilities and technology supported the delivery of safe care.

The environment within the delivery suite rooms looked dated with some staining on the floor in some of the delivery suite rooms. There were inconsistencies regarding the use of `I am clean' stickers and it could not always be determined whether a room had been cleaned.

Updated 16 August 2016

We found that the services for children were good for safe, effective, caring, responsive and well led.

There was openness and transparency about safety, and continual learning was encouraged. Staff were supported to report incidents, including near misses. Access to the children’s ward and neonatal unit was secure. Staff were clear about their responsibilities if there were concerns about a child’s safety. Safeguarding procedures were understood and followed, and staff had completed the appropriate level of training in safeguarding and other mandatory training.

The trust did not follow the Royal College of Nursing guidance on safe staffing levels for the paediatric wards. Whilst the trust did mitigate the impact of this overnight through effective rostering of competent staff, the system may not be sustainable. The unit was relatively small and not fully compliant with British Association of Perinatal Medicine (2010 Standards) requirements for a local neonatal unit as there was not a totally separate tier 1 rota, and the rota covered the children’s unit as well. However, there was no evidence of any negative impact of this arrangement. There were good levels of low and middle grade doctors and they were positive about the trust as a learning environment. The unit was also non compliant with the Royal College of Paediatric and Child Health Facing the Future: Standards for Acute General Paediatric Services (2015) as the unit did not have a consultant paediatrician available during the times of peak activity, seven days a week. Although a consultant was resident overnight

Care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice. The individual needs of children and young people were assessed and care and treatment was planned to meet those needs. Care pathways and multidisciplinary records were used to support practice. Staff assessed patients’ pain effectively and obtained consent to treatment appropriately and in line with legal guidance. A paediatric early warning system was used for early detection of any deterioration in a child’s condition and an early warning system for neonates was used in the NNU.

Staff were trained and had the skills and knowledge required to undertake their role. Staff completed appropriate competence assessments. Appraisals and supervision took place and this helped staff to maintain and further develop their skills and experience. Services, including access to consultant paediatricians, were provided seven days a week.

Feedback from children, young people and parents about the care and kindness received from staff was positive. All the children and families we spoke with were happy with the care and support provided by staff. Staff worked in partnership with parents, children and young people in their care.

Inpatient services were tailored to meet the needs of individual children and young people. There were suitable facilities on wards for babies, children and young people and their families. A paediatric assessment unit, open 13 hours a day, improved patient access and flow through the hospital. There were no barriers for those making a complaint. Staff listened to the feedback given to them by parents. Play therapy staff ensured children were supported during their hospital stay.

There was a clear governance structure to manage quality and risk. There was strong visible clinical leadership that had brought about positive developments. Staff at all levels of the organisation were proud to work in this department. The unit had also involved a child inspector from social services in making improvements to the service.

There was a strategic plan for paediatric services 2016/17 and the service was part of the ongoing Dorset wide Clinical Services Review, and the acute services Vanguard project.

Updated 16 August 2016

We rated critical care at this trust as good for safe, effective, caring, and well-led care. Responsiveness of the service required improvement.

There was a strong culture of reporting, investigating and learning from incidents. Patients were protected from avoidable harm and abuse and the principles of duty of candour were well understood.

Consultants were notably present on the unit and junior doctors were well supported in developing critical care skills. Nursing staff felt well supported by doctors and there was excellent communication between doctors and nurses during handovers. Physiotherapy assessments happened within 24 hours of an admission and physiotherapists were an integral part of the care team on the unit.

The unit aimed to have a senior nurse shift coordinator who was supernumerary on at all times in line with national guidance. This was not always achieved when there was unscheduled staff absence. However, we saw that during these times there was a clear escalation process and patient safety remained the priority.

Medicines, including controlled drugs, were stored and managed safely with the exception of a small number of emergency medicines, which were located in the emergency trolleys. The emergency trolleys in non visible areas were not tamper-evident. This was corrected during the inspection, medicines were put in sealed boxes on the trolleys.

The unit was submitting on-going data to the Intensive Care National Audit Centre (ICNARC). Patients’ predicted mortality outcomes at this critical care service were in line with, or better, than similar units, with the exception of patients admitted with pneumonia whose predicted mortality was below similar units. There were consistently low rates of unit acquired infection and audits showed consistent compliance with best practice hand hygiene standards.

Treatment and care followed current evidence based guidelines with the exceptions of the critical care outreach services which was not available 24 hours a day seven days a week and did not have follow up provision for critical care patients. The trust was working towards having a 24 hour critical care outreach team.

Staff were sufficiently skilled in delivering critical care and 59% of the nursing staff held a post-registration award in critical care in line with national standards. The clinical nurse educator oversaw the education and training development of the nursing team though was frequently required to cover routine clinical work, which distracted from this. Appraisal compliance was low on the unit at 79% of the overall staff team in December 2015. However, the critical care outreach team staff had all been appraised within the last 12 months.

Equipment was clean and well maintained but the layout of the unit was not optimal for the delivery of critical care. The unit was not compliant with Department of Health’s Health Building Notes (04-02), Risk assessments had been undertaken and there was ongoing review. The unit was not secure as there was a second entrance via another ward. There was not clear signage or mechanisms to stop visitors and staff from other wards walking on and off the unit.

Patients were not routinely discharged in a timely manner and delays occurred in over 40% of all discharges. Delays led to patients staying in mixed sex and sub optimal accommodation for significant length of time. Mixed sex breaches were not being reported immediately as they occurred which was not in line with national guidance.

Patients and their relatives were involved, where possible, in decisions made about their care and treatment. Staff were sensitive when required to deliver bad news and ensured that suitably skilled and experienced staff were available to support patients and relatives at these times.

Staff were responsive and worked collaboratively to meet patients’ health needs including those unrelated to their critical illness or condition. Staff made reasonable adjustments and used tools to support patients from vulnerable groups such as individuals with a learning disability.

Updated 6 November 2018

We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings.

We rated the service as good because:

• Staff had completed training which allowed them to undertake their roles safely and effectively. There were training opportunities to allow staff to expand their skills and knowledge.
• Staff took appropriate action to minimise the risk of cross infection between patients.
• Staff followed professional guidance and working practices during investigation to keep patients safe.
• Risk to patient safety due to the type of investigation being undertaken were identified and managed appropriately.
• Patients received care from staff who treated them as individuals and ensured their physical and emotional wellbeing needs were met.
• Staff felt valued and supported in their role enabling them to provide high quality care. Patient feedback confirmed this was happening.
• Innovative practice was supported and promoted by staff who took responsibility to explore options to increase the quality of patient care.

However:

• Reporting of images were not completed in a timely way and did not meet the key performance indicators agreed by the department and the trust.

Updated 6 November 2018

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

• The trust provided mandatory training in key end of life skills to all new staff at induction and at regular updates. There were enough staff with the right skills and experiences to ensure the delivery of care. Staff had access to professional development, were competent for their roles, and had opportunities for a review of their performance. Appraisal rates exceeded the trust target.
• Medical staffing levels had improved since the last inspection in March 2016.
• Equipment availability had improved since the last inspection. There was greater oversight of competence for the use of specialised equipment.
• There was good multidisciplinary working. The specialist palliative care team worked closely with the local hospice and there was access to clinical expertise within the hospital.
• Leadership of the end of life care was much improved following out last inspection in March 2016. The trust had clear statement of vision and values for end of life care.

However:

• Mandatory training rates for the end of life team did not meet the trust target.
• Staff did not always keep appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care. This included documentation of mental capacity assessments and or best interest decisions.

Updated 6 November 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated the service as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Systems and processes were used by staff to assess, monitor and manage risks to patients.
• In most areas the service managed infection prevention and control risks well. Staff kept themselves, equipment and the premises clean. There was a robust process for ensuring equipment was cleaned effectively and control measures were used to prevent the spread of infection at Dorset County Hospital.
• Equipment was well maintained and readily available in all the departments we visited.
• The service had enough staff to keep people safe from avoidable harm and to provide the right care and treatment.
• Medicine optimisation was safe and well managed.
• Patients records were stored securely and outpatient staff had access to the information they needed to provide care.

However:

• While there were systems for governance and risk management, these were not always effective and did not always provide adequate oversight of quality, risk and performance. There was no overarching strategy or vision for the outpatient service.
• We found some improvements and innovations in individual teams. However, there was no coordinated approach to improvement across the service. We found areas where required improvements had not been made. We could not always find evidence of learning from audit or benchmarking against other services.
• National safety standards had not been embedded across the service and we had concerns regarding infection control procedures and the suitability of premises in some areas.
• There were significant delays in the typing of clinic letters and the trust had not made sustained improvement since our last inspection. The service was not meeting the national referral to treatment times in some areas.
• The outpatients service did not meet the trust target for compliance against mandatory training and had significantly low compliance in some key modules.

Updated 16 August 2016

Surgery was rated as good because services were effective, caring, responsive and well led however some aspects of safety required improvement

We rated safe as requires improvement because:

Staff did not consistently complete the ‘Five Steps to Safer Surgery’ checklist to minimise the risk of patient harm. Patient records were not stored securely but in open trolleys, presenting a risk of breaching patient confidentiality. Mandatory training targets had variations of 50-100% compliance against the trust targets.

Staffing levels of registered nurses, particularly overnight left a poor contingency for absence. There was poor availability of therapy staff to support postoperative patients.

However, staff knew how to report incidents, and used the investigation of incidents and never events to share learning with colleagues. They were aware of their responsibilities under the Duty of Candour, adult safeguarding and used the safety thermometer data to inform patients, staff and visitors.

Patients received care and treatment based upon national guidance, standards and best practice recommendations. The surgical services were consultant led and delivered and there was good evidence of multidisciplinary team coordination to support patients. The surgical services participated in a number of national audits such as the Hip Fracture Database, where they had performed well. The trust had robust systems to monitor patient’s nutrition and fluid balance. The patients told us that their pain levels were regularly assessed and they received adequate pain relief.

Staff treated patients with kindness and showed regard to their dignity and privacy. The trust’s results of the Friends and Family Test showed a higher than average response rate. The surgical wards displayed 90-100% of people recommending the ward they had been a patient in. The patients described receiving good care, thoroughly explained and which they had been involved in any decisions relating to them.

The trust had developed services to support the needs of the patients’, the daily single point of access multidisciplinary (MDT) meeting helped to provide a coordinated approach to complex patient discharges. The one stop breast clinic provided timely and accurate diagnosis for patients awaiting breast cancer diagnosis.

The trust had taken steps to improve the Refer to Treatment targets and the majority of the surgical specialties were only just below target. Cancellation of patients’ operations was better than the England average.

Although the trust had a discharge lounge, there was no obvious drive for earlier discharges and poor usage of the discharge lounge by some of the wards caused the holding of post-operative patients in recovery, prolonging theatre lists. The lack of beds could also mean the opening up of the day case unit overnight and the admittance of orthopaedic patients into other surgical wards.

According to the surgical dashboard, surgery had failed to screen all emergency admissions over 75 years for dementia since April 2015 although of those screened 100% of patients were then appropriately assessed.

Staff were aware of the trust’s strategy and vision; there was good engagement from staff that were passionate about improving services and providing a high quality service to patients. Most staff felt the leadership of the trust and within surgical services were visible and supportive. Staff told us they felt proud of their service, the patients’ outcomes and feedback and the response rates for the NHS staff survey was higher than national average Patients were encouraged to be engaged in changes to services, i.e. patient hip and knee pathways.