Dorset County 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

Staff told us the Director of Midwifery and Neonatal Services (DOM) and Head of Midwifery and Neonatal (HOM) services were visible, inclusive and responsive.

Since our previous inspection the maternity service had developed a Maternity and Neonatal Strategy 2025 to 2027. The strategy focused on reducing health inequalities, enhancing the quality of care, empowering families, and supporting the workforce.

Governance processes had improved since our last inspection, with a clearly defined governance structure, which detailed the governance oversight and accountability from the service level to the trust board.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider 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.

Maternity services were led by a divisional triumvirate. The divisional triumvirate consisted of the divisional director of operations, divisional clinical director and divisional head of nursing.

The triumvirate had monthly `catch up' meetings, which were not formal meetings and were not minuted. Although the meetings were `catch up' in design, the service told us these meetings played an important role in maintaining cohesion within the triumvirate and supported divisional objectives. The meetings provided opportunity to align on key priorities, share updates, and discuss emerging issues or areas for improvement.

In addition to formal divisional governance meetings, where maternity were in attendance, triumvirate leads had an informal catch up.

The director of midwifery and neonatal (DOM) services was managed by the director of nursing

and worked alongside the deputy director for nursing and quality.

The DOM was supported by the HOM and between both leads they supported the antenatal and intrapartum matron, postnatal and community matron as well as specialist lead midwives.

The senior leadership team described how the executive team understood and supported their vision for the maternity service. Staff told us their Ward Managers; Matrons and the Head of Midwifery were visible and approachable on the maternity unit.

Leaders were visible in the service for women and staff. All leaders worked clinically with the maternity unit team on a regular basis and staff we spoke with during the assessment told us there was a positive culture between maternity and medical teams.

Since our previous inspection the maternity service had developed a Maternity and Neonatal Strategy 2025 to 2027. The strategies focus was on reducing health inequalities, enhancing the quality of care, empowering families, and supporting the workforce.

Included in the strategy was a clear vision of how the maternity service was going to deliver the services. The vision shared by the service was to develop a safe, personalised, and high-quality maternity and neonatal care that empowers families, reduces inequality, and ensures every baby gets the best start in life. With the overarching vision being working together to ensure safety and quality for women, birthing people and their families.

The strategy and ongoing review of the trust's maternity services had led to several new processes which were being embedded into the service. The senior leadership team had a focus on many areas to drive sustainability and improvements in care.

The service worked alongside the Local Maternity and Neonatal System (LMNS), Maternity and Neonatal Voices Partnership and Integrated Care Board. The HOM attended regular monthly meetings with the LMNS and local heads of maternity from local maternity services to share current challenges and shared learning within local maternity services.

Themed reports were presented to the LMNS such as the Perinatal Mortality Review Tool, Post partum Haemorrhage, Births Outside of Neonatal Designation and Term Admissions to the Neonatal Unit.

Dorset County Hospital maternity services had also supported on a 3-year delivery plan for Maternity and Neonatal Services within the LMNS with a focus on continuous improvement.

The provider 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. Staff we spoke with felt respected, supported and valued.

Staff told us the Director of Midwifery and Neonatal services (DOM) and Head of Midwifery and Neonatal (HOM) services were visible, inclusive and responsive. Leaders were valued by staff who told us they were well supported by their line managers.

The Trust completed a SCORE survey in 2024 which identified that topics discussed were mostly positive within the maternity service. The SCORE survey was an anonymous online survey tool to assess the culture of the service.

The survey showed staff felt engaged and they worked in a compassionate and inclusive culture. Staff felt able to raise concerns, ask questions, and give suggestions for areas of improvement. The maternity team described how they felt there was a strong team ethos within the service.

However, the survey lower scores were around staff wellbeing, high work pressures, conflicting demands, and burnout. Following on from the survey the service put an action plan in place to improve the areas which scored low in the survey regarding staff learning, staff morale and staff health.

There was a weekly initiative of a staff well-being tea trolley, which provided refreshments to staff. Leaders and staff described the aim of the trolley service, was to offer emotional support and social interaction between staff.

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

Women, birthing people and families knew how to complain or raise concerns, and how to give feedback on the service and their treatment.

Within the Maternity and Neonatal Strategy, there were 4 key priorities. The priorities were safety, collaboration, compassion and equality. Listening and ensuring care was personalised was a clear indicator within the delivery model.

Staff and leaders were currently in a process of change to drive improvement. Senior leaders and staff had awareness around inequalities within maternity care, with black women facing significantly higher risks of complications and adverse outcomes. The director of nursing had completed ‘The Black Maternity Matters programme for Southwest and Beyond senior leaders in NHS England’ training, and the head of midwifery had started the training this year, with the aim to have an inclusive culture change within maternity services.

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

Staff and leaders described how the service promoted equality and diversity within their daily work. The trust arranged a cultural exchange event, with maternity and obstetric staff. Staff brought food to share and wore traditional clothes.

Staff completed ‘Implicit Bias in Maternity Care’ training. This aimed to build a greater understanding of the inequalities of maternal and neonatal outcomes, explore bias and stereotypes within maternity care. The training presented lived experiences from black and brown women within maternity care.

Leaders worked with regional and innovations teams to roll out the training for a period of 12 months across the service to have discussions around clinical pathways for families.

The service provided a named midwife to support women who had relocated from Afghanistan were residing at a local military base. Women from this community were offered routine antenatal and postnatal appointments in the women’s home. The appointments were pre-booked with a translator and NHS maternity leaflets were printed in Dari and Pushto.

The service clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders had the experience, skills and abilities to run the service. They understood and managed the priorities and issues the service faced.

Governance processes had improved since our last inspection, with a clearly defined governance structure. This detailed the governance oversight and accountability from the service level to the trust board. Leaders operated an effective governance process and monitored key safety and performance metrics through a structure of governance meetings.

A governance lead midwife was now in post and there was perinatal quality surveillance model developed to provide oversight of the maternity service. The model reported on perinatal clinical quality and safety and provided lines for responsibility and accountability for addressing quality and safety concerns. This information was shared with the Intergrated Care Board and regional chief midwife.

Key performance indicators were incorporated into the maternity dashboard for monitoring and oversight. The dashboard was presented electronically and shared with both the trust board and the Local Maternity and Neonatal Systems (LMNS). The service used the maternity dashboard to identify outlier status and learning.

The maternity dashboard and the reporting of safety measures and outcome data was presented via maternity and neonatal reports to the quality committee monthly and the maternity and neonatal quality and safety report was presented to the trust board.

The maternity, neonatal and obstetric workforce report was also reported to the trust board alongside the bi-annual safe staffing report to meet national requirements.

Staff at all levels could describe their role in the governance process and had regular opportunities to meet discuss and learn from the performance of the service. They knew how to escalate issues to the clinical governance team and divisional management team.

Perinatal joint quality and maternity safety champion meetings were held regularly with a set agenda. Previous actions were reviewed, as well maternity and neonatal voice partnership updates, maternity safety champion walk arounds and quality improvement projects.

Minutes of these meetings confirmed discussions around the planning and monitoring of risk due to a potential higher acuity at Dorset County Hospital following the closure of a local NHS maternity service. There were ongoing discussions in managing risk and tracking incidents that may relate to the higher acuity within the maternity service.

Perinatal training compliance was monitored by the practice development lead. Compliance figures were tracked through the ‘Saving Babies Lives Care Bundle (SBL) audits and were reported quarterly to the trust board. The service presented audit findings monthly within the reproductive health clinical governance meetings.

The service worked alongside LMNS to review SBL audit report. The report was submitted through the trust governance committees for scrutiny and oversight of compliance through the reproductive health and quality governance group, the joint committee and to the trust board.

The service has an audit lead who had oversight of all audits and maternity guidelines. There was an electronic audit tracker and audit outcomes were reported into governance meetings. A guideline group was established following several guidelines being found to be out of date during our last assessment.

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

Service leaders attended regular meetings with the Local Maternity Network System (LMNS) to review governance and incidents.

Leaders worked with the Dorset Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Meeting minutes showed current work being undertaken between the local MNVP, maternity service and the LMNS.

The LMNS, MNVP and maternity service completed joint working on a project to enhance women’s experience. To improve safety on the postnatal ward, through care pathways to improve the flow and capacity and to reduce maternal and neonatal readmission rates.

MNVP attended meetings with the maternity and neonatal Safety Champions and patient experience meetings were embedded. The MNVP used social media to increase awareness around the maternity service and targeted posts were used to promote national events such as Maternal Mental Health Week and International Day of the Midwife.

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 women. Staff actively contribute to safe, effective practice and research.

All staff we met were committed to learning and improving services. They had a good understanding of quality improvement tools and had the skills to use them. Leaders encouraged innovation and encouraged research. We saw several examples of initiatives, innovations and quality improvement. For example, the service had developed a 3D tour of the maternity unit with funding received from NHS England. The 3D tour enabled women, birthing people and their families a digital tour around the antenatal, intrapartum and postnatal care. The project was supported by the MNVP who collated feedback from families.

The service provided a bereavement external training day for all staff involved with caring for bereaved families. Training was provided by bereavement charities and was offered to obstetric doctors, midwives, trust chaplains and students. The service had also invited the MNVP to attend as the team were part of the trust perinatal mortality review team.