Dorset County Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as Good. At this assessment the rating has remained.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

During this assessment we looked at 18 patient records and followed the journey of 2 patients through the Endoscopy unit, from arrival to back onto the ward. We spoke with more than 50 staff from a range of roles, talked with 10 patients and 1 relative.

Patients told us they were asked about their individual needs after arrival to ward areas. This included being able to say what they found difficult and needed help with. However, they could not tell us if they had a documented plan of care, agreed with them. We found in our review of patient records the staff had used a standardised assessment record. This included information for example, past medical and surgical history; physical and psychological well-being; social needs; allergies; smoking and alcohol use, and base line observations of pulse, blood pressure and respirations. We saw risk assessments, such as body maps recording any present skin damage, nutritional risks and falls. This information was used to state any actions that staff needed to take to manage the patients care. Where risks were identified, these were managed safely and care plans set out so staff could address the individual needs of patients. For example, skin care bundles and catheter care.

We saw evidence of electrocardiogram (ECG’s) having been recorded, of blood tests having been undertaken and reviewed and treatment escalation plans. Next steps were clearly outlined, including planning for discharge. An ECG is a to record the heart's electrical activity to check for issues with rate or rhythm. Patient’s pain was assessed and staff administered pain relieving medicine when needed. Patients we spoke with told us staff gave them pain relief and said their pain was well managed. Nationally recognised pain assessment tools were used where patients who could not express the degree of pain, for example patients living with dementia or patients who had a learning disability.

Progress notes were written by nursing and other allied health professionals, such as dietitians, members of the speech and language team (SALT), physiotherapists and occupational therapists. Consultants and other doctors wrote in the patient records to reflect their assessment, to request investigations and to summarise medical opinion and next steps.

Safety checks were carried out at each stage of the patients care in the Endoscopy Unit. This was in line with the 5-steps to safer surgery programme. These checks were recorded in patient records. Similar safety checks were carried out for patients having dialysis line insertions on the Prince of Wales Ward.

All nursing and medical records reviewed were clear and completed in a timely way. We saw evidence of the auditing of patient records and risk assessments. This was a monthly audit, which included 10 sets of patient notes. Information about the findings was shared with staff at briefings, via newsletters and meetings to help make improvements. We saw for example, information which suggested some improvements were needed in documenting information related to sepsis.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

There was access to trust policies and procedures to support new staff and when needed. This was via the trust intranet. Pathways of care for various specialties helped staff to follow best practice. Information was shared to staff in various ways, including at shift handovers, via newsletters and at safety huddles.

Staff participated in clinical audit and there were several regular audits undertaken on medical wards. This included, falls safety audit, peripheral venous cannula (devices to deliver fluids directly into a patient’s vein) and urinary catheter compliance audits. The audits were carried out monthly to check if policy was being followed by staff. Audits formed part of the ward performance dashboards and the IPM dashboard. Learning identified from the audits and escalation of concerns fed into divisional meetings.

Patients’ care and treatment was planned based on their individual assessment and personal needs according to their medical presentation. They could be referred to several specialists, depending on individual needs. In addition to expert doctors and specialty nurses, there was access to and involvement of for example, advanced clinical practitioners; the palliative care team; physiotherapists; occupational therapists; speech and language staff (SALT), orthotics and dietitians. Within medical services, staff followed best practice standards, for example, the Cardiac Rehabilitation Standards.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Patient records reviewed by us showed information about their dietary needs and fluid intake, likes and dislikes. When patients were referred to dietitians or the Speech and Language Team (SALT) team those speciality staff recorded information within the patients record. There was written advice on any dietary restrictions available to patients. This included for example, low phosphate diet and how to ensure a good level of protein was included in meals.

Most staff were experienced and had the right skills and knowledge to meet the needs of their patients. However, on Moreton Ward some staff reported feeling less skilled in caring for complex respiratory patients, particularly at weekends, when there was less support available and more junior staff were on duty. However, staff working on Moreton Ward had access to a range of support to care for complex respiratory patients including; 4 registered nurses, on each shift, which included a nurse in charge, either a band 6 or experienced band 5 in respiratory and general medical care. Monday to Friday there were 2 respiratory nurse specialists based on the ward and clinical support from the respiratory multi-disciplinary team were present throughout the day. Additional 24/7 support was available from the critical care outreach team via a bleep request.

In response to identified training need, a detailed in-house training programme had been developed to support all nursing and health care support workers on Moreton Ward. We were advised of some of the content of the training and that several sessions had already taken place with further study days rostered over the next 6 months.

Staff had access to additional training to support the delivery of skilled care. This included non-medical prescribing, leadership and management programmes and for psychological wellbeing practitioner roles. We saw additional training had been provided for example on stroke, frailty and dementia. Some staff had the opportunity to apply for worked based learning on aspects of the Renal (Kidney) speciality. There had been separate training related to mental health and learning disabilities, which had included, safe holding and supporting someone with a mental illness. A range of clinical competencies were available for staff to complete. This included for example, tissue viability, nutritional assessments, bowel care, transfusions and incontinence.

The dementia team provided education to staff including those working in doctor roles. They delivered teaching on cognitive impairment, delirium differentiation and mental health in frailty. Regular participation in scenario training helped to develop the multidisciplinary approach to distress and complex behaviours. There was specific medical registrars training across the trust which the stroke outreach team could join. As well as some scenario content, the sessions covered such areas related to stroke identification and management.

Managers provided new staff with an induction. There was a 2-week supportive programme for new staff, and an extension was possible if needed. Each new staff member had a buddy or mentor to support them in the location induction. Topics covered in the ward induction included for example, infection control, health and safety, documentation and professionalism. There was an Elderly Care induction for rotations of resident doctors (those in training). This was a good example of best practice, with learning and professional development opportunities identified.

We were advised that clinical supervision was being provided on an ad hoc basis, typically following incidents, after training, or as needed. Some of the education plans for supervision to support staff were shared with us. Moreton Ward had created a training matrix to identify and centralise all the staff training requirements, course attendance and competencies for the ward staff. This was used as part of the appraisal process and formed part of the learning needs review. Staff received an annual appraisal, the overall completion rate for these within the medical services was 80%. Doctors engaged with the appraisal process and the most recent figures showed more than 93% had been appraised.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They mostly made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We observed staff working very well together, taking a team-work approach to sharing information in several ways. We attended the morning handover from night to day staff on 3 wards. Information was shared about each patient, including any changes in their condition, interventions carried out and any new or changes in risk. The day staff were able to plan the delivery of care to their patients based on the information given, including any investigative tests or arrangements for discharge to be done. Medical staff led board rounds each day, where their patients were discussed, along with risk or safety matters and discharge arrangements. The complex discharge team, which had 6 staff, were involved in working with teams to ensure patients were discharged with the right packages of care. Community Hospital Team meetings were held on Saturdays with external agencies to ensure discharges were arranged.

The teams had effective working relationships with a range of specialists and told us the multidisciplinary team worked well together. Staff said their colleagues were supportive and approachable. This included for example, the hyper acute unit stroke team (HASU) staff. This team was responsible for assessing and managing the patient’s treatment and care. We saw patient treatment and care on medical areas was supported by a wide range of experienced staff with additional skills. This included nurse practitioners, lead consultants, therapists, dietitians, palliative care and the speech and language team. Staff told they had good working relationships and worked together for the benefit of the best patient outcomes.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, to reduce their future needs for care and support.

We saw that patients were encouraged to be as independent as possible with daily activities, as far as their conditions allowed and in preparation for discharge. Staff also supported patients to live healthier lives – for example, by giving information both verbally and via information leaflets on subjects such as stopping smoking. The trust had a ‘LiveWell’ team of coaches and advisors available to support people to stop smoking. A patient told us they had been receiving advice and support in this area since they came into hospital. They had been given information, including leaflets and alternative tobacco products. Staff had a separate advanced smoking assessment, which included a carbon monoxide test. This was completed by an addiction specialist and included a care plan. Data was collected on the smoking cessation service and was shared with the Integrated Care Board and NHS England. The trust saw between 100 and 170 patients per month through the Tobacco Dependency Service.

The Renal Unit provided information to patients who had chronic kidney disease, including how to prevent further problems. This included reducing salt intake and keeping fit. We saw several other information leaflets were available to support the verbal advice given to patients on the Renal Unit.

There was an Atrial Fibrillation (AF) clinic, with attendees supported to focus on lifestyle changes needed to reduce the burden of AF and to promote healthy living. Atrial Fibrillation is an irregular, often very rapid heart rhythm. An irregular heart rhythm, which can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

Working closely with the inpatient respiratory physiotherapy team, the trust had an Outpatient Respiratory Physiotherapy Service, which helped patients with long-term respiratory conditions, using various strategies. This included for example, managing symptoms, airway clearance and breathlessness management. By encouraging physical activity and pulmonary rehabilitation enrolment, they aimed to focus on improving quality of life, symptom burden, admission avoidance and reducing worsening situations.

Patients with certain conditions could also be referred to an Active 4 Health exercise programme run by the local council. Referral could be made by physiotherapist or other health professional. 

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised observational tools to improve the detection and response to clinical deterioration in patients. Records of checks on respiratory status, blood pressure, heart rate and temperature for example, were recorded in patient records and communicated to colleagues, where noted to be of concern. Staff had access to diagnostic services within the hospital and where treatment required patients to use these services, such as having blood rests or x-ray, results were made available for consideration. Ward testing was also available for checking patients’ blood sugar levels, respiratory function, body weight and monitoring oxygen levels.

Patient outcome data was collected as part of the Sentinel Stroke National Audit Programme (SSNAP). This is a major national healthcare quality improvement programme, which looks at how well stroke care is being delivered in the NHS. Information submitted by the trust in relation to the key measures showed an improved picture, having moved from an overall band rating of D in the last quarter January-March 2024/25 to B in quarter 3, October-December 2025. They scored above the national average in 4 of the measures. This included being admitted to a stroke unit in 4-hours and receiving treatment for blood clot. Two key areas were still challenging and included psychologist support and access to out of hours stroke nurse specialist. It was not known what was being done to improve these key areas.

There were several national audits which the trust submitted information to. This included for example, aspects of cardiology; diabetes; renal; kidney injury, colorectal, bowel cancer; Parkinsons, rheumatology and respiratory where the most recent reports were awaited. Most required continuous submission of information to the database, whilst some had specified submission dates. A number were in progress and some required escalation or were behind. There was a focus on audit within the various governance groups, including those which were in progress and where delays were likely to be because of vacancies within the audit team. We also saw a formal report on clinical effectiveness audit with a 6-month update plan, which focused on 2 key areas.

The National Respiratory Audit Programme – Adult Asthma showed that between 1 April 2022 and 31 March 2023, the service was in the top 25% for people admitted to hospital with an asthma attack who are reviewed by a respiratory specialist within 24 hours of arrival. They were in the middle 50% for people admitted to hospital with an asthma attack identified as current smoker with tobacco dependency addressed, and people who receive the necessary assessments and interventions within 1 hour of arrival at hospital.

National Audit of Dementia for the period August 2023 – January 2024 showed they were in the top 25% (100%) for ‘pain assessment’ compared to the national combined figures. They were in the middle 50% for ‘carers rating overall care received by the person cared for in hospital as "Excellent" or "Very Good“’, an ‘initial delirium assessment’ and ‘initiation of planning within 24 hours’’.

Where audit outcomes indicated improvements were required a clinical response to the findings was produced. This included recommendations and actions, with responsibilities set out. We saw for example information related to reducing patient falls and the planned actions set out.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff had access to trust policy related to consent processes, which included setting out responsibilities. Following policy, staff took all reasonable and practical steps to enable patients to make their own decisions. This included when patients lacked capacity and staff needed to make decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Patients told us they had been given information by staff in ways which helped them to make informed decisions and choices before consenting to investigative procedures, tests and treatment. Patient records showed information, including risks and options had been given, as part of the consent process. Consent forms had been signed and dated.