Dorset County Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

We score the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff assessed the individual needs of patients and made sure any actions required to meet these needs were outlined. This included for example, where a patient preferred to dress in day clothes or where their preferences for certain foods were stated.

Group therapy work was made available to stroke patients to support healthier living and reduce future care needs. These included Monday, Wednesday and Thursday breakfast club, where patients were helped to overcome challenges with a normal activity, through preparation of their own breakfast. We observed patients taking part in the monthly baking club, where they were supported to make cakes within a larger social group.

Other examples of supportive group sessions we were provided with information about included, the upper limb group, sit to stand group, music and an activity group. All these group activities were designed to provide opportunities for self-improvement and aid their progress. Patients could make their own choice as to be involved or not, although staff encouraged them to do so.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

There was an Acute Hospital at Home service (AHAH), otherwise known as virtual ward, allowing patients to get the care they need at home safely and conveniently, rather than being in hospital. The service was supported by a policy setting out its principles of safety and suitability, individualised care delivered by the multidisciplinary team. Staff could provide intravenous medicines or fluids, wound care, take blood samples and record vital observations. The service operated 7 days a week between the hours of 7:30am to midnight, with escalation outside of these hours. The patient remained under the specialty consultant. Responsibilities were clearly stated in the policy, as were arrangements for admission to hospital, should the need arise.

We saw a copy of the standard operating procedure for managing heart failure patients under the AHAH approach. This also set out clear standards for staff to follow. Similarly, there was a standard operating procedure (SOP) for palliative care virtual ward, where patients needed acute medical support at home, which would be provided by AHAH. This meant patients who chose to be at home for end-of-life care could still receive expert clinical input without having to go into hospital.

The Peritoneal Dialysis (PD) team provided a service called Share source, which meant patients could be at home on dialysis using a machine for 6-8 hours. Patients were monitored and the PD team could see all the treatments performed. They could assess, evaluate and monitor remotely, avoiding having to bring the patient into hospital. The patient was contacted directly if any changes were required.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients told us they were given information in formats they could understand. For example, in relation to stopping smoking, dialysis treatment and other medical related treatment and care. We saw a range of leaflets displayed which family or patients could help themselves to. Additionally, on the hospital website a range of information was available, listed alphabetically. This included for example, frailty; diabetes; gastroenterology; medicine for older people; blood tests and endoscopic procedures. The website also contained details about information governance and how patient related data would be collected what it would be used for, and privacy information. The ‘patient experience team’ were also available to help if needed.

A patient information leaflet had been developed to help patients know what to expect when cared for in an escalation area. This was called – ‘Your Care in Our Hospital.’ Easy read leaflets were available from the hospital website.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights and how to complain. Information was clearly displayed in all ward areas about raising a concern or making a complaint.

Managers ensured staff and patients had easy access to interpreters. Staff had access to guidance on interpretation services via the hospital intranet home page. We were informed there was 24/7 access to interpreters in more than 240 languages. Staff could access the service via telephone, iPads, laptops, or Information on Wheels (IOW) trolleys. We were advised that British Sign Language (BSL) support was also available, including at short notice. Document translation was also provided through the contracted supplier, Language Line.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. We viewed several menus available to patients to choose from. We saw information in patients records about sensitivities or allergy to food items. Dietitians were involved in supporting and advising on diet to aid good nutritional outcomes for patients. Notes were updated to indicate dietitian instruction and progress.

Staff ensured that patients had access to spiritual support. Members of the chaplaincy team attended wards regularly. They provided a 24-hour confidential service to patients, carers and staff. This service was for all people regardless of age, gender, religion, sexual orientation or any other form of diversity. There was a chapel and quiet space available. A leaflet on the chaplaincy service was available on the trust website.

Staff made notifications to external bodies as needed. Serious incidents, adverse events and unexpected deaths were reported in line with expectations. The service had formal processes to investigate and learn from such cases and to share learning with staff.

Information governance systems included the management of devices containing patient information and the confidentiality of patient records. Patient paper records were stored in individual folders, which were kept in a locked documents trolley. Some observational records were kept at the bedside and were covered by a laminated note to indicate they were confidential. Medicine records were stored on an electronic system, which was securely accessed.

Staff used printed handover sheets for information sharing to staff coming on duty. They were responsible for destroying these records at the end of their shift. White write on, wipe off notice boards were used to manage the patient bed status on wards. These did not contain the full name of patients and used their surname and Mr/Mrs.

The service complied with the Accessible Information Standard and had a policy to guide staff in their responsibilities.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The trust collected feedback from patients through the Friends and Family Test (F&FT). This was via a paper-based system, as funding was being awaited for digitalisation. Recognising responses via the paper system were not always as high as they would like, the trust were also using QR-codes, posted in areas and on business cards to try and increase feedback rates. July to September 2025 recommendation rate was 97.7%, which was above the trust standard of 95%. The F&FT results for December 2025 were 98.6% with a response rate of 6.3%. We saw there was also a specific way for people with a learning disability to give feedback. This was a poster displayed in areas which contained a scan link for people who were over the age of 18 years to get access to a code for feedback.

There was a Patient and Public Engagement Action Group where attendees were able to discuss services and agree actions. The aim of this was to involve patients/carers and service users in quality improvement and transformation projects. We saw minutes from these meetings and noted they included discussion of family and carers experiences.

Where feedback was given directly to staff, it could be collected via the electronic reporting system. This was shared with departments and used for reflective learning. We were informed that patients would not get a direct response from this feedback method. A formal complaint would be looked at and responded to as per the complaints process.

Across the medical areas there had been 40 complaints in the period of 1 April to 12 December 2025. Of these, 7 remained open. Most complaints arose from the cardiology service (22). Themes identified from all the complaints included for example, communication issues; delay or failure in diagnosis; failed discharge or inappropriate discharge. Most of the complaints generated an early resolution response, which meant they did not require extensive investigation.

We were provided with examples of action taken in response to complaints raised. This included for example, improvements in areas used for escalation areas, including the installation of call bells, retractable screens and hand basins. Staff had also been reminded to use an oral care chart to show patients had been assisted with teeth cleaning, if needed. Another example was staff documenting on admission family wishes regarding calls at home and under what circumstances.

We saw that information arising from complaints or the experiences of patients and families was shared through the ‘Experience of Care’ report. This was presented at the Experience of Care Committee. Patient Stories were also shared at meetings and a formal ‘Your Voice Report’ was produced too. The performance dashboard showing the medical areas showed 5 complaints having been received in December 2025 and 11 positive feedback messages from patients.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

There were no exclusions preventing patients from accessing medical services. There were, however, some specific criteria to manage admissions safely, to get patients to the most effective area to receive the care they needed and to ensure the patient received the right care and treatment. Access to some services were delayed because of capacity, making the referral to treatments longer than the expected targets. There were some delays to accessing the right discharge package of care in a timely way, which could result in patients’ length of stay in hospital being longer than they would want. Challenges related to support packages and community placements was one of the issues experienced by staff, despite their best efforts.

Stroke outreach was a good example of different services working well together for the benefit of patients, with access and treatment in mind. Video triage between ambulance staff and stroke consultants enabled the ED to be notified in advance of a patient’s arrival. This in turn allowed the patient to be met by the stroke team and to have their treatment started as quickly as possible.

The medical wards were either in care group 1 or 2, each having a performance dashboard, which helped them to have oversight of various targets and keep a focus on how each area was doing. Information then fed into an Integrated and Holistic Care Group Performance dashboard. This helped the medical division to have oversight of activity. We reviewed the care group 2 dashboard (7 wards included) for December 2025 and noted there had been 2,401 referrals, 7,634 appointments held and 6.1% non-attendances. The 18-week referral to treatment was at 73.3%, the incomplete pathway was 550 and the longest wait was 37 weeks. The incomplete pathway refers to a patient who has been referred for consultant-led planned treatment but has not yet started this. The Vascular and Metabolic Care Group 1 showed 726 patient referrals, 2734 appointment and a non-attendance rate of 5.8%. The 18-week referral to treatment was at 81.5%, incomplete pathway -1,992 and the longest wait of 55 weeks.

We were shown a copy of the Bed Management and Patient Flow Policy. This was focused on managing capacity, bed flow for inpatients and ensuring they received the safest and highest quality of care in the right place and at the right time. The policy referred to the use of escalation areas, corridor care and medical outliers (where medical patients are on surgical wards for example), and ensuring the fundamental standards of care could be met at such times. The policy was underpinned by the principle of equity of access and ensuring all patients were treated in a timely manner and in accordance with the standards for mix sex accommodation. We attended the bed meeting on the second day of inspection and heard information about no beds being available in the hospital, the number of patients waiting for beds, including 2 in the corridor of the ED, and the number of confirmed patient discharges. Actions were discussed and agreed before the meeting ended.

Performance dashboards included the monitoring of bed occupancy, use of escalation areas, single sex accommodation breaches and numbers of ward moves for clinical and non-clinical reasons, by numbers and at individual patient level. The number of ward moves for non-clinical reasons in the last 12 months was 5. The trust also followed the Getting it Right First Time (GIRFT) Summary Acute Medicine Indicator Table (SAMIT) and SAMIT 75+ for frailty. This data provides national comparative information for frailty at the site level about demand, flow and outcome for both the admission and recovery phases of frailty care. Information helped manage capacity and helped to highlight gaps which might be impacting on the delivery of a service. Improvements were seen in the length of stay in frailty patient bed days equal or greater than 21 days. We saw data indicated a fluctuating picture of the indicators over the whole of 2025. However, the trust showed an improved overall position of 53 out of 171. This was because of several improvements, for example, the implementation of the Frailty SDEC, the reorganisation of the pathway to form a short stay ward and increasing workforce. Additionally, there had been improved community frailty provision – community frailty teams and frailty virtual wards.

The Endoscopy unit held daily huddles to discuss the activity for the week and any specific needs. They also held capacity planning meetings weekly where they looked at capacity; the number of did not attends; flow through the department; room turnaround; cancellations and waiting list initiatives. A monthly user group meeting enabled the service to look at productivity and performance. We saw a detailed action plan for referral to treatment targets, with progress summarised against the person taking the respective lead.

Staff made reasonable adjustments for patients. We were provided with an example of staff taking action to ensure a patient who had learning disabilities was able to attend for an outpatient appointment with minimal upset and distress to them. Staff booked the test for a weekend, so it would be quieter and their next of kin was invited to come into the clinic room whilst the test was performed for reassurance. In advance, staff provided pictures of the department and where they would come to as well as a picture of someone having the test. They also provided the name and an image of the person who was to be carrying out the test. The patient’s hospital passport was also shared with staff before the appointment, so they knew more information about the patient.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency. On-call consultant specialties had responsibility for admissions during the on-call hours.

Staff aimed to start discharge planning within 24 to 48-hours after admission, with the aim of getting the person home. However, there were times where patients needed additional care and required a specific pathway, such as pathway 2 for assessment and intervention. Pathway 2 hospital discharge is a Discharge to Assess (D2A) model for patients who are medically fit to leave the hospital but need temporary, 24-hour bed-based rehabilitation or care. It acts as a "step-down" service to help patients recover before returning home or moving into long-term care. In this case patients may have needed to be discharged into short-term bed-based care. There was good liaison with care managers/co-ordinators. This included providing information to patients. Discharge was never delayed for other than clinical reasons, such as patient equipment needs or home alterations. Length of stay had shown an up and down picture considerable over the last four months of 2025 and was mostly higher than the regional averages over 7, 14 and 21 days. As of 4 November 2025, 50% of the core general and acute bed base had been occupied by patients with a LOS over 7 days (7-day rolling average), and 21% were occupied by patients staying over 21 days.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The trust collected information related to inequality, including people with protected characteristics. We saw data related to did not attend, referral to treatment waits for various medical related specialties. Information collected was reported into the Quality Committee.

We saw there had been significant use of bedding patients in areas not usually used for medical patients over the last 4 months of 2025. These were called medical outliers. The allocation of all patients, including outliers was handled throughout the day in medical handover meetings, which were consultant led. Where additional doctor support was required, this was managed by the rota coordinator. A digital tool helped doctors at all grades to have a single point view of patients to plan, treat and monitor progress. We saw formal documents related to patients who were being managed as medical outliers. The information within these documents ensured patients were not disadvantaged in any way, were seen by medical staff best suited to meet their needs and received the right treatment and care.

The trust engaged with the learning from lives and deaths of people with a learning disability, autistic people (LeDeR) process. The Integrated Care Board acted as the Local Area contacts and managed the review process. On completion of the report, it was shared with the relevant teams, the Mental Health and Learning Disability Steering Group and also the Hospital Mortality Group, 3 examples of which were shared with us.

Staff actively encouraged people using the service to give feedback and they recognised the value in getting both positive and negative views. Information was available to direct patients and families or carers to share their experiences.

Policies and procedures seen by us showed the provider had undertaken equality impact assessments of these. There was no suggestion that vulnerable people or people with protected characteristics were disadvantaged.

Staff received training on equality, diversity, inclusion and human rights. This was a 3-yearly requirement, and we saw information to show a 94% completion rate.

We scored the service as 2. The evidence showed some shortfalls. DNACPR decisions were not always made by the medical or nursing staff with the correct level of seniority however, people were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Medical care inpatient audits including the Emergency Department between October to December 2025 showed the decision on DNACPR was not always made by medical or nursing staff with the correct level of seniority and training in line with trust policy and not all audited records showed a consultant had formally approved the DNACPR decision within 48hrs of admission. Although the trust was assured DNACPR and TEP decisions were individualised, there was limited assurance of improvement as some ongoing improvement actions had no identified completion dates. Additionally, processes for reconciling community DNACPR forms with the hospitals’ systems could only be completed by medical staff due to access limitations to GP health records. There were sometimes delays in ED medical clerking for completion of patient health and care records, which presented a risk of cardiopulmonary resuscitation being given to a patient who did not want this. However, there were no reports of this type of incident.

Several patient notes had a formal Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) directive present. These were placed at the front of the patients’ personal record and had been completed, with required signatures. An audit of DNACPRs was carried out to check that a person’s learning disability was not used as a rationale for the DNACPR. The most recent audit in 2025 showed people’s learning disability was not used as a reason for having a DNACPR.

Patients told us they had been involved in discussions about their treatment and care and given options, including any risks to help them make decisions. Staff supported patients to make decisions about their care and treatment and their future. For example, we saw information had been recorded about people’s resuscitation status. Following the assessment of patients immediate and longer-term needs, staff created personalised care plans to account for the patient’s needs, wishes and feelings. Patients told us they were involved in discussions about their discharge, and we saw information recorded in patient records to show this. Where therapists had identified the need for specific equipment or care packages, this was stated. There was an escalation process for complex discharges, including where solutions had not been found or there were delays above what was expected.

The dietetic team worked closely with patients, including those who were being discharged, signposting patients and families to a range of local and national charities, with links to local foodbanks, Diabetes UK, and Coeliac UK. We were informed they held regular collections for the local foodbank and referred families in need.

Staff had access to the trust Palliative Care and End of Life Team. The team were available Monday to Saturday 8am to 4pm and via telephone on a Sunday. They worked with the wider team to ensure patients and their families had their quality of life maximised through the management of pain and other symptoms and the provision of psychological, social and spiritual support.