Dorset County Hospital

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. 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 a joint strategy for Dorset County Hospital and Dorset HealthCare. As a federated NHS trusts, which meant information from separate systems across the healthcare providers was used to help staff reduce waiting lists, improve efficiency, and enhance patient care. The strategy was called ‘Working together, improving lives,’ and covered the period 2024-2029. The trusts vision was stated as: for healthier lives, empowered citizens, thriving communities. Their mission was to work in partnership to provide high quality, compassionate services and to nurture an environment where people can be their best. There were 4 strategic objectives underpinning the strategy.

Linked to the strategy, the Medical Division were working on a new framework to support the patient pathways. This included for example, using the national framework for 72-hour care, starting at the hospital front door and extended acute assessment and virtual ward provision. Staff had been involved and were expected to be further included as they looked at models of care, focused on quality improvement, admission avoidance and non-admission pathways.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The trust values were clearly stated and understood by staff. The values were: Respect, Integrity, Teamwork and Excellence.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the staff. We observed staff living the values through their approach to one another, their interactions with patients and families.

We scored the service as 3. The evidence showed a good standard. 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.

Medical services sat within the Urgent and Integrated Care Division, overseen by clinical divisional directors and the chief operating officer. Wards and specified therapies reported into the divisional head of nursing and quality. Leaders had the skills, knowledge and experience to perform their roles. They understood the challenges within the services and looked for ways of addressing these and enabling their staff to provide the best they could.

Staff holding leadership roles in clinical areas and within the divisional structure had various responsibilities, which they delivered with commitment and enthusiasm. Leaders had been given the chance to undertake a leadership programmes, the content of which was shown to us. They had access to resources to support them in their roles, with a focus on creating positive team cultures, being able to address challenges, and to deliver high-quality, patient-centred care.

Leaders tried to be visible to their teams and the wider community and fostered an inclusive approach at every opportunity. Staff told us leaders were visible, and the sisters and ward managers were around and willing to help. However, staff in one area reported being told to perform better with no additional resources to help and of having unrealistic targets related to patient capacity. We were told these expectations did not reflect the standard operating procedure in the use of the Frailty Same Day Emergency Care Unit. Staff on Ilchester Ward felt the needs of their patients had not been considered fully when the decision was made to reduce the staffing.

The NHS staff survey results completed in 2024, division A had 650 responses, (41.85%) showed the same or higher for responses, except we are safe and healthy, which had a very slight fall. We are compassionate and inclusive scored 7.46 out of 10. We are a team scored 7.10 out of 10 and morale – 6 out of 10. Areas of focus had been identified by leaders, some of which were completed or in progress, and some still to progress.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff could raise matters with their direct line managers or if required through the speak-up route. This included via the freedom to speak up champions or guardians. There was a total of 44 contacts made with the Freedom to Speak Up Guardian (FtSUG) during the period 31 December 2024 and 1 January 2026. The main themes raised included by way of example, colleague/leadership/line manager behaviour’s; advice on management, recruitment and HR processes; Visa sponsorship; patient behaviour; patient safety, and colleagues speaking in their own language. We saw information demonstrating that FtSUG) provided information to the Board in Common. Actions to improve these points varied according to where the issue arose from, such as human resource matters. Managers and leaders tried to foster a working environment which respected each and every member of staff and encouraged others to mirror behaviours in a positive way. Signage was displayed about treating staff with due respect.

We were given an example where a staff group had raised matters related to structural reorganisation. Listening events had been held with the renal team, for staff to talk about how they were feeling. They had engaged with nursing teams and specialist nurses to get a wider view of some of the issues raised and work was in progress to take these points into consideration.

Quarterly meetings had been set up for night staff, where they could raise any concerns, share and receive information and offer suggestions. Staff could be paid to attend or get time back, as meetings were held between 7 and 8pm. A night staff forum newsletter was communicated to staff following these meetings.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. December 2025 results from the F&FT were positive at 98.6%, with many areas scoring 100% for good or very good. It should be noted however, the response rates were very low, out of 2286 patients, only 6.3% responded.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders in ED valued the diversity of their workforce. However, disparities in experience remained across the trust for some staff groups with protected characteristics. Although actions had been taken and improvements made, this did not always narrow the disparities in experience.

The trust used available data analysis to inform their inclusion and belonging strategies and anti-racism framework, but this was limited. There was no existing trust wide gap analysis report to compare whether disparities in representation, experience and outcomes of staff existed across divisions and teams. However, the trust was working with system partners to develop a business intelligence tool to bridge this gap.

The trust analysed and reported on mandatory workforce equality, diversity and inclusion information. This was performed in accordance with the Workforce Race Equality Standards (WRES), Workforce Disability Equality Standard (WDES) and Gender Pay Gap reporting. The trust used nationally approved toolkits such as the NHS Equality Delivery System 2 (EDS2) to make structured improvements to workforce. In the workforce health and wellbeing domain, the trust had achieved the expected level of performance for 3 out of 4 outcomes. To reach the expected level of performance in the final area, the trust needed to routinely analyse staff recommendation and experience data by protected characteristics and use this to address any disparities. The inclusive leadership domain still needed additional improvements for most outcomes to reach the same level of maturity. The leadership representation at Agenda for Change 8C and above across the hospital was limited and did not fully reflect the local population served. However, there were actions to address all areas which fell short of expectation.

The number and proportion of black and minority ethnic group (BME) staff at this trust continued to increase from previous years due to the increased reliance on international recruitment to fill essential roles. This meant BME staff made up 21.65% of hospital staff, while the local population remained at approximately 5%.

The 2024/2025 WRES report showed there were some indicators where the trust had not significantly improved the experience of staff who identified as being from a black or minority ethnic (BME) group since 2021. For some indicators, the disparity in experiences had instead widened. Staff who identified as being white were 3 times more likely to be appointed from shortlisting compared to BME candidates. BME staff were 1.38 times more likely than white staff to enter the formal disciplinary process when this was equally likely in 2021/2022 reports. BME staff experienced a higher proportion of bullying, harassment or abuse from members of the public and other staff in the last 12 months than white staff. However, average staff response rates for bullying and harassment indicators was 20.8%, below the national average of 25.3%. This meant there was a risk the responses did not fully reflect the experiences of staff. Additionally, the proportion of directly employed BME senior leaders remained the same as in 2021/2022 reports, despite the overall increase in BME staff overall.

However, the experience of staff who reported they had a disability generally improved in most indicators to be similar to staff who did not report having a disability. There was greater representation of disabled staff senior leadership level. This was positive and demonstrated the trusts’ commitment to equity in this area.

Despite this, during the onsite inspection BME staff spoke positively about the team working dynamic and how colleagues had welcomed them as internationally recruited staff. They reported being offered the same opportunities as other staff. During the onsite inspection, we did not hear of any experiences of bullying or harassment from other staff or members of the public.

The trusts’ 2023-2024 gender pay gap report reported significant improvements for equality of pay. The median pay gap had narrowed from the previous years’ 7.65% in favour of men, to 1.4% in favour of women. However, similair to other organisations, the trust had more men in higher paid roles than women. The trust was considering further actions to help close the gap as part of their wider strategy.

Staff said there was a range of inclusion-related guidance and practice resources available to support managers and staff in applying equality, diversity and inclusion in their daily work. This included guidance on inclusive language, dignity and respect, reasonable adjustments and inclusive leadership behaviours. The trust supported staff networks, with a policy to guide on how these should function. These groups were based on protected characteristics and staff were able to join these where they had shared experiences or interest.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They mostly acted on the best information about risk, performance and outcomes, and share this securely with others when appropriate. However, data showed gaps in driving improvement in sepsis management.

Over the last 3 years, the senior leadership of the Medical Division had tried to adapt the governance processes to link in with the teams better and to ensure clinicians could attend meetings. In the past 18-months there had been 2 adaptations, from rapid half-hour meetings held weekly to the now used care group model. Each care group had a 2-hour slot once a month, going through specialities on a deep dive basis. This approach had started prior to our inspection and had seen improved clinical representation. The meetings provided an opportunity to be clinically focused and patient orientated. A set agenda included such topics as, staffing; turnover rates; policies and guidelines; audit activity and risk registers. A case study from an incident or complaint was expected to be discussed as a means of learning and improvement. Information fed into the Quarterly Governance Meeting and then to the Divisional Performance Review. Any information of note was then escalated to the Board.

Performance Review Meetings provided the opportunity to review individual projects, such as those related to Cardiology and the Stroke Steering Group. We reviewed a wide selection of minutes from various governance meetings. This included for example, Cardiology Governance and Quality Meeting; Diabetes and Endocrine Business Meeting; Stroke Governance Meeting and the Department of Medicine for Older People Monthly Meeting. We noted discussion included risks; incidents; performance; complaints and audits for example. Action trackers were reviewed and completed as relevant, with a named person having assigned responsibility for the matter.

Divisional performance reviews considered information under a range of topics, such as incidents, pressure ulcers, falls, infections and deterioration. However, we could not see from the information provided to us, if there was a focus on sepsis monitoring. Further, we could not see in audits related to patient records and risk assessments any inclusion of sepsis screening. Therefore, it was not clear how closely the service was monitoring staff understanding and compliance with the expected standards of care for sepsis management.

The trust had experienced some changes within the Clinical Effectiveness Team, which had impacted on the delivery of national and internal audits. Work had been done to improve the situation, which included prioritising activities, such as the development of a data base, having a clearly defined audit programme based on priorities and clinical effectiveness workshops with divisional leads.

Policies and professional guidance related to medical areas was managed centrally. An email was sent out every month to indicate those coming up for renewal and those which were overdue. Each policy had an expert who was responsible for updating the policy and communicate those changes out to areas. The quality manager for the division held responsibility for overseeing this. We noted from information provided to us that there was focused attention on improving the oversight and strengthening policy governance and National Institute for Health and Care Excellence (NICE) guidance.

There were local audits in departments and on the wards, which were generally led by a nominated person. Information was collected and reported back on both when achieving good results or where some improvements were needed. Staff understood the arrangements for working with other teams within the hospital and as required, with external agencies to meet the needs of the patients.

There was an overarching risk register related to medical services, which had 7 entries, all of which were red rated following the traffic light principle of red being most concerning and green a low risk. Controls and gaps in control were stated, as were the actions taken. We saw there were risk registers by medical speciality, for example, the renal services. Risks registers were discussed in respective governance meetings and were updated with progress. Staff on wards and in medical service areas could raise a matter for consideration of being added to the risk register. This was usually via the electronic reporting system.

The medical services had plans for emergencies and resilience, which included how they could respond and adjust when things escalated. There was a critical incident declaration process to be followed by staff and a Business Continuity Management Policy. Business continuity incidents related to matters such as power outages and lack of bed capacity followed specific action cards. These followed a command-and-control approach, led by the internal incident team. There were escalation processes for staff to follow when the hospital was in an Operational Pressures Escalation Level (OPEL) 3 state and above. This is a high-pressure, "red alert" status in the NHS, showing the hospital or local health system is experiencing severe or major blockages which interrupt patient flow and safety. The service may not be able to meet demand, resulting in cancelling non-urgent, appointments, or redirecting resources. For medical areas it meant using escalation areas, such as the discharge lounge. The morning meeting held with senior leaders focused on how staff were feeling and to consider how escalation areas were overseen, including reviewing staffing models which accompanied escalation spaces.

The Emergency Planning and Resilience Group met monthly and discussed business continuity plans and recent incidents. If an OPEL 4 was declared, we were told discussion took place around the way they were doing things, the ‘Your Next Patient Protocol’, and working together.

Staff had access to the equipment and some information technology needed to do their work. They did not have electronic patient records but used a mixture of paper documents and electronic for medicines and some assessments. Staff were guided by the principles of safe and secure records and keeping information confidential.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders, such as commissioners and Healthwatch. Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

Several examples of the areas of wider community work were shared with us. This included the Dietetic service represented Dorset County Hospital at a Diabetes UK conference, where they presented a poster on improving engagement with young adults within a diabetes service. The trust participated in the South West Cardiovascular, Respiratory and Diabetes Clinical Network. We saw information on 2 learning events on the Future Models of Care programme. These quality improvement events brought together several stakeholders to discuss how they could deliver acute services in the future, to meet patient needs, ensure quality and safety and sustainability. The sessions had included a patient story and a focus on what good looks like and a model for improvement. The Dorset Respiratory Network involved external partners and took a joined-up approach to improve respiratory outcomes for the local and wider population. Asthma mortality information provided to us showed a consistent reduction in this area. We saw too the trust also had the lowest rate of chronic obstructive pulmonary disease (COPD) admissions in Dorset. Chronic obstructive pulmonary disease is a group of lung conditions which cause breathing difficulties.

The trust had a Health and Wellbeing, Information, Volunteering and Engagement Hub (HIVE). This was a community involvement hub, which provided a space for patients and families to provide feedback about their experience, raise any concerns, and be signposted to various support services available in Dorset. Additionally, the trust had held its first Conversation Café, where members of the profoundly deaf community were invited to attend to share their experiences and listen to staff representatives. This was supported by British Sign Language interpreters.

The trust had various areas of social values work. This had included engaging a creative health specialist who had been working with patients with dementia and their families to improve their wellbeing. This included recruiting and training volunteer creative health ambassadors and providing skills training and wellbeing benefits for members of the wider community.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. On Mary Anning Ward there had been a quality improvement project on ‘Hearing Staff voices. The aim of this was to improve patient care and the ward culture. By listening to staff and the use of different strategies, they were able to identify the changes to be made to develop patient-focused care practices. We saw information on the resulting actions taken, which included for example, reorganisation of the teams and how the workload was shared on the ward, improved communication and access to additional training. An example of learning related to pressure ulcer injury was shared with us. This showed actions had been identified related to increased training of staff and better skin assessments. We noted the Tissue Viability Group had also talked about a range of learning points from pressure ulcer incidents. Other examples of learning from various incidents were shared with us by ward area. These were detailed and clearly stated timelines and progress made.

We were provided with examples of research work taking place within the medical services. This included in the areas of respiratory medicine, for obstructive sleep apnoea; lung cancer and reducing pressure ulcers using a new medical device. There were formal consent processes for any research involving patients, and monitoring was done externally for some research activities.