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 good. At this assessment the rating has remained good. 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.

Staff and leaders in the ED were highly motivated and passionate about improving urgent and emergency care services at this trust. Every member of staff we spoke with understood how their individual contributions and involvement were important for the smooth running of the ED, effective improvements to the service and development of additional tailored services. Despite the challenges of continuing to deliver good quality emergency care in environments no longer fit for modern healthcare needs, ED staff remained confident in their leaders’ decisions and vision for their department.

The wider hospital worked closely with ED leadership to align service delivery to national urgent and emergency care policy expectations. The overarching 3 year ED strategy set out the trusts’ ambitions for equitable emergency care with key focus on integrating ED services with community, mental health and local partners. This strategy was well aligned with parallel strategies, including a recovery plan and forward improvement plans. The major funding packet provided by the New Hospitals Programme (NHP) and hospital fundraising teams provided the means for the trust and ED to deliver on this strategy.

The major improvement project in progress for the redesign and overhaul of ED services brought together all essential people required to make the right decisions at the right time. This involved complex project management with several overlapping progress points as part of the 3year plan for ED services. This included the overhaul of SDEC services, successive emergency services footprint moves to enable continued service delivery whilst building work was in progress and expansion of services and pathways such as the Acute Assessment Unit and Urgent Treatment centre. Project decisions involved engagement with internal and external stakeholders early in the process and showed ED leaders had a comprehensive understanding of the healthcare systems they worked in partnership with and the people who used their services.

Strategies for anticipating and responding to immediate short term improvement challenges while the mid and long term project was unfolding were practical and made best use of available resource. There was significant focus on developing a skilled, well supported, sustainable workforce to match the yearly increase in ED attendances. ED leaders recognised the need to build a resilient workforce and were negotiating increased numbers of both medical and nursing staff.

ED recovery plans showed the service was on track to deliver on planned actions, notably achieving improvement in ambulance handover times. Although some performance targets had not yet been achieved, ED leaders understood how to achieve this. Hospital wide joint working understood the need to relieve pressure on the ED by ensuring more appropriate local services took over care and treatment, addressing some of the social determinants of health. This included targeted processes such as escalation protocols for local teams and system partners to provide support when the ED ‘queue in’ was under pressure and admission avoidance for specific patient groups.

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.

The ED service was led by a triumvirate structure covering medical, nursing and operational leads. ED Leaders had the right skills, knowledge and experience to perform their roles. They encouraged staff to professionally develop and provided a supportive and positive environment for this to occur in. There were development opportunities available for all staff, whether they were advanced clinical practitioners (ACP), medical or nursing staff. The ED department and an ED ACP won awards at the trust annual apprenticeship awards for exceptional mentor of the year and apprentice of the year award.

ED leaders shared examples where training opportunities such as a master's in healthcare and management or internal trust leadership programmes supported staff to obtain triumvirate and executive leadership roles. All locally employed doctors (LEDs) were provided with access to yearly funds for additional courses and training. Resident doctors said they received weekly additional training, and staffing rotas had been adjusted by consultants to support and encourage attendance. International medical graduates were offered an additional training programme to familiarise staff with NHS practices. Nursing staff development resources were mainly focused on band 5 opportunities with a structured development programme to develop leadership skills in clinical teams. However, there were less opportunities for band 7 development resources as most senior band 7s had taken part in external leadership programmes between 2018 and 2021.

Nonclinical staff were also provided training opportunities such as business administration and chartered manager degree apprenticeships.

Management development programmes included topics such as quality improvement, risk management, people and team development and finance. Some of the core skills and considerations included equity related training such as neurodivergence, psychological safety and inclusion.

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.

The ED service had a well-established freedom to speak up (FTSU) service. Staff understood how to access this service, although many said they had not needed to. There were 3 FTSU champions appointed in ED and 1 in SDEC to support and encourage speaking up.

In 2025, there were 20 FTSU concerns raised by staff across ED and SDEC. Most of these were related to incivility or poor communication. There were several actions taken by ED leaders to address this, including staff empowerment training, increased visibility and discussion of these concerns within teams and additional engagement sessions to provide staff with the opportunity to raise concerns directly with the department.

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 in place 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. Black or Minority Ethnic 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, similar 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 care and treatment. They mostly acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. However, the service faced significant longstanding and evolving challenges while long term solutions were unlikely to bring significant improvement to service sustainability until completion in 2027.

Governance structures and the reporting processes supporting these mostly worked well to escalate risk up to the senior leadership team and filter back to Emergency Department staff. Emergency Department clinical governance meeting minutes showed contributions from specialty and systems meetings, and quality and safety groups reflected all areas of clinical governance. These meetings were well attended by a range of different staff roles and grades, including staff from other hospital teams such as the FTSU guardian.

Emergency Department leaders maintained accountability for standards amongst the comprehensive improvement works in progress, for example around Sepsis 6. Meeting minutes showed risks such as crowding and mental health bed delays were discussed in detail, including management plans, mitigating actions and escalation to senior leaders. Emergency Department leaders recognised the success of their team members, highlighting staff who had received compliments from patients and colleagues.

The service was developing new ways of running clinical governance meetings to improve reporting against their regulatory responsibilities. Staff were invited to take part in the consultation to develop the new meeting structure.

Risks identified at ED clinical governance meetings were accurately reflected in the risk register. Further to the risks above, hospital flow, staffing and regional service redesign were also rated at the highest level of risk. The longest standing risk areas were staffing and hospital flow from 2022, and the risk score remained unchanged for all but one risk area. This showed the service remained highly vulnerable to the many growing complex local and regional pressures despite hospital wide and system partner efforts to mitigate these. ED leaders repeatedly escalated these concerns to senior leaders, but significant improvements to service sustainability were reliant on the completion of the new and redesigned ED infrastructures, the associated improved patient pathways dependant on this and additional staffing the service needed to work effectively.

However, some areas where we identified risks, had not always been progressed well. For example, a quality improvement project in ED triage commenced in June 2025, but during our inspection in January 2026, we identified ongoing concerns around the clinical oversight of the walk in ED waiting room. Also, due to some open ended improvement actions, there was limited assurance that only suitably trained and senior staff were making DNACPR decisions.

The service had plans for a full range of business continuity incidents, including infectious disease outbreaks and chemical, biological, radiation and nuclear (CBRN) incidents. Staff and leaders had access to a suite of policies and action cards designed to support the hospitals’ continued function, if this occurred.

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 used a range of digital and paper record systems essential for daily working. This included some patient assessments, electronic patient record systems and medicines records. Staff were guided by the principles of safe and secure records and usually kept information confidential.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders, such as advocacy groups and community services providers ensuring the improvements they made could lead to better outcomes for people. Patients and staff could meet with members of the senior leadership team to give feedback. The NHP project invited early collaboration from external stakeholders and the communities they served. Since stakeholder engagement began in July 2025, the service shared updates with the local ambulance service, commissioners, media teams and system partner publications. Patient representative volunteers from the community were recruited to and involved in the design working groups and project meetings. ED leaders listened to people with lived experiences, such as those from local disability groups, using their insight to improve designs for the ED refurbishment.

The service worked well with local and regional partners to monitor, analyse and interpret which patients were the most likely to attend or require admission, enabling patients to access informal and formal services closer to home with community agencies available to support health and wellbeing. ED staff led on the high intensity users (HIU) work and collaborated with local primary care and mental health service providers to prevent unnecessary ED attendances. Staff said learning had been shared from neighbouring health and care commissioners who already had HIU processes which worked well. ED leaders were aware the main demographic were day attendances with the police department and an emerging risk group of vulnerable patients with frailty.

ED leaders recognised partnership working was a key area to improving patient experience and outcomes. Other notable projects in 2025 included the GP consultant connect service and ambulance handover improvements.

Local GP services had raised concerns that the referral service was not working well but improvements to the service saw the referral process improve from an average of 10 minutes to slightly over 3 minutes. ED leaders met with GPs and codesigned the new specialty referral service which was implemented from September 2025. Additional specialty phone lines were introduced and once a referral was accepted, patients were directly booked into ED or SDEC. This also included a direct line for arranging transport if needed. This process was expected to be rolled out with other external stakeholders such as local prisons, urgent treatment centres and minor injuries units.

The service worked with ambulance services to improve handovers and improve data quality. This included doing ‘perfect weeks’ where the ambulance service provided specialist staff to support both ED staff and their own staff with improving handovers. Perfect handover weeks are a targeted NHS initiative designed to significantly reduce or eliminate ambulance delays at hospital ED's. During the onsite inspection, ED staff and ambulance service paramedics said that handover times had significantly improved, despite the year-on-year increased level of activity during the busy winter period.

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.

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. Meeting records showed ED leaders encouraged multidisciplinary team service and quality improvement discussion, with representatives from different staffing groups reporting on initiatives such as wristband compliance, pain relief for neck of femur patients and a retrospective study on ketamine associated urinary tract infections.

Innovations were led by frontline staff who were passionate about improving the quality of care and improving patient outcomes. ED leaders were proud of the improvements and initiatives introduced by staff. This included a bleeding socket management pathway due to observed clinical need, a left without being seen (LWSB) safeguarding protocol for formal safety netting processes focused on children and young people, streamlined xray access, transfer team redesigns, triage efficiency initiatives, controlled drugs safety improvements and blood transfusion safety work.

Staff had opportunities to participate in research and participated in national audits relevant to the service and learned from them. At the time of the inspection, there were 2 research studies in progress. Staff from the ED service were involved with the CRASH-4 trial and TICH-3 study, contributing to national research projects. This encouraged staff to participate in research, audit record keeping and structured education.

Staff used quality improvement methods and knew how to apply them. Between 2021-2024, staff introduced a service improvement project for improving child safeguarding processes using the concern, witness, incident, location, time, escort and demeanour (CWILTED) tool. This tool was designed to improve the quality of safeguarding documentation for children and young people attending the ED. Following the quality improvement cycle and impact evaluation in January 2025, the ED service found significant improvements in safeguarding documentation across all CWILTED domains. The study was of good quality as it passed quality assurance processes of external double blind peer review and had been formally published. The findings of this study were shared internally within the trust and across regional forums.

ED morbidity and mortality meetings were attended by medical, nursing, allied health professional staff of all grades and management representatives. Staff were encouraged to identify cases for review, to support learning from deaths. Staff and leaders reviewed care and treatment records, for patients who had passed away in ED or within 30 days of discharge from ED. Meeting minutes showed effective cross divisional and cross committee sharing of learning, such as the palliative care team. PSII records showed the service investigated deaths well and had taken learning from these to update policies and procedures, in line with national guidelines and standards.

The ED service was selected as a pilot site for introducing Martha’s rule in ED environments which began in October 2025. As part of this, we observed posters and leaflets in the ED environment. Staff we spoke with were aware of this initiative and were able to describe how this pathway worked.