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We are carrying out checks at Poole Hospital using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 6 Sept to 12 Oct 2017

During a routine inspection

Our rating of services improved. We rated it them as good because:

  • Effective, caring, responsive and well-led care were good. The trust had a good track record in delivering effective, caring and well led care and had made significant improvements in the responsiveness of services we inspected. Although some aspects of safety across the trust have improved since our 2016 inspection, there were still concerns about safety within the three services we inspected.
  • Surgery was good when we inspected in January 2016. However, we have rated as requiring improvement following this inspection as there were new concerns about the safety and leadership of the service since our previous inspection.
  • Critical care was found to be providing effective, caring, responsive and well led care. Caring within this service was found to be good rather than outstanding as it had previously been rated following the previous inspection in January 2016.
  • Overall, services for children and young people had improved which is reflected in their rating which has moved from requires improvement to good. Caring had improved from good to outstanding and responsive, well led and safety from requires improvement to good. Effective remained good.

Are services safe?

Our rating of safe stayed the same. We rated it as requires improvement because:

  • During our previous inspection in 2016, we found that safety was not given sufficient priority across the trust. Since our previous inspection, this position appeared unchanged. We rated safety as requiring improvement in surgery and critical care though it was assessed as good in services for children and young people.
  • Medicines were not always managed safely in surgery and critical care. Medicines were not always stored securely, some medicines could be accessed by non-clinical staff and there was there was variation in safety checks of controlled drugs in surgical services.
  • There was no dedicated pharmacist in critical care and medicines reconciliation was not routinely taking place.
  • There were insufficient numbers of staff with the right qualifications, skills, training and experience to keep people safe and provide the right care and treatment in surgical services.
  • Infection prevention and control was not robust in some areas and some equipment and premises were not sufficiently clean. There was no assurance process for daily clinical cleaning in surgical services.
  • In surgery, staff did not always use the results of safety monitoring well to improve patient care.
  • Whilst incidents were reported, investigated and learning was shared, the number and frequency of surgical never events did not demonstrate that sufficient organisational learning had taken place.
  • The records of patients care and treatment did not always contain updated safety risk assessments and appropriate individualised care plans. Up to date records were therefore not always available to all staff providing care when needed.
  • Premises were not all in good order and there were considerable maintenance issues waiting to be addressed in the surgical service.

Are services effective?

Our rating of effective stayed the same. We rated it as good because:

  • We rated effective as good in surgery, critical care and services for children and young people.
  • Patients received care and treatment in line with national guidance including those from royal colleges. Policies and practice procedures had been developed and were based on guidance and were reviewed. Care bundles were embedded in practice which supported the care of very unwell patients in critical care.
  • Staff from different departments and disciplines worked together as a team for the benefit of patients. Hospital staff also worked well with those in the community to make sure patients continued to be cared for.
  • With the exception of adult nurses providing direct care to children and young people, staff were competent in their roles. Patients received care from staff that were suitably skilled, trained and proficient.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients who lacked the capacity to make decisions about their care.
  • Patients’ pain was assessed, treated and reviewed effectively.

Are services caring?

Our rating of caring stayed the same. We rated it as good because:

  • We rated caring as good in surgical and critical care services. We found caring had improved to be outstanding in services for children and young people.
  • Patients were treated with care and compassion. Patients and their relatives were complimentary about the care and treatment they received.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff offered emotional support to patients and their relatives. Where appropriate, staff could refer patients and their relatives experiencing stress and anxiety to additional services and/or support groups.
  • End of life care for children provided at Gully’s place was exceptional. Staff were compassionate to families’ needs and went above and beyond to grant children’s last wishes.

Are services responsive?

Our rating of responsive had improved from requiring improvement to good. We rated it as good because:

  • The trust, in conjunction with system partners, made efforts to plan services in a way that mostly allowed patients to receive the care they needed in the right place at the right time. It was of note that the trust continued to do this whilst awaiting the results of the Dorset wide clinical services review, ensuring that patient’s care was not adversely affected whilst this was underway.
  • Complaints were responded to in an increasingly timely manner and findings used to improve care.
  • There had been significant improvements to the critical care environment to ensure that patients had access to adequate bathroom facilities. This meant that patients who were able to could tend to their personal care needs without needing to leave the ward which had not been the case previously.
  • The trust had appropriate arrangements in place to identify and plan care for patients with a learning disability and individuals living with dementia or other mental health conditions.
  • Where the trust struggled to deliver services within accepted timeframes, or in line with national guidance, action was taken to ensure the risks to patients were minimised.

Are services well-led?

Our rating of well-led stayed the same. We rated it as good because:

  • We rated the leadership as good for critical care and services for children and young people. Previously, in 2016, leadership of the children and young people’s service was rated as requiring improvement and we saw clear evidence of improvement in this area. We rated leadership of surgical services as requiring improvement.
  • Managers within critical care and services for children and young people demonstrated the right skills and abilities to run a service providing high quality sustainable care.
  • Managers promoted a positive culture that supported and valued staff creating a sense of common purpose based on shared values.
  • Managers led their staff using appropriate knowledge, skills and experience to provide high quality care. They provided support and training to all staff to enable them to provide good services.
  • The three services we inspected engaged well with patients, staff, and the public and local organisations to plan and manage appropriate services.
  • Critical care and children and young people’s service leads had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, in surgery they had not demonstrated sufficient pace in addressing concerns previously raised following our inspection in 2016. A series of never events also showed that organisational learning was not robust in preventing reoccurrence.

Inspection carried out on 26 - 28 January and 8-10 February 2016

During a routine inspection

Our rating of services improved. We rated it them as good because:

  • Effective, caring, responsive and well-led care were good. The trust had a good track record in delivering effective, caring and well led care and had made significant improvements in the responsiveness of services we inspected. Although some aspects of safety across the trust have improved since our 2016 inspection, there were still concerns about safety within the three services we inspected.
  • Surgery was good when we inspected in January 2016. However, we have rated as requiring improvement following this inspection as there were new concerns about the safety and leadership of the service since our previous inspection.
  • Critical care was found to be providing effective, caring, responsive and well led care. Caring within this service was found to be good rather than outstanding as it had previously been rated following the previous inspection in January 2016.
  • Overall, services for children and young people had improved which is reflected in their rating which has moved from requires improvement to good. Caring had improved from good to outstanding and responsive, well led and safety from requires improvement to good. Effective remained good.

Are services safe?

Our rating of safe stayed the same. We rated it as requires improvement because:

  • During our previous inspection in 2016, we found that safety was not given sufficient priority across the trust. Since our previous inspection, this position appeared unchanged. We rated safety as requiring improvement in surgery and critical care though it was assessed as good in services for children and young people.
  • Medicines were not always managed safely in surgery and critical care. Medicines were not always stored securely, some medicines could be accessed by non-clinical staff and there was there was variation in safety checks of controlled drugs in surgical services.
  • There was no dedicated pharmacist in critical care and medicines reconciliation was not routinely taking place.
  • There were insufficient numbers of staff with the right qualifications, skills, training and experience to keep people safe and provide the right care and treatment in surgical services.
  • Infection prevention and control was not robust in some areas and some equipment and premises were not sufficiently clean. There was no assurance process for daily clinical cleaning in surgical services.
  • In surgery, staff did not always use the results of safety monitoring well to improve patient care.
  • Whilst incidents were reported, investigated and learning was shared, the number and frequency of surgical never events did not demonstrate that sufficient organisational learning had taken place.
  • The records of patients care and treatment did not always contain updated safety risk assessments and appropriate individualised care plans. Up to date records were therefore not always available to all staff providing care when needed.
  • Premises were not all in good order and there were considerable maintenance issues waiting to be addressed in the surgical service.

Are services effective?

Our rating of effective stayed the same. We rated it as good because:

  • We rated effective as good in surgery, critical care and services for children and young people.
  • Patients received care and treatment in line with national guidance including those from royal colleges. Policies and practice procedures had been developed and were based on guidance and were reviewed. Care bundles were embedded in practice which supported the care of very unwell patients in critical care.
  • Staff from different departments and disciplines worked together as a team for the benefit of patients. Hospital staff also worked well with those in the community to make sure patients continued to be cared for.
  • With the exception of adult nurses providing direct care to children and young people, staff were competent in their roles. Patients received care from staff that were suitably skilled, trained and proficient.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients who lacked the capacity to make decisions about their care.
  • Patients’ pain was assessed, treated and reviewed effectively.

Are services caring?

Our rating of caring stayed the same. We rated it as good because:

  • We rated caring as good in surgical and critical care services. We found caring had improved to be outstanding in services for children and young people.
  • Patients were treated with care and compassion. Patients and their relatives were complimentary about the care and treatment they received.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff offered emotional support to patients and their relatives. Where appropriate, staff could refer patients and their relatives experiencing stress and anxiety to additional services and/or support groups.
  • End of life care for children provided at Gully’s place was exceptional. Staff were compassionate to families’ needs and went above and beyond to grant children’s last wishes.

Are services responsive?

Our rating of responsive had improved from requiring improvement to good. We rated it as good because:

  • The trust, in conjunction with system partners, made efforts to plan services in a way that mostly allowed patients to receive the care they needed in the right place at the right time. It was of note that the trust continued to do this whilst awaiting the results of the Dorset wide clinical services review, ensuring that patient’s care was not adversely affected whilst this was underway.
  • Complaints were responded to in an increasingly timely manner and findings used to improve care.
  • There had been significant improvements to the critical care environment to ensure that patients had access to adequate bathroom facilities. This meant that patients who were able to could tend to their personal care needs without needing to leave the ward which had not been the case previously.
  • The trust had appropriate arrangements in place to identify and plan care for patients with a learning disability and individuals living with dementia or other mental health conditions.
  • Where the trust struggled to deliver services within accepted timeframes, or in line with national guidance, action was taken to ensure the risks to patients were minimised.

Are services well-led?

Our rating of well-led stayed the same. We rated it as good because:

  • We rated the leadership as good for critical care and services for children and young people. Previously, in 2016, leadership of the children and young people’s service was rated as requiring improvement and we saw clear evidence of improvement in this area. We rated leadership of surgical services as requiring improvement.
  • Managers within critical care and services for children and young people demonstrated the right skills and abilities to run a service providing high quality sustainable care.
  • Managers promoted a positive culture that supported and valued staff creating a sense of common purpose based on shared values.
  • Managers led their staff using appropriate knowledge, skills and experience to provide high quality care. They provided support and training to all staff to enable them to provide good services.
  • The three services we inspected engaged well with patients, staff, and the public and local organisations to plan and manage appropriate services.
  • Critical care and children and young people’s service leads had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, in surgery they had not demonstrated sufficient pace in addressing concerns previously raised following our inspection in 2016. A series of never events also showed that organisational learning was not robust in preventing reoccurrence.

Inspection carried out on 24 January 2014

During an inspection to make sure that the improvements required had been made

This inspection was to follow up on the shortfalls in assessing and monitoring the quality of the service identified at our inspection in May 2013. In addition to this we looked at staffing in the pathology department in response to concerns received about staffing levels.

We spoke with sixteen staff this included nurses, doctors and pathology staff, the adult safeguarding nurse and department managers. We also spoke with the chief executive, director of nursing, deputy director of nursing and head of legal services. We did not speak with patients at this inspection.

We found there were enough qualified, skilled and experienced staff to meet people’s needs in the pathology department.

We found the trust had implemented learning and actions from incidents.

There was an effective system in place to regularly check and monitor the quality of the service people received. There were effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Inspection carried out on 22, 23, 24 May 2013

During a routine inspection

We carried out unannounced visits to wards and units at Poole Hospital NHS Foundation Trust between 22 and 24 May 2013. Over the three days we inspected: Maternity at St Mary’s, community midwifery, main and day case theatres, NICU (Neonatal Intensive Care Unit), TCU (Transitional Care Unit), Acrewood and Bearwood (children’s wards), Sandbanks (oncology), B3( orthopaedics), C3 Green (trauma), A4 Arne (respiratory), A & E (accident and emergency), Discharge Lounge and Lytchett (elderly medicine).

When visiting wards and units we spoke with 32 patients, seven visiting relatives and 41 members of medical, nursing, auxiliary staff and equipment managers. We observed interactions between staff and patients including babies and children.

We also met with two representatives of the Council of Governors, the medical director, director and deputy director of nursing, the director and deputy director maternity and midwifery and ten consultants.

All patients we spoke with were positive about their experiences at the hospital. Comments from patients included, “Couldn’t wish for better”, “Hospital gets flying colours”, “It’s been very good actually” and “I think it’s a very good hospital”.

We found that patients consent was sought before they received any care or treatment. They also received the care, treatment and support to meet their individual needs.

Inspection carried out on 5 December 2012

During an inspection to make sure that the improvements required had been made

The purpose of this inspection was to check whether people and or their representative’s views were taken into account in relation to Do Not Attempt Resuscitation (DNAR) decisions.

We visited C3 Trauma Green, Lulworth ward, Lilliput ward, Rockley ward and Brownsea ward. We spoke with nursing and medical staff, the deputy director of nursing and the senior resuscitation nurse.

We did not specifically speak with people about their stay at the hospital. However, we observed that people being treated and cared for at the hospital were comfortable

We had received concerns about the building works and staffing levels on C3 Trauma Green. We requested staffing information from the trust and we did not identify any concerns from the information provided. There was an ongoing programme of refurbishment on C3 and the disruption to patients and staff was minimised wherever possible.

We found that overall Do Not Attempt Resuscitation (DNAR) decisions and records were fully completed. They included a record of the discussion with people and or their representatives where relevant.

Inspection carried out on 4 July 2012

During an inspection to make sure that the improvements required had been made

We carried out unannounced visits to wards at Poole Hospital NHS Foundation Trust between 2 July 2012 and 4 July 2012. Over the three days we inspected: Rockley ward, Brownsea ward, C3 Trauma, Accident and Emergency, Ansty, Acrewood and Bearwood children's wards, B2 ENT and women's health ward, Durlston ward and Lulworth ward.

When visiting wards and units we spoke with patients, some visiting relatives and members of medical, nursing and auxiliary staff. We also reviewed written records relating to people's care. On one ward, we used the Short observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We also spoke with the hospital lead for adults safeguarding, the director and assistant director of nursing.

We requested and received information from the hospital about how they were complying with the areas we inspected.

We received good feedback from people and their visitors. We were told that people were fully informed about their treatment options and were involved when there were choices about their treatment.

All of the people said that the staff were courteous, caring and respectful of their privacy and dignity.

All the people we spoke to who were able to tell us about their stay in hospital were happy with their care and treatment. One person said, “I’m really pleased with how they have looked after me”, another said “It’s been good in here, the staff are lovely”, and a relative said, “We’ve been very happy with the treatment on each occasion Mum has been in, staff are very friendly and kept us informed”.

At our last inspection in November 2011 we found shortfalls in completion of Do Not Attempt Resuscitation (DNAR) forms as they did not include evidence of patients or their representatives' involvement. We found on most wards that completion of these records had improved. However, there were shortfalls in most of the forms on one ward. This meant that these important decisions about whether those individuals should be resuscitated had not been fully considered as the trust policy dictates.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 23 November 2011

During a routine inspection

We carried out unannounced visits to wards and units at Poole Hospital NHS Foundation Trust between 21 and 23 November 2011. Over the three days we inspected: Rockley ward, Brownsea ward, C3 trauma admissions unit, A3 Ashley ward, Accident and Emergency, Ansty, St Mary’s maternity unit post natal ward and TCU (Transitional Care Unit), Acrewood and Bearwood children’s wards, B2 ENT and women’s health ward, Durlston ward, Lulworth ward and Forest Holme (palliative care unit).

In April 2011 we carried out a review of maternity services at Poole Hospital. As a result of that inspection an improvement action was made in relation to maintaining appropriate staffing levels. This improvement action has been followed up as part of the visit to Poole Hospital.

When visiting wards and units we spoke with patients, some visiting relatives and members of medical, nursing and auxiliary staff. We also reviewed written records relating to people's care. On one ward, where patients were not able to tell us about their experiences, we used a formal observational tool to help us gain an understanding of how the needs of people were being met.

We also spoke with the hospital leads for adults and children’s safeguarding, three members of the council of governors, the director and deputy director of nursing and the head and deputy head of maternity and midwifery.

We requested and received information from the hospital about how they were complying with the outcome areas we inspected.

Overall, we received good feedback from people and their visitors. We were told that people were fully informed about their treatment options and were involved when there were choices about their treatment. The majority of people said that the staff were courteous, caring and respectful of their privacy and dignity. In the main this was supported by the observations we made, apart from some isolated incidents where people were not treated as individuals and their dignity was not maintained.

People were happy about the care, treatment and support they received and how they were involved in their discharge arrangements. We found that on four out of the fourteen wards visited there were some shortfalls in the assessments, records and for a small minority of people the care and support provided on these wards could have been improved.

Inspection carried out on 4 April 2011 and 5 April 2012

During an inspection in response to concerns

We spoke with eight people and visiting relatives/partners on the antenatal and postnatal wards during our visit.

Overall, people told us that they were happy with the care and support they had received during their experience. Comments from people included, ‘Fantastic’, ‘virtually faultless’, ‘They were brilliant; they let me know everything that they were doing’ and ‘very very good’.

People spoken with were satisfied with the staffing levels and staff availability during their experience in hospital. Some people said that throughout their pregnancy they did not always see the same midwife, doctor or consultant and for a majority of them this was not a concern.

People told us, ‘there were enough staff on all the shifts’, ‘the staff were amazing’, ‘always enough staff’ and ‘there was always somebody there’.