Musgrove Park Hospital

On this page

• 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a clear vision and a set of values including quality and sustainability. There was a realistic strategy for achieving the priorities and delivering good quality sustainable care. Staff knew and understood what the vision, values and strategy were, and their role in achieving them.  

Somerset CAMHS and Paediatric services aimed to work together to create an integrated and inclusive paediatric service that delivered holistic care. Long term strategic aims for the service included improvements to the workforce numbers, workforce well-being, environment, patient pathways and joined governance across the hospitals. There was a direction and vision for the service. 

Staff felt supported, respected and valued, and were positive and proud to work in the service. There were cooperative, supportive and appreciative relationships among staff. It was clear their work was important to them, and they felt passionate about their contribution to care and were committed to improving the health of children and young people. 

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. They understood and managed the priorities and issues the service faced. Staff told us the leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. Leaders understood the challenges to quality and sustainability and could identify the actions needed to address them. 

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff were aware they could raise concerns about patient care and safety with the Freedom to Speak Up Guardians. Most staff said they were encouraged to speak up and felt comfortable about raising any concerns. They felt listened to and encouraged to make suggestions. The Freedom to Speak Up Guardians exercise their duties trust-wide, including Community Services. Their roles are proactive and reactive. 

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. 

The service promoted equality and diversity in daily work and provided opportunities for career development. 

The service demonstrated clear responsibilities, defined roles, robust accountability systems, and sound governance. These elements facilitated the management and delivery of high-quality, sustainable care, treatment, and support. Staff utilised current information regarding risk, performance, and outcomes, sharing it securely when appropriate. Leaders implemented effective governance processes across the service. Staff at all levels understood their roles and accountabilities and engaged in regular opportunities to discuss and learn from service performance. Effective structures, processes, and accountability systems supported the delivery of the strategy and sustainable, high-quality services. These were subject to regular review and improvement. All levels of governance and management functioned effectively and interacted cohesively. 

However, the service had recently introduced the National Paediatric Early Warning System (PEWS) in electronic form. The most recent audit of PEWS data revealed that observations and paediatric early warning scores were not consistently performed according to national guidance. The trust's 'Patient Deterioration Audit' from December 2024 indicated that 33% of records lacked admission observations, and 70% of all observations were late or missing.  

The trust completed a review of this audit results and developed appropriate actions to address the shortfalls to drive improvement in this area. 

In addition, a deteriorating child protocol had been devised but not yet ratified: “Observation and National Paediatric Early Warning System (nPEWS) Escalation – Recognition and Response to the Paediatric Deteriorating Patient”. The guidance provided best practice around escalation and management of critically ill children. The trust had plans to implement this protocol at Musgrove Park Hospital. 

Digital Board Minutes documented the decision to pilot PEWS at Musgrove Park Hospital before wider implementation to the Yeovil site. The Musgrove Park Hospital NEWS Protocol, currently in use across both sites pending final approval, followed testing as part of a quality improvement initiative. The trust reported that measures were being taken to fully embed the Musgrove Park Hospital’s 'Deteriorating Child Protocol' across the organisation. This included the implementation of guidance reflecting best practice in 'escalation and management of critically ill children from child health to critical care', and a focused review of all high dependency cases to ensure adherence to intended practice and process.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff shared information and learning with partners and collaborated for improvement. 

There was an onsite CAMHS liaison team which provided weekend support and were included in handovers. The CAMHS team had worked closely with the local authority and children and young people, to change the patient pre-admission pathway. The service partnered with the local council and an employment charity to create a new service development for looked after children. 

Children requiring urgent care could attend the PAU service directly during open hours, avoiding attendance to the emergency department. Ambulance services were aware of this arrangement and regularly brought patients that met the criteria to be assessed at the Paediatric Assessment Unit which avoided the attendance of children and young people to the adult’s emergency department. 

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research. Leaders and staff aspired to continuous learning, improvement and innovation. This included participation in research projects such as “Early oral antibiotics in infants with UTI” and the “Interesting case learning database”. There were standardised improvement tools and methods, and staff had the skills to use them. Learning from internal and external reviews was effective and included those related to mortality or death of a person using the service. Staff regularly took time out to work together to review individual and team objectives, processes and performance which lead to improvements and innovation. There were systems to support improvement and innovation work, including objectives and rewards for staff, data systems, and processes for evaluating and sharing the results of improvement work.