Yeovil District Hospital

Updated 27 June 2025

Date of assessment: 13 January to 11 February 2025. 

Yeovil District Hospital provides a range of NHS hospital services. Services at Yeovil District Hospital were not previously inspected under Somerset NHS Foundation Trust. Therefore, the rating from the Children and Young People Service has not been combined with ratings of the other services from the previous inspections. See our previous reports to get a full picture of all other services at Yeovil District Hospital. The overall rating of Yeovil District Hospital is insufficient evidence to rate. This assessment looked at the Children and Young People Service due to new and emerging risk. We rated this service as Inadequate.

In our assessment of the Children and Young People service we found a lack of a strong learning culture and there was an insufficient number of medical staff. Consultant paediatricians did not consistently lead the required number of medical handovers, and not all acutely admitted children were seen by a consultant within the expected timeframe. Mandatory training compliance for paediatric life support and safeguarding was below target. The service did not always inform children about their consent rights or consistently respect these rights during care. Records indicated a lack of understanding of the Mental Capacity Act and Mental Health Act. Some staff told us they felt some rules had been imposed on them. Governance systems were not effectively addressing risks and performance issues in a timely manner. 

However, the service maintained clear and up-to-date records of children's care, stored securely and readily accessible to staff. There was 24-hour access to mental health services, and sufficient suitable equipment was available with regular safety checks. Infection risks were assessed and managed, and medicines and treatments were generally safe and met individual needs. The service routinely monitored care and participated in audits to drive improvement, effectively assessing and planning care with children and young people. There was good teamwork across different services. The service aimed to integrate with local mental health services to provide holistic care and had a clear direction with long-term strategic goals. Some staff reported feeling supported and valued.  

The service remained in breach of previous legal regulations concerning mandatory training and safeguarding, as well as new breaches related to staffing, consent, premises and good governance. 

Updated 29 October 2024

Date of assessment13 January 2025 to 11 February 2025.

We carried out this assessment as a focused responsive inspection due to new and emerging risk using the Single Assessment Framework (SAF). We assessed 3 key questions; safe, effective and well led, and have combined the scores for these areas with scores from the last inspection to give the rating. We issued a Section 29A Warning Notice under the Health and Social Care Act 2008. Our rating of this location went down. We rated it Inadequate because:

There was not a strong learning culture with a focus on learning from significant incidents. The service did not have enough medical staff.Consultant paediatricians did not lead at least 2 medical handovers every 24 hours.Not every child who was admitted to the paediatric department with an acute medical problem was seen by a consultant paediatrician within 14 hours of admission. Mandatory training compliance did not meet the trust target for safeguarding level 3. There were not sufficient staff trained in paediatric advanced life support in the hospital at all times. There was a lack of assurance of the quality of the external training, and whether those undertaking that training followed the same procedure/process in an advanced life support scenario.Children who required high dependency level care were transferred to adult intensive care if their condition deteriorated, and cared for by trained adult nurses, or supported by a paediatric nurse which depleted the nursing team on the ward.The service was not always able to control potential risks in the care environment due to an ageing estate. Child protection medical assessments were not being completed by a consultant paediatrician with child protection experience and skills.

However, staff kept clear and up to date records of children and young people's care and treatment. Records were stored securely and easily available to all staff providing care.The service had 24-hour access to mental health liaison and specialist mental health support The service had enough suitable equipment to help them to safely care for children and young people and carried out daily safety checks of specialist equipment. The risk of infection was assessed and managed. The service made sure medicines and treatments were safe and met people’s needs, capacities and preferences.

The service did not always tell children and young people about their rights around consent and did not always respect their rights when delivering care and treatment.Records showed a lack of understanding of the Mental Capacity Act, Mental Health Act, restraint and consent. Staff were not confident and lacked demonstrable legal compliance knowledge. There was a risk children and young people stayed in hospital longer than they needed to as there was not always a second consultant led handover in 24 hours to facilitate discharge planning.

However, the service routinely monitored care and treatment to improve it and participated in relevant national and local clinical audits to review its effectiveness. The service made sure children and young people’s care and treatment was effective, by assessing, reviewing and planning their health, care, wellbeing and communication needs with them. The service worked well across teams and services to support children and young people.

Governance systems were not operating effectively to ensure risk and performance issues were addressed with timely action.The issues identified in the safe key question had been recognised by the trust but agreed actions to address these issues and mitigate the risk to patients had not been timely to drive improvement in the quality and safety of the services provided. There was a level of resentment felt by some medical staff. Some staff told us the key leadership roles had been appointed and therefore felt new ways of working had been imposed upon them. There was not a culture of continuous improvement.Some staff told us they perceived a culture of individual blame. There was no clear oversight of paediatric life support training compliance overall asthe trust did not have a system to record external training. This was something the trust was working on.

However, the service aimed to work together with the localchildren and adolescence mental health service to create an integrated and inclusive paediatric service that delivered holistic care.There was a direction and vision for the service, with long term strategic aims.Some staff felt supported, respected and valued, and were positive and proud to work in the service.

The service was previously in breach of the legal regulations in relation to mandatory training and safeguarding service users from abuse and improper treatment. Improvements were not found at this assessment, and the service remained in breach of these regulations.

The service was also in breach of the legal regulations in relation to, staffing, need for consent, premises and equipment and good governance.

In instances where CQC has decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been included.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 8 May 2019

Our rating of this service improved. We rated it as good because:

• We rated safe as requires improvement and effective, caring, responsive and well-led as good. Overall, we rated the service as good.
• The effectiveness of the service continued to be good. People received care and treatment that reflected current evidence-based guidance and achieved good outcomes. Performance in national audits met national standards most of the time.
• The care provided by staff continued to be good. People were supported, treated with dignity and respect, and were involved as partners in their care.
• The responsiveness of the service had improved. There were innovative services to meet the needs of the population. Staff cared for patients with additional needs well and care for patients living with dementia had improved.
• The management of the service had improved. We found the leadership, governance and culture supported the delivery of high-quality care. There were clear governance processes from ward level up to the trust board. The trust worked well with the local authority and external providers to deliver high quality services. Staff were engaged with quality improvement projects.

However:

• Systems and processes to keep people safe were not always followed in relation to the risk assessments for patients, responding to deteriorating patients and the quality of nursing records. Records were not always up-to-date in a way that kept people safe.
• Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Staff did not always follow the trust policy and procedures when a patient needed a mental capacity assessment.

Updated 27 July 2016

The overall rating for the critical care services was good.

We rated the safety of critical care as good. Patient safety was given sufficient priority. An effective system was in place for the reporting and investigation of incidents, and this had led to improvements in the delivery of patient care and outcomes. There was sufficient equipment for the delivery of patient care and the environment was clean.

The unit had nursing and medical staff vacancies and recruitment was a challenge. Additional intensive care consultants were needed to enable the care of all patients on the critical care unit to be led and managed by an intensive care consultant at all times.

Senior nurses supported the critical care outreach service on a rotational basis which provided a good development opportunity but also impacted on the number experienced staff on the unit. Senior staff continually monitored staffing levels to ensure patient safety was maintained. The outreach service assisted in the early recognition of patients who were at risk of deterioration throughout the hospital and the follow up of patients who had been discharged from critical care.

We rated the effectiveness of critical care as good. Patients received evidenced based care that was based on comprehensive patient assessments and regular evaluation. Patient outcomes were monitored and were good.

Despite not having a dedicated clinical educator staff overall were supported in their personal development and training. Access to the critical care post registration qualification however was limited to two staff per year and less than 50% of the nurses currently held this critical care qualification as required by the Core Standards for Intensive Care. Although the multidisciplinary team (MDT) was an integral part of the patient care, a daily MDT ward round involving all members of the team did not take place.

We rated caring on the unit as good. Patient and relative feedback was very positive and care was patient centred. Staff understood the impact critical illness had on both patients and their relatives and this was reflected in the care that was delivered and how it was delivered. Patient diaries were well managed and assisted patients to recover and relatives to feel supported following a period of critical illness.

We rated the responsiveness of critical care as good. Critical care was delivered in a way that met the individual needs of critically ill patients. Patients were not always discharged from the unit within four hours of the decision being made to discharge them or before 10pm. Whilst this was not in line with the Core Standard for Intensive Care requirements, the timeliness of discharging patients was influenced by the availability of beds within the hospital. This was not in the direct control of the critical care unit. There was no evidence to suggest that bed availability was leading to non-clinical transfers of critically ill patients to other hospitals however elective operations had been cancelled due to critical care beds being available. Patients were offered the appropriate support with their rehabilitation following a critical illness, and a clear rehabilitation pathway was in place which included a follow up clinic visit.

Senior nursing staff were visible and accessible to patients, visitors and staff. The senior sister provided clear and professional leadership. There was an open and honest culture and staff were passionate about patient care. The senior leadership team were clear in their objective of wanting to meet the Core Standards for Intensive Care and have a closed unit model of care; with care being led by a consultant in intensive care medicine. At present any consultant can admit a patient to the unit without review by an intensivist. They were actively recruiting medical staff to enable this objective to be met.

Updated 8 May 2019

Our rating of this service improved. We rated it as good because:

We rated effective, caring, responsive and well-led as good and safe as requires improvement.

• There were some concerns about infection prevention and control in the ageing mortuary estate, and the completion of risk assessments and documentation of decisions about resuscitation. However, the specialist palliative care team responded well to changes in patients’ conditions.
• End of life care was delivered in line with national guidance. There were systems to monitor performance and there was good multidisciplinary care and support for the benefit of the patient. However, there was an inconsistent approach and documentation to support patients’ mental capacity assessments.
• Care for patients approaching the end of their life was provided with compassion and respect. Staff sought to involve patients’ next of kin. The bereavement service and chaplaincy services continued to support relatives after the death of a loved one.
• The specialist palliative care team were responsive and reviewed referrals promptly, although they were only available during the week in normal working hours.
• Leadership and governance processes had strengthened since our last inspection. The service had a vision and a strategy to achieve this. However, processes to identify risks and incidents relating to end of life care needed to be improved. The governance processes did not have sufficient structure.

Updated 10 May 2024

Updated 27 July 2016

We rated outpatients and diagnostic services (OPD) at Yeovil District Hospital as good overall.

Systems were in place for keeping people safe. Staff were aware of how to report incidents, safeguarding issues and the Duty of Candour process. Risks to patients using the service were assessed and appropriately managed.

Consent to care and treatment was obtained in line with legislation and guidance. Staff were suitably qualified and skilled to carry out their roles effectively. Staff described a good learning environment, with good role progression.

We saw good examples of the service being redesigned and improvements made to meet the needs of the patients.

Patients spoke positively of staff that they encountered, and the care they received. Staff were observed to be caring and compassionate in the way they cared for patients, their families and carers.

Changes made to appointment booking and reminder system were structured to target the clinics with highest did not attend rate. These changes were monitored before implementation throughout the department.

Staff felt included in the changes made in the unit. They described a supportive environment in which to work.

Updated 27 July 2016

Overall, we rated surgical services as Good.

Staff were not aware of current infection prevention and control guidelines, particularly in relation to documentation of water testing for legionella. Cleaning schedules and logs were not available. However equipment was available, which appeared visibly clean, safe and well maintained. Controlled medicines were managed and stored correctly, however we found some documentation relating to intravenous medication to be out of date.

Staff attended mandatory training. We found staffing levels were within establishment boundaries, the ward teams were not able to provide the trust recommended 1:8 nurse to patient ratio. Patients were on the whole risk assessed appropriately although were not provided with individualised care plans. Patients were assessed individually for pain relief and for their nutritional requirements. However the Malnutrition Universal Screening Tool (MUST ) was not used consistently across all areas.

Safe systems were in place for reporting incidents, duty of candour and safeguarding issues. However, there had been one never event in the reporting period. We found that the five steps to safer surgery checklists were completed consistently.

Staff provided care and monitored compliance in line with national best practice guidelines. Surgical wards received a relatively high number of medical patients, for whom the medical wards did not have sufficient capacity. This impacted on the quality of care for all patients.

Patients, carers and families were positive about the care and treatment provided. They felt supported, involved and staff actively engaged with patients whilst providing kind, compassionate care. We observed positive interactions when staff obtained consent. Staff supported patients and relatives with their emotional and spiritual needs.

The surgical care group participated in a number of local and national clinical audits and acted upon any recommendations. Data from the audits was positive and the trust had action plans in place.

Staff were competent and supported by managers. Multidisciplinary team working was established and effective within the surgical wards and theatres.

Service planning and delivery took into account the needs of local people. Discharges were planned with the multidisciplinary team, however due to community pressures these were not always timely.

NHS England data showed that the national 18 week referral to treatment time targets were not being met. The number of cancelled elective operations as a percentage of elective admissions was consistently above the England average. However, of the 101 cancelled operations between October 2015 and January 2016 all but six have been rebooked within 28 days which was consistently lower than the England average.

There were clear governance structures in place and lines of accountability. Leaders were visible and staff were positive about local leadership. Trust values were understood by staff and embedded in appraisal documentation. Information on how the public could provide feedback was displayed in some departmental areas.

Updated 8 May 2019

Our rating of this service improved. We rated it as good because:

• We rated responsive as outstanding, and safe, effective, caring and well-led as good.
• The service had improved in providing safe care. Patients were risk assessed and triaged in a timely manner. Changes had been made following our previous inspection to address safety concerns.
• To be effective, services were provided in line with evidence-based practice. Staff were competent and induction and competency frameworks had been introduced. Patients suffering pain were well managed within guidelines and protocols.
• There was good care provided to patients. Staff were committed to giving the best care to patients, and frequently went above and beyond. The emotional needs of patients and relatives were recognised and addressed.
• The department was outstanding in its response to delivering its services. Services were planned and developed based on demand and patient need. The organisation was achieving the national targets for seeing, treating and discharging patients. People were treated as individuals and their needs were met.
• The leadership team for the frontline service had the skills and experience to carry out their roles. There had been improvements with governance arrangements to bring this closer to staff in frontline leadership roles. There was good engagement with stakeholders and partners to improve and coordinate services. There were no barriers to innovation and development.

However:

• We were not assured the service was meeting the requirements to provide safe care at all times in all areas. There were issues with cross infection processes and the environment for ambulances on arrival at the department.
• The service was not achieving all national patient outcomes.
• There were areas of the governance structure which needed to mature and become embedded in the department. The governance arrangements and vision and strategy were under review and development at the time of our inspection.
• The department needed to strengthen their audit and risk management processes.