England’s Chief Inspector of Hospitals has rated the services provided by Dorset County Hospital NHS Foundation Trust as Requires Improvement following an inspection by the Care Quality Commission in March.
A team of inspectors, which included a variety of specialists and experts by experience, visited Dorset County Hospital in Dorchester and services provided by the trust at two community hospitals.
The trust’s medical care, surgery, critical care and children’s and young people’s services were all rated Good. Maternity, end of life care, outpatients and urgent and emergency services were rated Requires Improvement. Full reports including ratings for all of the provider’s core services have been published.
Professor Edward Baker, Deputy Chief Inspector of Hospitals, said:
“Dorset County Hospital NHS Foundation Trust is midway through a review of its strategy which is aimed at working more closely with other organisations in the county to deliver a range of integrated services between them. There is a relatively new executive team who recognise that there is work still to do before patients see all the benefits.
“Although we found there was a commitment to provide safe care and to improve performance across the trust, this had not yet been achieved. In particular, the board was not properly aware of the improvements needed in some services such as end of life care where areas for improvement were identified two years ago. There is now evidence of a shift of focus to continuous quality improvement. To their credit the trust has sought external advice and are working to improve how the board monitor quality and risks.
“Throughout our inspection we found that staff were enthusiastic about the trust and the quality of care they provided - although there were not always enough nurses or doctors to provide safe care. The trust is still working towards a full seven-day services, and there is not a formal ‘hospital at night’ team.
“While we have found areas of good practice, we also found areas where the need for improvement had previously been identified but the changes had not implemented or embedded. Following this inspection we will continue to monitor the trust's progress and we will return at a later date to check on its progress."
Inspectors found that the trust often faced challenges with patient flow through the hospital and the number of available beds. The bed occupancy was consistency above the England average. The trust had invested in a range of initiatives to find alternatives to emergency admissions and support timely discharge from hospital. These included the opening of step down beds and acute hospital at home.
There were not enough consultants for end of life care services across the hospital and there were not always enough nurses, doctors, midwives and therapists with the right skill mix to provide safe and effective care.
There were delays in clinic letters being typed and sent to GPs in a number of specialities, including cardiology, haematology and dermatology.
The treatment and care provided in most services took account of current guidelines although maternity and gynaecology services did not always take accord with latest guidance. There had been a slow response to implementing best practice guidance in end of life care.
The inspection has identified a number of areas for improvements including:
- All equipment must be clean and fit for purpose and ready for use in the emergency department.
- There must be regular monitoring of the environment and equipment within the emergency department, and action taken to reduce risks to patients
- The numbers of nurses on duty must be based on the numbers planned by the trust all times of the day and night to support safe care.
- The number of midwives must be increased according to trust plans and in line with national guidance, to support safe care for women.
- Turnaround times for typing of clinic letters must be consistently met, with action taken when targets are not met across all specialities.
- All patient records must be stored securely to maintain patient confidentiality
- Risk registers at local, directorate and divisional level must be kept up-to-date, including all factors that may adversely affect patient safety. Progress with actions must be monitored.
The inspection team also found a number of areas of outstanding practice, including:
- A hospital-at-home service providing a valuable service supporting medically fit patients to have earlier discharges to their homes. This service was provided at all times and helped improve access and flow in the hospital as well as improving outcomes for patients.
- The support for renal dialysis patients was outstanding, with individualised care for patients to receive home dialysis and holiday dialysis when appropriate and safe.
- Two bereavement midwives made home visits following a stillbirth or neonatal death. They made follow up visits and offered to provide antenatal care for women in any subsequent pregnancy. They also set up the monthly Forget Me Not bereavement support group in a local children’s centre.
- A gynaecology specialist nurse ran a support group along with a former patient to provide support for women diagnosed with a gynaecological cancer.
The Care Quality Commission will present its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
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For media enquiries contact John Scott, Regional Engagement Manager on 07789875809 or CQC’s press office on 0207 4489401. For general enquiries, call 03000 61 61 61.
We found that staff were enthusiastic about the trust and the quality of care they provided - although there were not always enough nurses or doctors to provide safe care.
Professor Edward Baker, Deputy Chief Inspector of Hospitals