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Archived provider: Poole Hospital NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 31 January 2020

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

At core services level, safe was requires improvement overall, with effective, responsive and well-led rated as good. Caring was rated as outstanding. The rating of well-led at core services level was good overall, and this was the same for the trust management. This led to a combined overall rating for the trust of good.

At core services level, safe remained as requires improvement overall following our last inspection published in early 2018, and more work was required in this area. The questions of effective, responsive and well-led remained as good. Caring improved and was rated as outstanding, following a good rating at the last inspection. This rating came from maternity services and end of life care services where it was rated as outstanding. This joined with the rating of outstanding for caring for children’s and young people’s services from our last inspection. In maternity, responsive was rated as outstanding for the first time. Maternity was not rated as outstanding overall due to a requirement for improvements in the question of safety.

We rated well-led at the trust management level again as good. We saw improvements had been made from our last inspection. As before, there was strong, consistent, visible leadership. The vision and strategy for the trust was clear. There was a great culture in the trust and among the staff across all areas. We were impressed with their friendliness and warmth. There was good engagement with patients and staff, although some more work to be done in the coming months when the trust starts to make significant changes. Innovation and improvement were strongly encouraged.

However, there were areas of concern around how the trust showed it learned from complaints, death and incidents. It was not achieving targets around appraisals and mandatory training and some areas were not improving. We found governance was not interconnected enough to provide full assurance.

Medical care (including older people’s care) was rated as good overall. However, the ratings stayed the same as last time with safe continuing to be rated as requires improvement. The other key questions were rated as good, and the service as good overall. In safe, mandatory training was not meeting the trust target in a number of key skills. We were concerned with safeguarding training and infection prevention and control not being met. We were concerned with some risk assessments for patients not being completed and records not always being maintained or clear. Nursing and medical staff vacancy rates were challenging for the hospital. Not all patients or those caring for them said they felt involved and informed in decisions about their care and treatment or offered emotional support following life changing news. However, patients were protected from abuse. Infection risk was well managed as were medicines. Patient records were mostly stored securely, and emergency equipment was checked as required. Patients were well looked after with care of their nutrition and hydration. Leadership of the service was good and staff had strong values focused on caring for the patient at the heart of these.

Surgery was rated as requires improvement overall. At our previous inspection, safe and well-led were rated as requires improvement. They remained at this rating, but responsive was downgraded to requires improvement from good. Effective and caring were rated as good. The service did not have sufficient levels of nurses or junior doctors. There was consequently a high degree of agency staff being used. There were issues with mandatory training compliance in the medical staff, infection risk was not always controlled well, and safety checks on emergency equipment not always carried out. Patient records were not always clear, including around nutrition and hydration and mental health assessments. Services were not being delivered in line with targets so some patients were having to wait too long. There was limited adaption for patients living with dementia. Governance and assurance were not well documented. However, patients were protected from abuse. Staff provided good care and treatment and were competent and skilled. Patients were treated with compassion and kindness, respecting their privacy and dignity. Staff felt respected, supported and valued.

Maternity was rated as good overall. Safe was requires improvement and caring and responsive were outstanding. The service was not rated outstanding overall as safe required improvement. Midwifery staff were up-to-date with their mandatory training. Infection risks were well managed, and midwife staffing levels were safe and regularly reviewed. Care and treatment were effective and based on national guidance. There was outstanding care given to women and families. The service met the needs of women and included those in need of extra support. The service was well-led, and staff felt supported and valued. There was effective governance and management of risk. Innovation and improvement were encouraged. However, medical staff were not achieving mandatory training compliance. There were missed opportunities for early identification of a safeguarding concern and there were a number of medicine errors identified on inspection.

End of life care was rated as good overall. Safe and effective remained good, with responsive moving from requires improvement to good, and caring from good to outstanding. Well-led remained good. Safe care was provided across end of life care services. Care was based upon national guidance and evidence-based practice. Staff were competent and skilled. Patients were able to make choices and supported to take decisions about their care and treatment. Care was patient-centred and there was strong emotional support for those close to the patient. Patients were treated with compassion, dignity and respect. The leadership had a clear vision and supported staff who felt valued and supported. Governance was working well with areas for improvement underway.

On this inspection we did not inspect urgent and emergency care (A&E), critical care, services for children and young people, or outpatients. The ratings we gave to these services on the previous inspection published in 2018 are part of the overall rating awarded to the trust this time.

Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RD3/reports

Inspection areas

Safe

Requires improvement

Updated 31 January 2020

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

There was a lack of compliance with staff being up-to-date with their mandatory training. Some patients’ records, risk assessments, and mental capacity assessments were not completed or reliable. There were issues with infection prevention and control in some areas and there were misses opportunities to identify a significant safeguarding concern in maternity. There were shortages of staff, but we recognised how most staffing levels were safe, but from a high use of agency staff. The trust was working tirelessly to address this. Medicines were mostly managed safely but there was a lack of recognition and reporting of medicine errors in maternity. Not all emergency equipment was checked as it should be.

However, patients were protected from harm. Incidents were reported and staff were confident about reporting and it was encouraged. Deteriorating patients were managed safely and staff used monitoring safely to protect patients.

Effective

Good

Updated 31 January 2020

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

Patients received care in line with national guidance. Outcomes for patients were good and some were among the best in the country. There was a strong multidisciplinary approach to patient care, with input from staff with different skills and expertise to provide better outcomes. Staff were competent, skilled and experienced.

However, not all malnutrition screening and pain management was recorded well. Not all staff had had a performance review in the last year, and the organisation could therefore not provide assurance around staff development and capability.

Caring

Outstanding

Updated 31 January 2020

Our rating of caring improved. We rated it as outstanding because:

Patients were cared for with compassion and kindness. Staff supported them to get better or cared for them to the best of their ability when they were at the end of their life. Privacy and dignity were respected and patients seen and treated as individuals. Patients were given emotional support and involved in their care and treatment. Staff understood the emotional impact of being in hospital and receiving treatment and supported patients and those who cared for them to cope.

However, not all patients or those caring for them said they felt involved and informed in decisions about their care and treatment or offered emotional support following life changing news.

Responsive

Good

Updated 31 January 2020

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

The service was designed to meet the needs of local people. Patients were treated as individuals and care provided to meet different needs. The service was inclusive and staff recognised how people needed different approaches to give them the best outcome. People were able to complain or raise concerns and these were taken seriously and carefully addressed. People requiring cancer services were treated in line with national standards.

However, most referral to treatment times for surgery (18 week standard) were not being arranged within the target time due to high demand on services. The trust was also below the England average.

Well-led

Good

Updated 31 January 2020

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

At trust level the service had strong and capable leadership which was respected and supportive. There was a clear vision and values and strong culture. The patient was at the centre of the work of the trust, but staff were equally valued and respected. Staff were clear about their roles and responsibilities. Innovation and improvement were encouraged. Most information was accurate and timely and there was a high quality of performance data for staff to use.

However, not all governance processes were effective or joined up. There was poor evidence of the organisation learning from complaints, incidents and deaths. There was no evidence of continued failings in care from an inability to learn, but evidence to be able to show how this was done was poor. Governance was not consistent or strong at all levels, although most risks were understood and managed.

Assessment of the use of resources

Use of resources summary

Good

Updated 31 January 2020

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

The trust’s overall cost per weighted activity unit benchmarked in the lowest national quartile despite the trust being regarded as unsustainable in its current form, with a very high level of non-elective inpatient activity. The trust operated in a challenging environment with plans to merge with a nearby trust and clinical services changes across the county. Despite this context, the trust performed relatively well on operational performance and demonstrated good clinical productivity and benchmarked well on clinical support services and corporate services. The trust however could make further progress on workforce (particularly around managing agency spend and staff retention) and it needed to consolidate its financial improvement trajectory.

Combined rating

Combined rating summary

Good

Updated 31 January 2020

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

Both the trust overall and the use of resources were rated as good. The combined rating for the trust is therefore good, which was the same as our previous inspection.