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Archived: Poole Hospital NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings

Latest inspection summary

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Background to this inspection

Updated 31 January 2020

Poole Hospital NHS Foundation Trust operates from Poole Hospital, located close to the centre of the town of Poole in Dorset, and provides acute services for the local population of around 500,000 people. This include those people predominantly living in Poole, Purbeck and east Dorset. The patient population increases over the summer months with the influx of tourists to the area.

Patients receive outpatient and inpatient consultant services for a range of specialties for which the trust employs 4,143 staff.

Along with the other acute, community and mental health trusts in the county, the trust has been part of a Dorset-wide clinical services review undertaken by the Dorset Clinical Commissioning Group (CCG). The results of the wide-scale consultation were made publicly available on 20 September 2017.

Following this review, the Dorset CCG confirmed its decision to reconfigure the two east Dorset acute hospital sites. This is in order to create a major emergency hospital on the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (RBCH) Bournemouth hospital site and a major planned care centre on the Poole site.

From January 2019, NHS Improvement and the Competition and Markets Authority, supported joint interim appointments with RBCH of a chairperson and chief executive. Furthermore, joint arrangements have been made for seven clinical services (trauma and orthopaedics, surgery, urgent and emergency care, older people’s care, maternity, cardiology and stroke care) to merge their activities during the intervening months/years leading up to full merger during 2020.

Within the plans, Poole will have a modernised larger operating theatre suite in a new wing of the hospital. There will be a new urgent treatment centre and the existing accident and emergency department will close.

Overall inspection

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