Maternity services rated inadequate in Poole
Hospital bosses say they are disappointed but improvements have been made
Last updated 10th Mar 2023
The Care Quality Commission also inspected medical care and surgery at the Royal Bournemouth Hospital and Poole Hospital.
Following the inspections, CQC rated Poole Hospital’s maternity service inadequate. The service was previously rated good, but the latest inspection found there had been deterioration in the quality of its safety and leadership arrangements.
CQC also took enforcement action by serving the trust a warning notice regarding its processes to summon help in an emergency in Poole Hospital’s maternity service. The trust has taken action since the inspection to address this risk.
CQC rated Poole Hospital’s surgery requires improvement again. Inspectors’ assessment of the hospital’s medical care did not lead to a rating being issued, so the service remains rated good.
CQC rated Poole Hospital requires improvement overall. It was previously rated good.
No rating was issued for the Royal Bournemouth Hospital, so it remains rated good overall. Similarly, inspectors’ assessment of the hospital’s medical care and its surgery did not lead to new ratings being issued – so both remain rated good.
The inspections did not lead to trust-wide ratings being issued.
Cath Campbell, CQC deputy director of operations in the south, said:
“Standards of care and treatment had deteriorated in the services we inspected at University Hospitals Dorset NHS Foundation Trust.
“This was particularly evident in Poole Hospital’s maternity service, where care and treatment fell below standards people have a right to expect.
“Behind this was a staffing shortage, and risk management which needed strengthening.
“While NHS services and those in the wider care sector continue to struggle to recruit and retain staff, leaders must ensure this doesn’t lead to people being exposed to avoidable risks.
“However – despite the pressure they faced – staff ensured the maternity service was clean, and that medicines were managed well.
“Medical care and surgery at Poole Hospital and the Royal Bournemouth Hospital also experienced staffing shortages that undermined people’s safety.
“People’s discharge from the trust’s medical care was sometimes delayed due to shortages of beds elsewhere, which increased pressure on the service. We also found some people receiving treatment when they had broken their hip experienced unacceptable delays.
“However, staff knew how to safeguard people. They also treated people with kindness and compassion, and they considered their individual needs and preferences.
“Following the inspections, we reported our findings to the trust. Its leaders know what must be improved, and where there’s good practice on which they can build.
“We’ll inspect these services again to assess whether improvement has been made. If there’s insufficient progress or if people are at immediate risk of harm, we won’t hesitate to take further enforcement action.”
In Poole Hospital’s maternity service, inspectors found:
• There were not always enough staff to keep women and babies safe.
• Systems and processes for managing risk were not always effective, especially in maternity triage.
• Maintenance of the environment, especially regarding the emergency call bell systems, were not adequate to maintain people’s safety.
• Managers did not always investigate incidents thoroughly or in a timely way.
• The maternity leadership team was new and did not always have enough capacity or experience.
However:
• Staff understood how to protect women and children from abuse.
• The environment was visibly clean.
• Staff managed medicines safely.
• Staff felt respected, supported and valued. They were focussed on the needs of women receiving care.
• The service had an open culture where women, their families and staff could raise concerns without fear.
In medical care at the Royal Bournemouth Hospital and Poole Hospital, inspectors found:
• There were not always have enough staff to keep people safe.
• Staff did not always complete and update risk assessments, and records were not always stored securely.
• Medicine storage was not always safe.
• People did not always receive enough food and drink.
• Some people who were medically fit for discharge stayed in the service longer than they needed to, due to a lack of community and social care packages in the region.
• Staff morale was low, but staff remained focused on the needs of people receiving care.
However:
• Staff knew how to protect people from abuse.
• Infection risk was controlled well.
• Staff mostly identified and quickly acted for people at risk of deterioration.
• Staff assessed and monitored people regularly to see if they were in pain, and they mostly administered pain relief in a timely way.
• Staff supported people unable to communicate using suitable assessment tools, and they gave additional pain relief when needed.
• Staff collaborated well to benefit people.
• Staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues it faced.
• The service had an open culture where people, their families and staff could raise concerns without fear.
In surgery at the Royal Bournemouth Hospital and Poole Hospital, inspectors found:
• There were not always have enough staff to care for people and keep them safe.
• Safety incidents were not always well managed.
• Care was not always planned to meet local people’s needs.
• At Poole Hospital, people on a fractured neck of femur pathway mostly did not receive treatment within recommended timescales. This led to worse outcomes and longer recovery times for them.
• People remained in Poole Hospital’s surgery service when they were fit for discharge, due to a lack of community and social care packages in the region.
• At both hospitals, surgery staff did not always feel supported and valued. They described the challenges of working with not enough staff and how that affected them.
However:
• Staff assessed risks to people, acted on them and mostly kept good care records.
• Staff treated people with compassion and kindness, respecting their privacy and dignity.
• Staff were focused on the needs of people receiving care.
Siobhan Harrington, chief executive said: “I know how hard our staff are working, often under pressure, so it is disappointing to receive the judgements. However, we know that these reports are reflective of the challenges across the Trust as we are not currently providing consistent standards of care.
“I do believe though that the themes within the reports are fixable. We have already put improvements in place and addressed some of the issues raised. We recognise though that there is more to do and will ensure we take the actions needed.
“I was very pleased that the CQC reports also highlighted some best practice across our hospitals, including the caring nature of our colleagues, with the CQC stating that patients told them our staff treated them well, with compassion and kindness.”
“In light of the CQC’s advice we now need to make sure we have everything in place to improve processes, management and leadership across the Trust that have been impacted by the disruption of our merger, the pandemic and industrial action. With the wonderful colleagues I have across UHD I know we can do this. We look forward to welcoming the CQC back to our hospitals to show them the changes we are making.”
Some themes in the reports are in common with other Trusts across the NHS at the present time, which we are working hard to address, including staffing and the safe discharge of patients from our hospitals when medically ready. There are also specific issues about UHD that we acknowledge and accept from the reports.
Rob Whiteman, chair of UHD said: “We recognise that we need to have clearer and more effective ways of making improvements and learning from ourselves and others. Working with our Trust Board and receiving insights from our Council of Governors, we will continue to strengthen governance – how we work as an organisation - and risk management. We have a strong ambition to make UHD the best place for both our staff and our patients and these reports will help us in this work.”