Dorset County Hospital NHS Foundation Trust has been rated “requires improvement”, after inspectors found there were not always enough nurses to provide safe care.
Inspectors raised concerns about staffing levels following a visit in March to Dorset County Hospital in Dorchester and services at two community hospitals.
“We found that staff were enthusiastic about the trust”
Following the inspection, the Care Quality Commission stated: “There were not always enough nursing, midwifery, therapy and medical staff with the right skill mix to provide safe care.
“Staffing levels had been reviewed, but changes to staffing levels identified as necessary from the reviews had not been fully implemented at the time of the inspection,” it warned in its latest report on the trust.
There were particular concerns about staffing levels at night, said the CQC inspectors.
For example, on Lulworth Ward at Dorset County – a step-down ward for the high dependency unit and intensive therapy unit with high levels of acuity – there were often only two registered nurses on duty at night covering 28 beds.
“Thus, for the majority of the night, one registered nurse would be caring for 14 patients which is in excess of the one for eight that the trust stated as the requirement for the patient acuity,” said the report.
“We have more work to do to bring all our services up to the high standards we expect”
Meanwhile, the midwife-to-birth ratio in maternity did not meet national guidelines. According to the CQC report, the funded ratio was one midwife to 34 births. However, an assessment with a staffing tool in July last year found this should be one to 27.
The CQC told the trust that it must ensure “the numbers of nursing on duty are based on the numbers planned by the trust all times of the day and night to support safe care”, and also increase the number of midwives.
Maternity – where inspectors noted “consultants did not all work well as a team and working relationships were strained” – was one of the services rated “requires improvement”, alongside end of life care, outpatients and emergency services.
In contrast, the trust’s medical care, surgery, critical care and children’s and young people’s services were all rated “good”.
The CQC acknowledged that the trust was midway through a review of its strategy, with the aim of working more closely with other organisations in the county to deliver services together – and also had a relatively new executive team that recognised the need for improvements.
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“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,” said Professor Edward Baker, CQC deputy chief inspector of hospitals.
“The trust is still working towards a full seven-day service, and there is not a formal ‘hospital at night’ team,” said Professor Baker.
He added: “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.”
Inspectors highlighted some examples of “outstanding” practice, including a 24/7 hospital@home service that helped ensure medically fit patients could get home as swiftly as possible.
The initiative has helped improve the flow of patients through Dorset County, reduced the length of hospital stays and improved patient welfare, said the CQC report.
“Discharge planning was instigated at the time of admission,” it added. “Ward staff and the discharge team worked with partners to improve the co-ordination of patient discharges and transfers.”
The report also highlighted the work of two bereavement midwives who supported families after a neonatal death or stillbirth.
The service included visiting families at home to tell them post-mortem results in person, and setting up a private social media page for women who have lost babies during pregnancy or after birth.
Midwives also ran tailored antenatal, breastfeeding and smoking cessation sessions for young mums, who were offered special tours of the maternity unit, noted the regulator.
Meanwhile, it highlighted that a gynaecology specialist nurse ran the Go Girls Support Group, along with a former patient, to support women diagnosed with a gynaecological cancer.
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Trust chief executive Patricia Miller praised the “tireless efforts” of staff and said the many good aspects of care highlighted in the CQC report reflected their commitment.
She said the trust had already acted on many of the recommendations made by inspectors.
“The overall rating of ‘requires improvement’ does not mean Dorset County Hospital is providing poor care,” she said. “The thousands of local people using our services know this is not the case.
“It means we have more work to do to bring all our services up to the high standards we expect,” she said. “We are already striving towards this and our aim is to achieve a rating of ‘outstanding’.”