The Care Quality Commission (CQC) has recommended that University Hospitals Dorset NHS Foundation Trust continues to work closely with partners in the Dorset health and social care system to reduce waiting times in three services following an inspection at the trust in June.
A short notice announced focused inspection was carried out because CQC had concerns about care and treatment in urgent and emergency services at The Royal Bournemouth Hospital, Poole Hospital, outpatients at Poole Hospital and The Outpatient Assessment Clinic at Dorset Health Village.
As it was a focused inspection, no ratings were produced but CQC focused on the key questions of well-led, safe and responsive for these services as well as caring for urgent and emergency services at both hospitals. University Hospitals Dorset NHS Foundation Trust is yet to receive a rating by CQC for its services or hospital locations.
Roger James, CQC deputy director of operations in the south, said:
“When we inspected University Hospitals Dorset NHS Foundation Trust, we found capable leaders who had the skills to run services well using reliable systems, and staff who worked exceptionally well together with the aim of providing people with the most effective care and treatment.
“However, we saw long-standing, nationally reflected, issues with access and flow throughout the whole Dorset health and care system, creating pressures on demand and capacity. Coastal towns such as Bournemouth had been overwhelmed with the number of people needing access to services, not just through the traditional busy winter period but also through the height of the summer holidays.
“At The Royal Bournemouth Hospital for example, as a result of these pressures, staff were frequently unable to move people from the emergency department to a ward bed when ready for further care and treatment. This meant they were staying longer in the department than was appropriate clinically, or for their well-being. This was also having an impact on staff morale.
“The access and flow problems were having a knock-on effect on waiting times across all of the services we looked at. We saw an increase in the amount of people who were leaving Bournemouth’s urgent and emergency department without being treated due to the long waiting times, putting them at risk of their health deteriorating. However, the trust did have measures in place to alert children’s services if parents or carers left the department before their child had been seen, to ensure young people’s welfare and encourage them to return.
“Although the care itself was generally very good in the outpatient departments at Poole Hospital and at Dorset Health Village, people were waiting too long to be seen. This was partly due to a backlog caused by the COVID-19 pandemic as well as industrial action, but the trust must take steps to urgently address this.
“We saw several issues with the environment at the urgent and emergency departments across both Bournemouth and Poole Hospital which were a potential risk to people’s safety. It’s encouraging to hear that lots of these issues should be solved with Poole’s department relocating to the forthcoming Bournemouth Hospital extension and new emergency department, but the trust needs to do more to mitigate these risks until the move is successfully completed.
“Following this inspection, we’ve recommended the trust continues to work closely with partners across the whole system including the Dorset Integrated Care Board. They should do this to address the significant delays faced by people in urgent and emergency care waiting for a ward bed, and those who are unable to be admitted to hospital as ambulances are delayed in their handover.
“We’ve reported our findings to the trust, and we’ll return to ensure the trust are building on the good foundations we’ve seen, to make further improvements.”
Inspectors found the following at both urgent and emergency departments:
- Not everyone could access services in a timely and clinically safe way, with some remaining in the departments for much longer than necessary
- Inspectors saw some people who needed to remain in the emergency department because there were no porters available to transfer them to a ward causing a blockage
- This blockage meant new people waiting to come into the department for treatment were delayed. This caused lengthy delays for ambulance crews waiting to handover people to the hospitals meaning other people in the community were waiting longer for care and treatment from the emergency services
- The layout of the departments meant staff couldn’t see everyone in the waiting area, making it difficult to spot if people’s health was deteriorating. There were some mitigations put in place, such as a live camera feed for reception staff, but it wasn’t monitored consistently
- There wasn’t always a dedicated space for young people and their families, meaning children weren’t always protected or removed from seeing and hearing adults using services, some with complex needs
- Neither reception was fully accessible or suitable for wheelchair users. Inspectors observed wheelchair users attempting to stand to be seen and heard by reception staff which was unsafe
- People’s records weren’t always consistently completed in full or easily accessible but a new record system had just been installed and as being rolled out
- There was enough suitably trained staff to care for people safely, most of the time but staff skill mix and experience wasn’t always optimally balanced
- However staff and managers worked hard to prioritise people in terms of clinical need well, and there was a clear understanding of everyone’s needs and reasons for delays
- There was exceptional teamwork across all staff groups, which was highly valued by all staff
- Staff received training specific for their role on how to recognise and report abuse. They could give examples of how to protect people from harassment and discrimination, including those with protected characteristics under the Equality Act.
Inspectors found the following at all services during this inspection:
- Managers monitored the effectiveness of services and made sure staff were competent
- There was an open and honest culture where people could raise concerns
- Staff were supported and trained in key skills and understood how to protect people from abuse, acting where necessary
- Safety incidents were well managed, and lessons were learnt and shared to prevent them from happening again
- Staff felt respected, valued, and proud to work in the organisation
- It was easy for people to give feedback
- Staff were kind, compassionate and caring.
Inspectors found the following at both outpatient departments:
- There was enough suitably qualified staff to care for people safely
- People could not always access the service when they needed it and had long waits for treatment putting their health at risk of deteriorating
- Services used multiple information systems as well as paper records for triage and booking of appointments which meant there was a reliance on staff to ensure tracking of appointments.