Yeovil District Hospital

Updated 10 May 2024

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Yeovil District Hospital.

We inspected the maternity serviced at Yeovil District Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

Yeovil District Hospital provides maternity services to the population of Yeovil in South Somerset, North and West Dorset, and the Mendips.

Maternity services include an outpatient department, maternity assessment unit, triage, maternity ward for antenatal and postnatal care (Freya Ward), delivery suite, two maternity theatres, bereavement suite, antenatal clinics and an ultrasound department. Between April 2022 to March 2023 there were 1259 births at Yeovil District Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

This was the first time we inspected Yeovil District Hospital maternity services since merger of the two organisations. Our rating of this hospital went down. We rated it as requires improvement because:

• Our rating of inadequate for maternity services changed ratings for the hospital overall. We rated safe as inadequate and well-led as Inadequate.

We also inspected 2 other maternity services run by Somerset NHS Foundation Trust. Our reports are here:

• Musgrove Hospital – https://www.cqc.org.uk/location/RH5A8

• Bridgwater Community Hospital - https://www.cqc.org.uk/location/RH5K6

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited triage, the labour ward, the antenatal and postnatal wards.

We spoke with 18 staff including obstetric medical staff, midwives of different seniority, support staff and 2 women and birthing people. We received 2 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 9 patient care records, 6 observation and escalation charts and 5 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 8 May 2019

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

• We rated safe as requires improvement and effective, caring, responsive and well-led as good. Overall, we rated the service as good.
• The effectiveness of the service continued to be good. People received care and treatment that reflected current evidence-based guidance and achieved good outcomes. Performance in national audits met national standards most of the time.
• The care provided by staff continued to be good. People were supported, treated with dignity and respect, and were involved as partners in their care.
• The responsiveness of the service had improved. There were innovative services to meet the needs of the population. Staff cared for patients with additional needs well and care for patients living with dementia had improved.
• The management of the service had improved. We found the leadership, governance and culture supported the delivery of high-quality care. There were clear governance processes from ward level up to the trust board. The trust worked well with the local authority and external providers to deliver high quality services. Staff were engaged with quality improvement projects.

However:

• Systems and processes to keep people safe were not always followed in relation to the risk assessments for patients, responding to deteriorating patients and the quality of nursing records. Records were not always up-to-date in a way that kept people safe.
• Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Staff did not always follow the trust policy and procedures when a patient needed a mental capacity assessment.

Updated 8 May 2019

• The trust provided an effective, caring, responsive and well led service for children and young people.
• Staff safeguarded children and young people and were knowledgeable regarding the action to taken where abuse was suspected.
• The control of infection was managed well and staff were knowledgeable about the prevention of cross infection and health related infectious diseases. Staff had access to appropriate equipment to meet the care and treatment needs of children and young people. The ward was decorated in a style to appeal to children and young people.
• The service had enough nursing staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment. Staff worked well together as part of multi-disciplinary teams to meet the needs of children and young people and provide them with a seamless service.
• The service followed best practice when prescribing, giving, recording and storing medicines.
• The service managed patient safety incidents well. Staff recognised and were confident in reporting incidents.
• The care, treatment and support of children and young people promoted a good quality of life and was based on national guidelines and recommendations. The nutrition and hydration needs of babies, children and young people were assessed, monitored and met. Staff used appropriate tools to assess, monitor and manage the pain experienced by babies, children and young people. Parents and carers were included in the assessment of their child’s pain.
• Staff were competent and skilled within their roles, they worked together well as a multi-disciplinary team to meet the needs of babies, children and young people admitted to the wards. The staff supported and encouraged patients and their families to live healthier lives and provided health promotion information and practical assistance. For example, the provision of leaflets and nicotine replacement therapy.
• Children and young people were consulted regarding their care and treatment. Parents and carers were included in discussions regarding care and treatment plans and their views listened to.
• Children, young people and their families and carers were treated with compassion, kindness, dignity and respect. There was a happy atmosphere on the ward and children and young people were engaged in activities relevant to their interests and ages. Staff offered emotional support and reassurance to children, young people and their relatives and carers to minimise their distress.

However:

• We rated safe as requires improvement. There were identified issues with the environment which impacted on the safety of children and young people who were admitted to the ward. These had not been addressed although the senior leaders had submitted a business plan which would reconfigure the layout of ward 10 and mitigate against many of the risks. This had yet to be approved.
• Not all staff had completed their mandatory training. For example, a number of medical staff had not completed safeguarding children training.
• Treatment and care plans were not always easy to locate within medical records.
• Staff were due to be provided with update training and guidance regarding the programme for the treatment of eating disorders in children and young people. This was because it had been identified that staff had not always followed the strict and complex regime for children and young people admitted for this care and treatment.
• There was a limited therapy service to the ward at weekends, for example from the physiotherapists.

Updated 27 July 2016

The overall rating for the critical care services was good.

We rated the safety of critical care as good. Patient safety was given sufficient priority. An effective system was in place for the reporting and investigation of incidents, and this had led to improvements in the delivery of patient care and outcomes. There was sufficient equipment for the delivery of patient care and the environment was clean.

The unit had nursing and medical staff vacancies and recruitment was a challenge. Additional intensive care consultants were needed to enable the care of all patients on the critical care unit to be led and managed by an intensive care consultant at all times.

Senior nurses supported the critical care outreach service on a rotational basis which provided a good development opportunity but also impacted on the number experienced staff on the unit. Senior staff continually monitored staffing levels to ensure patient safety was maintained. The outreach service assisted in the early recognition of patients who were at risk of deterioration throughout the hospital and the follow up of patients who had been discharged from critical care.

We rated the effectiveness of critical care as good. Patients received evidenced based care that was based on comprehensive patient assessments and regular evaluation. Patient outcomes were monitored and were good.

Despite not having a dedicated clinical educator staff overall were supported in their personal development and training. Access to the critical care post registration qualification however was limited to two staff per year and less than 50% of the nurses currently held this critical care qualification as required by the Core Standards for Intensive Care. Although the multidisciplinary team (MDT) was an integral part of the patient care, a daily MDT ward round involving all members of the team did not take place.

We rated caring on the unit as good. Patient and relative feedback was very positive and care was patient centred. Staff understood the impact critical illness had on both patients and their relatives and this was reflected in the care that was delivered and how it was delivered. Patient diaries were well managed and assisted patients to recover and relatives to feel supported following a period of critical illness.

We rated the responsiveness of critical care as good. Critical care was delivered in a way that met the individual needs of critically ill patients. Patients were not always discharged from the unit within four hours of the decision being made to discharge them or before 10pm. Whilst this was not in line with the Core Standard for Intensive Care requirements, the timeliness of discharging patients was influenced by the availability of beds within the hospital. This was not in the direct control of the critical care unit. There was no evidence to suggest that bed availability was leading to non-clinical transfers of critically ill patients to other hospitals however elective operations had been cancelled due to critical care beds being available. Patients were offered the appropriate support with their rehabilitation following a critical illness, and a clear rehabilitation pathway was in place which included a follow up clinic visit.

Senior nursing staff were visible and accessible to patients, visitors and staff. The senior sister provided clear and professional leadership. There was an open and honest culture and staff were passionate about patient care. The senior leadership team were clear in their objective of wanting to meet the Core Standards for Intensive Care and have a closed unit model of care; with care being led by a consultant in intensive care medicine. At present any consultant can admit a patient to the unit without review by an intensivist. They were actively recruiting medical staff to enable this objective to be met.

Updated 8 May 2019

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

We rated effective, caring, responsive and well-led as good and safe as requires improvement.

• There were some concerns about infection prevention and control in the ageing mortuary estate, and the completion of risk assessments and documentation of decisions about resuscitation. However, the specialist palliative care team responded well to changes in patients’ conditions.
• End of life care was delivered in line with national guidance. There were systems to monitor performance and there was good multidisciplinary care and support for the benefit of the patient. However, there was an inconsistent approach and documentation to support patients’ mental capacity assessments.
• Care for patients approaching the end of their life was provided with compassion and respect. Staff sought to involve patients’ next of kin. The bereavement service and chaplaincy services continued to support relatives after the death of a loved one.
• The specialist palliative care team were responsive and reviewed referrals promptly, although they were only available during the week in normal working hours.
• Leadership and governance processes had strengthened since our last inspection. The service had a vision and a strategy to achieve this. However, processes to identify risks and incidents relating to end of life care needed to be improved. The governance processes did not have sufficient structure.

Updated 10 May 2024

Updated 27 July 2016

We rated outpatients and diagnostic services (OPD) at Yeovil District Hospital as good overall.

Systems were in place for keeping people safe. Staff were aware of how to report incidents, safeguarding issues and the Duty of Candour process. Risks to patients using the service were assessed and appropriately managed.

Consent to care and treatment was obtained in line with legislation and guidance. Staff were suitably qualified and skilled to carry out their roles effectively. Staff described a good learning environment, with good role progression.

We saw good examples of the service being redesigned and improvements made to meet the needs of the patients.

Patients spoke positively of staff that they encountered, and the care they received. Staff were observed to be caring and compassionate in the way they cared for patients, their families and carers.

Changes made to appointment booking and reminder system were structured to target the clinics with highest did not attend rate. These changes were monitored before implementation throughout the department.

Staff felt included in the changes made in the unit. They described a supportive environment in which to work.

Updated 27 July 2016

Overall, we rated surgical services as Good.

Staff were not aware of current infection prevention and control guidelines, particularly in relation to documentation of water testing for legionella. Cleaning schedules and logs were not available. However equipment was available, which appeared visibly clean, safe and well maintained. Controlled medicines were managed and stored correctly, however we found some documentation relating to intravenous medication to be out of date.

Staff attended mandatory training. We found staffing levels were within establishment boundaries, the ward teams were not able to provide the trust recommended 1:8 nurse to patient ratio. Patients were on the whole risk assessed appropriately although were not provided with individualised care plans. Patients were assessed individually for pain relief and for their nutritional requirements. However the Malnutrition Universal Screening Tool (MUST ) was not used consistently across all areas.

Safe systems were in place for reporting incidents, duty of candour and safeguarding issues. However, there had been one never event in the reporting period. We found that the five steps to safer surgery checklists were completed consistently.

Staff provided care and monitored compliance in line with national best practice guidelines. Surgical wards received a relatively high number of medical patients, for whom the medical wards did not have sufficient capacity. This impacted on the quality of care for all patients.

Patients, carers and families were positive about the care and treatment provided. They felt supported, involved and staff actively engaged with patients whilst providing kind, compassionate care. We observed positive interactions when staff obtained consent. Staff supported patients and relatives with their emotional and spiritual needs.

The surgical care group participated in a number of local and national clinical audits and acted upon any recommendations. Data from the audits was positive and the trust had action plans in place.

Staff were competent and supported by managers. Multidisciplinary team working was established and effective within the surgical wards and theatres.

Service planning and delivery took into account the needs of local people. Discharges were planned with the multidisciplinary team, however due to community pressures these were not always timely.

NHS England data showed that the national 18 week referral to treatment time targets were not being met. The number of cancelled elective operations as a percentage of elective admissions was consistently above the England average. However, of the 101 cancelled operations between October 2015 and January 2016 all but six have been rebooked within 28 days which was consistently lower than the England average.

There were clear governance structures in place and lines of accountability. Leaders were visible and staff were positive about local leadership. Trust values were understood by staff and embedded in appraisal documentation. Information on how the public could provide feedback was displayed in some departmental areas.

Updated 8 May 2019

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

• We rated responsive as outstanding, and safe, effective, caring and well-led as good.
• The service had improved in providing safe care. Patients were risk assessed and triaged in a timely manner. Changes had been made following our previous inspection to address safety concerns.
• To be effective, services were provided in line with evidence-based practice. Staff were competent and induction and competency frameworks had been introduced. Patients suffering pain were well managed within guidelines and protocols.
• There was good care provided to patients. Staff were committed to giving the best care to patients, and frequently went above and beyond. The emotional needs of patients and relatives were recognised and addressed.
• The department was outstanding in its response to delivering its services. Services were planned and developed based on demand and patient need. The organisation was achieving the national targets for seeing, treating and discharging patients. People were treated as individuals and their needs were met.
• The leadership team for the frontline service had the skills and experience to carry out their roles. There had been improvements with governance arrangements to bring this closer to staff in frontline leadership roles. There was good engagement with stakeholders and partners to improve and coordinate services. There were no barriers to innovation and development.

However:

• We were not assured the service was meeting the requirements to provide safe care at all times in all areas. There were issues with cross infection processes and the environment for ambulances on arrival at the department.
• The service was not achieving all national patient outcomes.
• There were areas of the governance structure which needed to mature and become embedded in the department. The governance arrangements and vision and strategy were under review and development at the time of our inspection.
• The department needed to strengthen their audit and risk management processes.