Inspectors rate Yeovil District Hospital's children's services as inadequate
Inspectors found that some children had waited 14 hours to be seen in A&E.
The Care Quality Commission (CQC) has told Yeovil District Hospital to make "rapid, specific changes" following an inspection in January.
The inspections were the first children and young people’s services since the merger of Yeovil District Hospital NHS Foundation Trust and Somerset NHS Foundation Trust on 1 April 2023.
Following the inspection, CQC has issued the trust with a warning notice to focus their attention on making rapid, specific changes to improve people’s safety regarding the areas of staffing, learning from serious incidents, and management.
The trust has closed the Special Care Baby Unit and therefore inpatient maternity services for six months at Yeovil District Hospital following the inspection, in response to safety concerns and staffing pressures in children’s services, including neonatal care.
Children and young people’s services at Yeovil District Hospital were rated as inadequate overall as were the ratings for safe and well-led.
Effective was rated as requires improvement.
Inspectors also visited the children and young people’s services at Musgrove Park Hospital which were rated good overall as were the ratings for safe, effective, and well-led.
Catherine Campbell, CQC deputy director for operations in the south, said:
“During our inspection of Yeovil District Hospital, we found that the paediatric service lacked enough qualified and experienced staff during its busiest times to meet people’s needs. The trust had already identified this risk and, following our visit, took the proactive step of temporarily closing the Special Care Baby Unit and therefore inpatient maternity services in response to safety concerns and staffing pressures.
“There was also a lack of timely learning from significant incidents. While staff reported and investigated events, the lessons weren’t consistently applied to improve care or embed good practice.
“Child protection medical assessments weren’t always carried out by consultant paediatricians, as required. National guidance says these assessments should begin within 24 hours but between March 2023 and February 2024, only 89% of children were seen within this timeframe. Not all were assessed by paediatricians with appropriate child protection expertise, falling short of national standards.
“Management systems failed to respond quickly to known issues. Some staff felt excluded from decision-making and described a culture that lacked continuous improvement, with a focus on individual blame rather than learning.
“There was no clear system to track paediatric life support training especially for training completed externally though the trust is working to improve this.
“In contrast, at Musgrove Park Hospital, we saw a strong learning culture where staff felt safe to raise concerns and were actively involved in safeguarding.
“The department runs daily child protection clinics, seeing 16 to 20 individuals each month. Leaders encourage professional curiosity and recognise it as vital to protecting children. Staff recently showed outstanding use of this principle, with several examples formally recognised through excellence reporting.
“The team also managed environmental risks well. They completed daily checks on specialist equipment, with no lapses. All equipment was in-date, secure, and ready to use ensuring a safe environment despite the challenges of an ageing estate.
“Trust leaders understand what must change. The warning notice we’ve issued will help focus attention on the areas needing urgent and sustained improvement. We’ll continue to monitor these services closely to ensure progress and to keep children and young people safe.”
At Yeovil District Hospital Inspectors found:
• Consultant paediatricians or associate specialists did not see all children admitted with acute medical problems or those attending the emergency department within 14 hours, breaching national guidance.
• Staff did not always manage emergency situations effectively, although some systems and processes were in place to mitigate risks.
• The service introduced a daily emergency safety huddle to improve emergency preparedness.
• The service collaborated with local child and adolescent mental health services to provide integrated, holistic paediatric care, supported by a clear long-term vision and strategy.
• Staff included all critical information during shift changes and handovers to ensure child and young person safety.
At Musgrove Park Hospital Inspectors found:
• Staff regularly completed and updated risk assessments, taking swift action for children and young people at risk of deterioration.
• The joint mental health and paediatric service had a clear goal of medical and mental health integration.
• The trust began implementing Martha’s Rule, offering families a formal process to request urgent reviews when concerned about deterioration; however, implementation was still in early stages.
• Medical bleep holders covered widely spaced areas, causing delays in out-of-hours triage and treatment. Staff were required to walk between buildings, which sometimes resulted in unprofessional situations, for example, delivering difficult news to families while soaked from rain.
• The ward layout with individual cubicles made infection control challenging. Inspectors also noted black mould in a shared shower cubicle used by parents and young people.
Peter Lewis, chief executive of Somerset NHS Foundation Trust, said:
“We thank the Care Quality Commission (CQC) for their reports following the inspections of our paediatric services at Yeovil District Hospital (YDH) and Musgrove Park Hospital (MPH) that took place in January.
“The CQC has rated the paediatric service at YDH as inadequate overall and the paediatric service at MPH as good overall.
“We are working hard to address the safety, quality and fragility of the paediatric service at YDH. Our priorities are to provide an equitable service for babies, children and young people across Somerset, to recruit to key roles, and to ensure our paediatric services have strong governance processes and a positive learning culture.
“To achieve this, we are doing a number of things including:
- Designing and recruiting to senior paediatric roles across Somerset, that provide opportunities for candidates to specialise in either paediatrics or neonatology and will play a leading role in the improvement of the service.
- Looking at what we can learn from other providers, and
- Working through the steps and criteria that need to be in place for us to enable us to reopen the Special Care Baby Unit and inpatient maternity services.
“This is a very challenging time, but we are confident that we can build a stronger, more sustainable service for babies, children and young people in Somerset.
“I thank everyone who is working hard to achieve this, who is working differently through this difficult period and is supporting those whose care has been affected by the temporary closure of the Special Care Baby Unit and inpatient maternity services at YDH.
“We undertook to provide a formal review of the temporary closures after three and six months. This will provide updates on the impact of the temporary closures, and our work to improve the safety, quality and fragility of the paediatric service at YDH as we work to provide an equitable service for babies, children and young people across Somerset.”