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Provider: Dorset Healthcare University NHS Foundation Trust Outstanding

Reports


Inspection carried out on 30 April 2019 to 4 June 2019

During a routine inspection

Our rating of the trust improved. We rated it as outstanding because:

  • We rated the trust outstanding overall because over the past four inspections we have seen a consistent pattern of progressive improvement in the quality of core services that is reflected in the ratings of these services.
  • We rated the trust outstanding overall for the key question is the trust well-led due to the inspirational leadership provided by the senior team. In rating the trust overall, we took into account the current ratings for the services not inspected this time.
  • At this comprehensive inspection (2019) we found the trust had made the required improvements in the safe key question to increase its rating to good.
  • We rated the trust as outstanding overall for the key questions are services caring and are services well led. In addition, we rated the trust good for safe, effective and responsive. We rated one out of six core services that we inspected as outstanding overall which was community health services for adults.
  • We were particularly impressed by the strength, knowledge and integrity of the leadership at the trust. They had a comprehensive knowledge of current priorities and challenges and took prompt action to address them. The board was visible and supportive to the wider health and social care system. Reports from external sources including NHS England/Improvement and commissioners were consistently positive. The trust had quality and sustainability as its top priorities.
  • We were also impressed with the trust attitude towards and application of innovation and service improvement. The delivery of high-quality care was central to the trust values and all aspects of running the core services. We got a true sense of the trust’s main focus was on providing care that truly benefited patients and carers and supported the wider system. There was a dedicated quality improvement (QI) team which engaged frontline staff and empowered and inspired them to use innovative means of improving services.
  • There was a strong learning culture within the trust and staff showed caring, compassionate attitudes, were proud to work for the trust and were involved in the development and improvements within the trust. Staff embraced and modelled the values and behaviours in both mental health and community health services. Throughout the trust staff treated patients and each other with dignity and respect. Staff morale was high in the services. Staff told us they felt respected, supported and valued by their managers and the trust. Staff used creativity to ensure patients were treat well and their care needs listened to.
  • Staff, patients and carers were actively involved in the development of the services, and the trust were creative in engaging all the relevant people. Senior leadership in the trust had good relationships with partner organisations and were engaging positively in the wider health systems. The trust had a mixture of highly experienced and new senior leaders with the skills, abilities, and a commitment to provide high-quality services. The executives and non-executives presented as a strong unified board.
  • Two of the wards for older people with mental health problems (Herm and St Brelades) had been awarded the Gold Standard Framework (GSF). These were the first older adult’s mental health unit in the country to receive this award. All community hospitals in the trust were GSF accredited. The GSF is a systematic evidence based approach to ensuring all patients approaching end of life receive the best possible compassionate care in the best possible place. This meant patients approaching the end of their lives on these wards could remain on the ward rather than be transferred to another place to receive this care.
  • The trust had effective systems and processes in place for identifying risks and how to eliminate or reduce them. Staff had training in how to recognise and report abuse and applied it. The trust had an innovative focus on reducing incidents of falls and pressure ulcers and were committed to improving services by learning when things went well or wrong. The pharmacy management leadership team ensured patients were safe and good governance was in place. Medicines safety risks were identified, actioned and shared appropriately within the trust and with external partners. Learning actions from medicines incidents and audits were shared across the trust.

  • Excellent governance arrangements were in place in relation to Mental Health Act (MHA) administration and compliance. One of the non-executive directors had a legal background and was highly experienced and chaired the MHA monitoring group. Minutes demonstrated that it covered an appropriate range of subjects including monitoring of MHA review report findings. The trust ensured they were responsive in their approach to issues raised within these reports. There was clear, robust and effective multi-agency working arrangements around the MHA. A regular programme of MHA audits took place. Where MHA audits had identified gaps in knowledge the MHA lead provided targeted training and support.
  • Trust premises were clean and well maintained although several buildings were not fully fit for purpose. There was an estates strategy in place and the trust had a clear idea of what needed to be done but planning permission was required for many the changes which was proving difficult to get due to the nature of the buildings. We saw during our core service visit that the gardens in Herm and St Brelades wards were not dementia friendly and unsafe in some areas. However, this was addressed quickly and funding made available to improve these areas further. Staff were clear on their responsibility to mitigate safety and ensure dignity of patients in shared accommodation. During our well led inspection we saw many improvements had already been made to these areas.
  • Staff at all levels worked well with each other and external organisations to provide care and treatment to patients based on national guidance. Staff generally kept clear records of patients’ care and treatment and confidentiality was maintained. Patients had access to psychological support and occupational therapy. The physical healthcare needs of patients within mental health services was excellent. Patients in community health services benefitted from outstanding care and support from staff.

However:

  • Recruitment in some areas (e.g. community CAMHS) remained a struggle. The trust was working creatively with commissioners to resolve this and the implementation of a new care model in CAMHS services should ease some staffing pressures.

  • A bed was not always available when needed on return to the acute mental health wards. There had been some inappropriate placements on the wards, due to the wards not having control over bed management.

  • There remained shared accommodation on one acute mental health ward and some of the older people’s mental health inpatient wards. Bedrooms and shared accommodation did have lockable storage facilities for clothing and possessions and the provider had taken action to mitigate the adverse effects of privacy or safety. Capital funding had been secured with a plan in place to remove all shared accommodation.


CQC inspections of services

Service reports published 31 July 2019
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Community urgent care services Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Wards for older people with mental health problems Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 30 April 2019 to 4 June 2019 During an inspection of Community health services for adults Download report PDF | 513.95 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
See more service reports published 31 July 2019
Service reports published 13 April 2018
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community health services for children, young people and families Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Forensic inpatient or secure wards Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Child and adolescent mental health wards Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community end of life care Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community-based mental health services for older people Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
Inspection carried out on 14th November 2017 to 6th December 2017 During an inspection of Community health inpatient services Download report PDF | 524.57 KB (opens in a new tab)Download report PDF | 4.18 MB (opens in a new tab)
See more service reports published 13 April 2018
Service reports published 26 July 2017
Inspection carried out on 3 May 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 215.27 KB (opens in a new tab)
Service reports published 24 February 2017
Inspection carried out on 14 December 2016 During an inspection of Substance misuse services Download report PDF | 278.02 KB (opens in a new tab)
Service reports published 7 September 2016
Inspection carried out on 15 – 17 March 2016 During an inspection of Community-based mental health services for older people Download report PDF | 254.48 KB (opens in a new tab)
Inspection carried out on 15 -17 March 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 281.38 KB (opens in a new tab)
Inspection carried out on 15 - 17 March 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 261.7 KB (opens in a new tab)
Inspection carried out on 15th -17th March 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 301.91 KB (opens in a new tab)
Inspection carried out on 15-17 March 2016 During an inspection of Community urgent care services Download report PDF | 291.94 KB (opens in a new tab)
Inspection carried out on 15th -17th March 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 264.49 KB (opens in a new tab)
Inspection carried out on 15 - 17 March 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 296.86 KB (opens in a new tab)
See more service reports published 7 September 2016
Service reports published 16 October 2015
Inspection carried out on 23-25 June 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 333.77 KB (opens in a new tab)
Inspection carried out on 23-26 June 2015 During an inspection of Community forensic mental health team Download report PDF | 276.4 KB (opens in a new tab)
Inspection carried out on 23-26 June and unannounced 9 July 2015 During an inspection of Community health inpatient services Download report PDF | 391.62 KB (opens in a new tab)
Inspection carried out on 23rd – 25th June 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 419.18 KB (opens in a new tab)
Inspection carried out on 23 to 26 June 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 353.4 KB (opens in a new tab)
Inspection carried out on 23-25 June 2015 During an inspection of Child and adolescent mental health wards Download report PDF | 292.17 KB (opens in a new tab)
Inspection carried out on 22 - 26th June 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 344.24 KB (opens in a new tab)
Inspection carried out on 23-26 June and unannounced 9 July 2015 During an inspection of Community urgent care services Download report PDF | 389.14 KB (opens in a new tab)
Inspection carried out on 23-25 June 2015 During an inspection of Community-based mental health services for older people Download report PDF | 351.11 KB (opens in a new tab)
Inspection carried out on 23 - 26 June 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 312.69 KB (opens in a new tab)
Inspection carried out on 22-26th June 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 379.45 KB (opens in a new tab)
Inspection carried out on 23-25 June 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 353.41 KB (opens in a new tab)
Inspection carried out on 23 -26 June 2015 During an inspection of Community health services for children, young people and families Download report PDF | 418.88 KB (opens in a new tab)
Inspection carried out on 23-26 June 2015 During an inspection of Forensic inpatient or secure wards Download report PDF | 324.96 KB (opens in a new tab)
Inspection carried out on 23 -26 June 2015 During an inspection of Community health services for adults Download report PDF | 386.28 KB (opens in a new tab)
See more service reports published 16 October 2015
Inspection carried out on 14th November 2017 to 6th December 2017

During a routine inspection

Our rating of the trust improved. We rated it as good because:

  • We rated effective, caring, responsive and well-led as good. We rated safe as requires improvement. Our rating for the Trust took into account the previous ratings of services not inspected this time.
  • We rated well-led at the Trust level as good. The senior team had led a very effective programme of improvement which had resulted in the majority of issues we had identified in our previous inspection being addressed.
  • The trust’s senior leadership team had the skills, knowledge, experience and integrity necessary for successfully overseeing a large, complex organisation.
  • We saw evidence of some excellent leadership at all levels across the trust with many dedicated, compassionate staff who were striving to deliver the very best care for patients.
  • Communication across the Trust had improved with the Board and senior managers being more visible to staff. There was also a noticeable improvement in the culture across the Trust, with increased openness and transparency and a clear desire in staff at all levels to learn and improve.
  • Staff within the services inspected were generally providing safe, effective, compassionate and kind care to patients.

However:

  • We rated safe as requires improvement. We identified a number of issues, some new and others on-going, primarily in relation to the safety of patients and staff at a smaller number of services. We require the Trust to take action to address those issues and will request an action plan from them to identify clearly how they will do so.

Inspection carried out on 1st February 2017

During an inspection to make sure that the improvements required had been made

We did not rate this service at this inspection.

The purpose of the inspection was to follow up the concerns raised at the Mental Health Act scheduled visit on the 23 January 2017 of Twyneham ward by Mental Health Act reviewers.

The concern raised from the Mental Health Act visit was patients who failed to attend the 9.00am meeting or groups held on the ward lost all or parts of their leave and that patients perceived the withholding of leave as punitive.

The concern about the restrictions on patients leave had been raised during a previous Mental Health Act visit in July 2015. Our concerns were thus known to the ward but no action had been taken to rectify this. On this previous visit the Mental Health Act reviewer had included references from the revised Code of Practice, which had introduced guidance on blanket restrictions.

The report in 2015 stated:

‘All patients were restricted from entering their bedrooms by them being locked on weekdays during the working day, other than for an hour at lunchtime.

All patients were normally required to attend a full daily group programme, or they would not be permitted to go out on ground or community leave. On the day of our visit this consisted of four groups of approximately 45 minutes a day for most patients.’

Following this inspection the trust stated in their action statement :

‘No service user who refuses to participate in their personalised group programme loses leave as a result of their non-participation or cooperation - .any such decision to rescind leave or restrict leave is based on factors other than the immediate presenting one of refusal to comply with their group programme. The decision is based on mental state examination, presence of identified relapse indicators or the presence of increased (known) risk factors.’

The Mental Health Act reviewers on their visit on 23 January 2017 found that those restrictions were still in place.

On this inspection (01 February 2017), we spoke with a range of staff and patients.

The four patients that we spoke with at this inspection and the four spoken with at the Mental Health Act reviewers’ visit in January 2017, were all unclear about the link between attending the morning meeting, the group therapy sessions and the restrictions on their leave. They told us that if they did not go to the groups they lost all or part of their leave and viewed this as punitive. They said that there was a three-stage warning system relating to their behaviour in the group and that if they received three warnings then they lost their leave. They said that the staff member in the team that made the decision about them going on the leave often was not one of the staff who took part in the group. They were concerned about the lack of information they received from staff about the restrictions on their leave.

We looked at information given to patients about their attendance at the groups in the handbook and in rules of the group and there was no information about the link between non-attendance at the groups and leave restrictions.

Staff members we spoke with were not clear about the link between the attendance at groups and leave and the decision making process. They told us they completed risk assessments about a patient’s current state of mental health if they did not attend groups. However, we could find no evidence in the care notes of risk assessments or rationale to rescind leave. Generally, risk assessments and care plans seen were not updated to reflect patients leave restrictions. Staff were unable to provide clear criteria for leave restrictions to ensure consistent working and decision making.

The consultant told us that he made decisions about leave and leave conditions and these were discussed at meetings of the multi-disciplinary team (MDT) following a review of the patient’s current health. The consultant stated that these decisions should not be changed without further discussion by the multi-disciplinary team. We saw these were reflected in the MDT notes in patients’ progress notes.

The consultant told us that he believed that there was a lack of communication within the wider team. Staff from a range of other professional groups also raised concerns about the management of the ward and the lack of effective working and communication within the staff team (across the range of professions).

On the 10 February 2017, we wrote to the trust detailing our concerns. We stated that patients and staff must have a clear shared understanding of the link between patient attendance at morning meetings and groups held on the ward and leave restrictions. We asked the trust to implement a policy that clearly identified how patients would be assessed and when and for what reasons leave would be rescinded. We stated that If there was any link between restricting leave and attendance at meetings, this must have a clear rationale and all staff and patients must understand this. All staff must receive training in how to apply the policy and who can make the decisions about restricting leave.

We asked the trust to forward the policy and provide assurance that all staff had an understanding of the policy and were applying it appropriately and assurance that all patients knew of the policy and had an understanding of how it would be applied and in what circumstances. We asked for this to be provided by the 24 February 2017.

The trust sent us an action plan to address our concerns on the 24 February 2017. The plan detailed how the ward manager had reviewed the policy and the plans in place to ensure clarity on rescindment of leave. A system was put in place whereby staff recorded when they had read the protocol and this was monitored by the manager.

On the 27 February 2017, staff and patients attended a training session about patients’ leave and the new protocol. They told us this was to ensure that all patients understood and were clear on the leave protocol. A copy of the attendance at the event was forwarded to us.

The trust was also in the process of updating the section 17 policy in line with code of practice. The deadline for completion was the end of March 2017 and the trust stated they would then forward the document to us.

As the trust acted promptly to address our concerns, we have taken the decision to take no further action at this present time. We will use this information to inform our future inspections and will return to the ward if we have any additional concerns.

We will return to the ward in due course to ensure the actions identified have been implemented.

Inspection carried out on 15th - 17th March 2016

During an inspection to make sure that the improvements required had been made

We found the trust had made improvements to the services where we had identified concerns during our comprehensive inspection in June 2015. However, the overall rating for the trust remains Requires Improvement as some of the work in services had not yet been completed.

Improvements were particularly evident in the minor injuries units and child and adolescent mental health services. Both of these had received a rating of Inadequate for Safe in our June inspection. Following this inspection, we have changed the ratings to Good overall for these services.

  • Urgent care services, which consisted the minor injuries units, had improved greatly. Staffing had been reviewed and there was no longer any lone working in the units. Safe systems of work had been introduced, including triage procedures and medicines management. Staff training and support had been improved. A senior professional minor injuries unit lead had been appointed to oversee the transformation. Staff felt engaged with the improvements and felt that leadership had improved.

  • Child and adolescent mental health services now considered risk at every point in the child’s pathway through services; this was evident in team meetings, records and from family members. Waiting lists were monitored and staff were enthusiastic about the changes and fully engaged in the improvements to the service.

Improvements were also found in the older people’s mental health wards and the long stay rehabilitation wards which led to their ratings also being changed to Good.

  • The trust had addressed concerns around privacy and dignity in older people’s mental health wards. This included addressing the culture on the wards as well as the environments. Staff were warm, kind and respectful when interacting with patients.

  • We found a full and comprehensive programme of therapeutic, recovery focussed activities across the long stay rehabilitation wards of Nightingale Court, Nightingale House and Glendinning ward. Glendinning ward had created a new arts and crafts room and had audited the success of its patient led activities program. Activity plans were patient led and designed around personal needs and choices. However, there were still some environmental concerns on the long stay rehabilitation wards that had not been addressed.

However, community mental health services for adults of working age, older people and the crisis teams had not made as much progress. Although some progress had been made, many of the issues that we had found previously were still present. The ratings for these services remained the same as Requires Improvement.

  • The community mental health teams and crisis team still had challenges with staffing and relationships between them still needed to be improved. Record keeping still had gaps. There was an action plan by the trust in place to address this and the trust has kept us informed of further progress since our visit. There had been progress in some areas including the introduction of a new crisis line and a staffing review which identified shortfalls in team sizes which was being addressed.

  • Community mental health teams for older people also had inconsistent record keeping. We were concerned that application of the Mental Capacity Act was not embedded in practice. Teams still worked in isolation and practice and elearning was not shared. However, a strategic review of older people’s mental health services was being undertaken and caseload sizes had been reduced.

We were unable to rate the key question of whether the crisis team and health based place of safety were Safe due to our methodology on this focussed return visit.

The trust had made considerable progress since our last inspection however the lack of progress in community mental health services meant that although four services had their ratings changed to Good, the overall trust rating of Requires Improvement remains the same.

We will continue to monitor the trusts actions to address those concerns.

Inspection carried out on 23 -26 June 2015

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Overall, we rated the trust as requires improvement because:

  • The services that the trust provided varied in their quality. We had particular concerns about the child and adolescent mental health services, minor injuries units, and mental health crisis and rehabilitation services. We found some significant variance in the quality of care delivered between teams and across the trust.
  • The child and adolescent mental health services (CAMHS) in Weymouth and Portland and in Bournemouth and Christchurch did not assess risks to young people waiting for assessment or treatment effectively. Also, the teams were unable to meet the waiting time targets because of the number of vacant posts and staff who were on sick leave.
  • At Weymouth, Portland and Bridport minor injuries units there was a lack of clinical leadership. There was no clearly defined system for triage and clinical assessment of patients arriving at the units. This meant that the service was not assessing and responding to potential risks, and patients could be waiting for some time without clinical assessment, when possibly needing urgent or more acute care and treatment. This was not in line with the trust’s service operational policy or national guidance. In addition, there were staff shortages and a lack of an appropriate skill mix across the service, and on occasions agency staff were working alone without adequate support or induction.
  • We found conflicting and contradictory evidence about staffing and sickness levels in the east Dorset crisis team. However, we found evidence to indicate that staffing issues had a marked adverse effect on the team’s ability to provide a robust home treatment service.
  • The telephone call management systems, set up specifically to deal with calls at night, did not function effectively and patients experienced difficulties accessing the east Dorset crisis team if experiencing a crisis, posing a potential significant risk.
  • At Nightingale House and Nightingale Court patients were not able access comprehensive rehabilitation programmes in the community; they were unable to do their weekly shopping and cooking. During the inspection we saw that some patients on these rehabilitation wards spent much of their time smoking rather than engaging in meaningful activities. There were high levels of detention under the Mental Health Act on all rehabilitation wards and some patients had been detained on the wards for a considerable length of time which is unusual on rehabilitation wards.
  • We found inconsistencies in the planning and delivery of a number of services across the trust.
  • There were deficiencies in monitoring and checking safety and emergency equipment across older people’s mental health services and in inpatient wards in community hospitals
  • The quality of patient records in community health services was variable. A combination of electronic and paper patient records were in use where care was delivered in patients’ homes. In community health care inpatient services, records were stored securely on SystmOne. However, there were inconsistencies within SystmOne due to how it had been set up, which meant that staff had limited access to some parts of the system as patients moved across services and not all agency staff had access it.
  • The governance frameworks did not always operate effectively for minor injuries units. There were insufficient processes for proactively identifying, assessing and managing risks and seeking staff views. There was insufficient auditing of quality or learning across the service.

However:

  • The trust responded very quickly and positively when we raised concerns about the risk assessment process for children and young people on waiting lists in the Weymouth and Portland and Bournemouth and Christchurch child and adolescent mental health services and took prompt action to review and reduce the highest risks. The trust drew up an action plan to review all waiting lists, caseloads and the risk assessment process, and has kept us updated on the positive progress with this.
  • The trust responded quickly and positively when we raised concerns about the safety of services delivered in Weymouth and Portland minor injuries units. It assured us that only experienced clinicians would work at these units and that if safe cover could not be found the units would close. All units would have a band six nurse at all times as a minimum. The trust also told us that it is considering how it could provide band 7 shift leaders in each unit. The opening hours at Portland would be changed, with no weekend working, and there would be receptionist cover during opening hours.
  • There was visible and positive clinical leadership at Blandford and Swanage minor injuries units, which resulted in a locally well led and well organised service.

In addition:

  • We observed outstanding care and treatment in both inpatient mental health services and the forensic community services.
  • In inpatient mental health services we found that the model of care and acute care pathway optimised patients’ recovery and that there was a strong emphasis on recovery-orientated therapeutic programmes, many of which were instigated by patients.
  • The forensic community Pathfinder service worked with patients with a personality disorder who were at risk of offending to improve their outcomes and at significantly lower cost than being in hospital. The service was psychology led and worked with patients around their risk behaviour. The staff within the community forensic services went out of their way maintain contact with patients placed on wards out of the area and worked hard to bring patients back into the area as soon as they could, including supporting the maintenance of relationships with relatives.
  • The trust had a relatively new board (executives and non-executives), with the majority having been appointed only since the arrival of the chief executive in 2013. The director of nursing had been in post for ten months before our inspection and a new medical director was due to take up post immediately after our inspection. The leadership team was positive, passionate, energetic and open and transparent. We concluded that they were a cohesive team who respected one another and shared a common purpose.
  • The executive team, along with the senior managers, were aware that the trust needed to improve and we found that, despite many of them only recently coming into post, they had been very active in working quickly to address and identify issues. They had engaged well with staff, developing a new vision, ‘to lead and inspire through excellence, compassion and expertise in all we do’, which was underpinned by the principle of doing ‘better every day’. In addition, they had engaged positively with stakeholders, an aspect for which the chief executive had taken specific responsibility.  This included creating active relationships with the clinical commissioning groups (CCGs), NHS England, local authorities, and visiting groups of GP's.  They had been successful in changing attitudes and fostering positive relationships – so much so that commissioners and other stakeholders now held the trust in high regard and were positive about the future, whereas previously they had held a very different view. It was clear that there was a cohesive strategy based around driving improvements in clinical practice and working in partnership with patients, staff and stakeholders; we saw clear evidence of this in several areas across the trust.
  • We found that the trust had developed an impressive, high quality and detailed governance system to support it to achieve its vision and this was in the process of being rolled out, although it was not yet fully embedded across all services. We found those systems were robust and we were confident that, given time, areas of concern could be identified speedily and managed well.
  • In addition, the trust had recently moved to a locality-based delivery model to promote integration of both physical health and mental health services. This model was in the early stages and was developing well for some services but not so well for others, resulting in some variation in the quality of services and some services feeling fragmented as a result. For example, staff felt there was now a lack of strategic focus for people with functional illness across older people’s community services. Staff questioned whether the child and adolescent mental health service was too small to be split across localities and they felt that there was insufficient leadership of urgent care services.
  • We found good practice across the services that we inspected, with a caring, enthusiastic and committed workforce that in the main treated patients in their care with dignity and respect.
  • Although we found some care that gave us cause for concern, as identified above, throughout the inspection the trust was very receptive to any comments that we made and we saw immediate and appropriate action taken when we raised a concern.
  • We have not taken any enforcement action and are confident that the trust will quickly address all areas of concern identified in the requirement notices detailed in this report.

We did not provide a rating for the 'safe' domain for the mental health crisis and health based places of safety core service due to conflicting and contradictory evidence which meant a definitive, robust judgement could not be made.

Dorset HealthCare University NHS Foundation Trust requires improvement. However, we saw that it was well led by its new leadership team and was in the process of deploying effective systems that we were confident would result in the delivery of improved, high quality services for the patients it serves in the future.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

 

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.