Dorset Healthcare University NHS Foundation Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.
At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant the service was well-led. Leaders and the developing culture they promoted high-quality, person-centred care. However, the governance of the ward needed to be further developed.
 

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders were working with staff and an external stakeholder to develop a shared vision and culture based on transparency, equity, equality, human rights, diversity and inclusion, and meeting the needs of patients. Staff told us there had been significant changes on the ward following enhanced oversight from the provider collaborative, and although some found these changes unsettling, they recognised improvements and reported that the ward environment had become more positive. Staff described a culture that supported learning and development, including reflective practice sessions and staff development days focused on psychological safety, professional boundaries and healthy team functioning. The wards presented as calm and relaxed and patients said it was mostly like this.
However, some staff told us there were still tensions between the multidisciplinary team and ward staff, which had previously affected communication and confidence in raising concerns. Other staff felt these issues had largely been resolved. An external provider continued to monitor the service, and the ward had implemented an action plan to address concerns about relational security and professional boundaries. These were discussed in away days and staff made changes to the communication between the staff groups in meeting, one to ones and MDT. Not all the staff team were at the staff meeting on the day of inspection but those present were positive about the changes made.Following the inspection, a series of staff meetings were held to further explore and understand the staff culture.

Staff at the inspection told us that leaders at all levels were visible, approachable and supportive. The ward manager was based on the ward and readily accessible to staff, enabling concerns to be raised and addressed promptly. Many staff described feeling supported by their immediate manager and by the wider senior leadership team, who were regularly present on the wards and engaged with frontline staff.
The ward manager had significant experience within the service, having previously worked as a nurse and care coordinator on the ward before stepping into the managerial role two years ago. The multidisciplinary team was established and included the ward manager, senior nurses, consultant psychiatrist, consultant psychologist, assistant psychologist, occupational therapy staff, activities coordinator and social worker.
Senior leaders demonstrated strong clinical credibility, with all members of the senior leadership team being clinicians who had experience working in secure services. Staff told us this enhanced leaders’ understanding of the challenges faced by the workforce and contributed to a culture of compassionate and informed decision making.
However, not all staff expressed the same level of confidence in the ward manager. Some members of the ward team, described tensions within working relationships and differing views about communication and decision making on the ward. For example the compliance rate in the 2024 survey was low and staff said they did not all feel they could comment freely on the management of the ward. There were concerns about confidentiality and favouritism. Leaders were aware of these concerns and had begun work to address them through increased visibility, facilitated discussions and strengthened supervision structures. Staff told us that these issues were being acknowledged openly and that progress was being monitored through governance and clinical effectiveness meetings.
We saw evidence of leadership competency, development and succession planning. Senior leaders had received training in quality improvement methodologies, and the organisation had delivered staff development and away days to increase leadership visibility, strengthen engagement and support continuous improvement. Leaders recognised that cultural improvement was ongoing, and learning was being shared across teams to support a more cohesive and collaborative working environment.
Recruitment processes ensured that leaders met fit and proper person requirements, and there were clear structures in place for reporting, oversight and leadership development. Systems supported succession planning and the ongoing development of managers at all levels.

A Freedom to Speak Up Guardian regularly visited the ward, providing drop in sessions and staff were aware of the process for raising concerns. Senior leaders and staff acknowledged that historically the culture had not always been fully open, with some staff previously expressing concerns about confidentiality and perceived favouritism. In response, the manager had introduced separate reflective practice sessions, staff development days and team meetings to encourage open discussion and support staff to raise concerns. Staff present during the inspection told us they now felt more confident raising issues outside of formal supervision, and there was evidence of a positive shift toward openness and transparency.
However, some staff told us they remained apprehensive about raising concerns and were not confident that action would always be taken in response. Following the inspection a series of staff focus groups took place to explore these issues further and support continued improvement in the ward culture.

The ward valued diversity and promoted equality and equity for staff. Mandatory training included equality, diversity and human rights modules, with compliance at 90% at the time of inspection. Managers put reasonable adjustments in place to support staff in carrying out their roles safely and effectively. For example, shift patterns were adapted to help staff meet caring responsibilities, and flexible working arrangements were supported where needed. Staff were also provided with individual adjustments based on their health needs.
A staff member with inattentive ADHD received regular breaks and access to additional ventilation, and pregnant staff were exempt from participating in restraints to ensure their safety. The ward arranged supernumerary clinical and administrative days to help manage staff exhaustion.
There was equality monitoring of the workforce to ensure the staff group was diverse and reflective of the patient population. These measures demonstrated a commitment to creating an inclusive and supportive working environment that recognised and responded to individual needs.
 

We identified some concerns regarding governance processes during the inspection. Cleaning records were not consistently completed and could not demonstrate that all areas of the ward were cleaned regularly. For example, the mattress cleaning audit had not been completed since May 2025. There was no clear record showing how often the seclusion room had been cleaned, including mattresses and bathrooms. During the inspection we also observed environmental issues such as clutter on the ward, paper on the floor in the clinic room, and full bins in shared bathrooms.
We also found gaps in medicines governance. Temperature monitoring records for medication fridges were incomplete, with gaps of up to four days in some records. Calibration solutions for blood glucose monitoring equipment were not dated when opened, meaning staff could not be assured that equipment was being used safely. The clinic room couch had not been serviced for over a year.
Some environmental and estates issues had remained unresolved for extended periods. The ward manager had logged several maintenance requests, including locks on cupboards in the occupational therapy kitchen and privacy screens, with some outstanding for more than 30 days. Refurbishment works to shared bathrooms had also been ongoing for several months.
However, the service continued to receive enhanced oversight from an external stakeholder following previous concerns relating to relational security and professional boundaries. The ward remained under enhanced monitoring and had developed an action plan. Performance against this plan was monitored through regular governance and oversight meetings with senior trust managers. The trust told us they were aware of all the issues identified during the inspection and already had an action plan in place to address them.
The ward had systems in place to monitor quality and performance. Incidents, complaints and safeguarding concerns were discussed at team meetings and nursing handovers and reviewed by senior leaders to identify themes and learning. Ward managers monitored performance through key performance indicators including incidents, restraints, complaints, compliments, mandatory training, supervision and appraisal rates. The service used a quality dashboard which enabled managers to monitor performance and identify areas requiring improvement. Staff told us the electronic patient record system supported them in their work, and there were systems in place to manage fire safety, ligature risks and medicines management. Staff we spoke with were aware of the high risk areas of the ward and knew how to access relevant risk information.
Following the inspection, the trust provided additional information to indicate that many of the issues identified during the inspection were already known to the organisation and were being monitored through internal governance processes and the ongoing oversight arrangements with an external stakeholder.
 

Patients that we spoke with said that they were able to maintain links with services in the community such as community forensic teams. Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.
Senior leaders regularly engaged with external stakeholders, such as the provider collaborative and commissioners. The Collaborative expressed concerns about the ward being isolated and work was underway to address this.
The advocates attended the ward and were invited to patient meetings and the senior leadership team meetings. Advocacy information was widely available on the wards and advocates were provided with confidential spaces to meet with people.
Community meetings took place regularly on each ward. Advocates regularly attended the ward and senior leaders and ward staff were supportive of the service.
 

Ward managers and staff described their developing systems for reporting and investigating incidents to ensure debriefs were offered to staff, feedback was shared and safety improvements were made in response to lessons learned.
Staff gave us examples of an improvement made due to lessons learned following an incident
Managers had visited other forensic services to gather insights and had increased wages of paid patient roles.
Cultural improvements were underway with assistance from the provider collaborative
Senior managers told us about the patient engagement lead role which was focussed on engagement with staff at all levels after action reviews. There was also a piece of work to involve staff in incident simulations as some new staff had never encountered aggression. Some ward managers were not engaged with or aware of the drivers for improvement at the trust, for example previous CQC findings or the recommendations from external reviews.