Dorset Healthcare University NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that young people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good.

• Young people could get involved in a range of activities. However, managers could not consistently track young people’s participation and outcomes and, since our last inspection, the trust had not built upon previous outstanding work to involve young people within the community and local businesses.
• Individual care plans were developed with young people, which were reviewed regularly through multidisciplinary discussion and updated as needed.
• Staff assessed the physical and mental health of all young people on admission.
• Staff provided a range of treatment and care for young people based on national guidance and best practice. The ward team included or had access to the specialists to meet the needs of young people on the ward.
• Staff from different disciplines worked together as a team to benefit young people.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 5 care and treatment records during the inspection. Staff had completed a detailed mental and physical health assessment of the young people after admission. Staff gave young people and their families an information pack which included useful information about ward routines, banned items and visiting times.

Care plans were personalised, looked at all aspects of care and treatment and contained goals for the young people to achieve. Staff wrote care plans in a way that young people could easily understand. Many young people had contributed to their content and presentation. We saw copies in the bedrooms so young people could refer to them easily. We saw that staff updated care plans promptly and regularly.

We spoke to staff who knew the young people and their care plans in detail. We heard that staff were knowledgeable and motivated to help young people achieve their treatment goals. We saw staff interacting with sensitivity, compassion and support, when a young person hesitated and became anxious when trying a new activity.

However, one care record contained a lot of information and it was difficult to find some risk documentation. This meant staff took longer to access urgent information for that young person. Managers were working to find a solution.

Responsible clinicians clearly knew the young people on the ward very well. They used this to review treatment plans, including medication and were able to provide examples of how this was effective.

Staff supported young people to access physical healthcare, including specialists when needed. Training records showed staff had the skills needed.

Staff provided a range of care and treatment interventions. These included psychological, art, music and family therapies, as well as medicines.

Managers had renamed a talking therapy ‘Acceptance and Change’ to help young people understand its method and aims. We saw it was supported with a wall presentation area with quotes from young people and staff. Most staff had been trained in supporting the therapy and there were now regular individual and group sessions. Managers told us young people and staff used this therapy to work towards meeting their treatment goals and to reduce harm and the need for restraint.

Mental Health Act

On the day of our inspection, 87% of staff had received training in the Mental Health Act.

Staff explained to young people their rights under the Mental Health Act in a way that they could understand, repeated them as required and recorded that they had done so.

Staff ensured that young people were able to take Section 17 leave (permission to leave hospital) when this had been granted.

Young people had easy access to information about independent mental health advocacy.

We observed a ward meeting where staff shared safety information about young people to improve the quality of the care they provided. Staff also held regular multidisciplinary meetings, including weekly reviews of care plans. We accompanied a weekly ward review and saw that staff confidently shared their own updates and ideas. Staff involved the young people in these meetings by asking them to write feedback beforehand or be there in person.

There was a ward transition team who help plan discharges and supported the young people and their families for 6 weeks after leaving the ward. The team were involved from admission and had effective working relationships with others that improved ongoing care for young people when they left the ward.

The ward provided a range of indoor and outdoor recreational and therapeutic spaces. Young people had access to a pool table, lounge, TVs, films and projector, games consoles, board games and books. There were also music, art and hairdressing areas. There was a large garden with decking, grass and seating. There were areas to play table tennis and basketball. There was an indoor and outdoor gym. Young people’s gym routines were displayed and staff had created a running group.

Young people could cook in the kitchen and we saw a parent bring food in and help their child cook a halal meal. The main food for the ward was cooked offsite and brought to the ward daily. This included a varied menu of meals that could meet young people’s dietary needs including vegetarian and halal food. However, one young person was not satisfied with the halal food provided and brought their own food in.

There was a sensory room that provided a low-stimulus environment.

Therapeutic activities were available individually or in groups and were included in young people’s care plans. Examples included music and art‑based sessions.

A therapy dog visited weekly.

The young people were allowed to use mobile phones in their bedrooms until 10.30pm, when they were handed in to encourage a balanced use.

There were board games available for the young people to play but they were stored in locked and unmarked cupboards. This meant young people were not always aware that they could be requested. The young people told us they had requested staff involve them more in playing board games.

However, some young people told us access to the garden was restricted at night. Managers told us this was not the case but some young people did not realise they could ask to visit the garden area, even when it was dark.

We saw that staff used recognised tools to assess and record risk, symptom severity, and clinical outcomes.

Staff we spoke with demonstrated a clear focus on achieving positive outcomes for young people. We reviewed examples of how staff had supported young people to work towards their individual goals.

Staff described examples where young people had engaged in structured ‘Acceptance and Change’ therapeutic work and had made measurable progress towards their agreed goals. Staff told us that therapy supported improvements in young people’s emotional and physical wellbeing.

We reviewed information about the average length of stay on the ward, which was 184 days. While a small number of young people had been admitted for extended periods, most had a stay of between two and three months before discharge.

However, managers and staff did not routinely record all activities that had been changed or cancelled. This meant the service could not consistently track participation, when and why activities were cancelled or evaluate the effectiveness of the activity programme.

We reviewed care and treatment records and saw examples where staff had assessed and recorded young people’s ability to make decisions when they were admitted to the ward. Records showed that staff checked young people’s understanding of decisions that affected them, assessed their capacity to consent on a decision‑specific basis and recorded their views appropriately. Where young people lacked capacity to make certain decisions, staff made these decisions in their best interests and took account of their wishes, feelings and individual circumstances.

Care and treatment records also included information reminding young people of their legal rights and the support available from advocacy services.