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 outstanding. At this assessment the rating has changed to good.

• Leaders promoted high-quality, person-centred care and fostered a positive staff culture for the benefit of young people.
• Staff felt supported and valued by leaders.
• Leaders worked to improve the quality of care delivered.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us they worked with staff to promote a culture focused on supporting young people to enjoy meaningful and fulfilling lives. Staff reported that they enjoyed working within the team and described a positive team ethos.

Leaders recognised good staff performance and provided open praise when appropriate.

Leaders demonstrated the skills, knowledge and experience needed to carry out their roles. They had a clear understanding of the services they oversaw and were able to explain how teams worked to deliver high‑quality care.

Leaders and staff aimed to remain close to young people and were described as visible and approachable to both young people and colleagues.

Staff reported feeling valued and supported by leaders. For example, senior leader visited and supported staff following serious incidents and tools were used to monitor and support staff wellbeing after incident debriefs.

Young people and carers told us they had opportunities to provide feedback about the service in ways that reflected their individual needs. Leaders and staff had access to this feedback and used it to inform improvements. For example, following staff feedback, a dedicated staff rest area had been requested. Leaders had identified a room to use that was being refurbished for staff to use at the time of our visit.

Staff reported feeling confident to raise concerns within the ward or the wider organisation and were familiar with the process for doing so. They described positive changes being made as a result of speaking up. For example, following a serious incident, a senior leader now visits the ward to check directly on staff welfare.

Leaders supported working towards an inclusive and fair culture by improving equality and equity for staff.

Staff could apply to adjust their working hours. For example, to account for personal circumstances such as caring responsibilities and health needs.Leaders had implemented reasonable adjustments for some staff members to support them to carry out their job, for example flexible working arrangements.

There was a clear framework outlining the topics to be discussed in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and reviewed.

Leaders maintained a risk register at ward level, so staff were aware and could see how to manage those risks safely. They had access to information to support them in carrying out their role, including data on training, staffing and young people’s care outcomes.

Staff valued the work of the transitions team, which supported the planning and coordination of transfers of care.

Young people and staff met or had opportunities to give feedback to leaders.

Staff understood the arrangements for working with other teams, both within the trust and externally, to meet the needs of the young people. For example, we heard from leaders that multi-agency meetings with other professionals were requested when needed.

Leaders told us that the trust responded promptly to information requests from other agencies to help manage wider risks. Leaders met with police to support effective joint working and to plan for managing risks.

However, leaders also reported unresolved concerns about joint working with some external professionals. For example, following an incident when staff had been hurt while escorting a young person in the community, there had not been any multi-agency review feedback received about what had happened, to share learning. This meant the same risks to staff may be unnecessarily repeated.

Mangers gathered staff feedback through surveys and had made several changes in response. These included publishing a staff wellbeing booklet and a flowchart outlining available support options and how to access them. They had introduced a compliments box on the ward and read out praise and comments at team meetings. Staff wellbeing had been added as a regular agenda item to team meetings. Mangers completed a wellbeing tracker following incidents and each member of staff now had an agreed personal wellbeing support plan. Reflective supervision had also been introduced. Staff had been trained to deliver debrief sessions following incidents.

The ward has been accredited by the Quality Network for Inpatient CAMHS (QNIC). QNIC is a national quality network for inpatient children and young people’s services run by the Royal College of Psychiatrists and designed to improve the quality of care in CAMHS inpatient services.

Staff had opportunities to take part in research and were supported to undertake study or qualifications that could enhance the care provided to young people.

Leaders had used quality improvement approaches, including reviewing restrictive practices, developing ‘Mutual Expectations,’ introducing talking therapies into care plans to help reduce restraint and implementing initiatives to improve staff wellbeing and strengthen the culture of care.