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 staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last inspection, we rated this key question as Good. At this assessment, the rating has remained Good.

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.

The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

During our onsite visits, we reviewed a randomised sample of clinical records and noted people had an adequate record of medical history had been documented, with thorough clinical notes detailing their care, treatment, safety-netting and referral pathways as required.

Staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during consultations. Clinical staff used templates when carrying out care to support the review of people’s wider health and wellbeing. The service had effective systems to identify people with previously undiagnosed conditions.

All walk-ins to the MIUs received an initial assessment to determine the level of urgency of treatment. The outcome of which may lead to redirecting people to relevant healthcare services where required. The service carried out initial triage assessments within national guidelines measuring observations and risk assessed to determine further care and treatment pathways. People who booked into the service via NHS 111 had already undergone a triage assessment, including screening for red flag symptoms, which were reassessed by the MIU upon arrival. Staff were trained to assess and identify signs of deterioration in a person’s condition, including escalation procedures such as transfer to local emergency departments. A service audit between April 2025 to March 2026 showed a total of 1076 people assessed at Blandford MIU and 11,721 people assessed at Wimborne MIU, of which 83% and 82% of people at these sites were triaged and initially assessed within a 15-minute period. Although, the national key performance target for this standard is 95% for walk-ins, people could arrive at the service’s MIU either by walk-in or via pre-booked NHS111 appointment. The key performance indicator for a person arriving via NHS 111 booked appointment should be seen by a clinician within 30 minutes of their appointment time, without needing a secondary initial assessment. From the total number of people assessed at both MIUs demonstrated 100% of people at Blandford MIU and 98.5% of people at Wimborne MIU within this reporting period. The service also ensured any breaches of the 4-hour treatment target are escalated and reviewed by MIU leads. The Trust demonstrated effective oversight of each MIU assessment and treatment of people who attended the service.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

Staff followed trust policies and procedures relating to the service to ensure they provided the standard of care people expected. Staff had regular safety huddles where they discussed people’s needs and appropriate care and treatment plans in line with best practice and national guidelines. We saw evidence of clinicians delivering care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols. Clinical staff had access to guidelines from the National Institute for Health and Care Excellence (NICE) and used this information to help ensure people’s needs were met. Where gaps had been identified or where additional guidance was required, protocols had been developed and were subject to regular reviews to ensure ongoing relevance and effectiveness, such as the Trust’s ‘Safe to Wait Initial Assessment’ standard operating procedure and a locally agreed prescribing framework for people following temporary lower limb immobilisation.

The service had an induction programme for clinical and non-clinical staff which included information for training, appraisal and guidance for providing evidence-based care. Clinical staff had access to local care pathways and prescribing guidelines with the British National Formulary (BNF).

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Staff worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

Staff told us senior staff were available to discuss care and treatment concerns if clinicians needed advice. Staff could contact an urgent care consultant at the local acute hospital when they needed more specific clinical support.

Staff referred people to an appropriate service if they needed additional care and treatment following their visit to the MIU. Staff had good relationships with local GP services for the area they covered as well as local accident and emergency services and could access mental health support if needed. Staff held regular and effective multidisciplinary meetings to discuss people and to improve the consistency care.

Clinicians had access to radiologists daily via ‘hot reporting’ for radiological reporting advice for more complex musculoskeletal injuries. During our site visit, we were provided evidence to demonstrate Advanced Nurse Practitionershad been trained to interpret radiological images, such as x-rays, and local hospital radiologists carried out reports to ensure care and treatment plans remained appropriate to the diagnosed injury.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff provided people with information about healthy living and would encourage them to visit their NHS GP service or pharmacist for follow up support. Information packs were available on self-management advice following care and treatment provided at the MIUs.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. From the clinical notes we reviewed, we noted people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

A service monitored its unplanned follow-up attendances to ensure its care and treatment was appropriate for people. Unplanned follow-up rates, such as people returning unexpectedly to a MIU within 72 hours of discharge, is a national standard indicator of initial treatment effectiveness, diagnostic accuracy and safe discharge planning. High rates of unplanned follow-ups can indicate the intended clinical outcomes may have not been met on the first visit. For Blandford and Wimborne MIUs, a service audit between April 2025 to March 2026 demonstrated people who had attended the MIUs as an unplanned follow-up averaged approximately 2.1% for Blandford MIU and 0.7% for Wimborne MIU compared to the national target of 5%. This showed outcomes for people receiving effective care and treatment were better than national average.

People’s accessibility and communication needs were recorded in their clinical records. Staff incorporated checks for gaining consent about people’s wishes, mental capacity decisions, and any treatment escalation planning when assessing people’s care and treatment needs. Staff we spoke with were trained and understood the requirements of consent, adhering to the Mental Capacity Act 2005. Staff took all practical steps to enable people to make their own decisions about their care and treatment. Staff demonstrated they gave people information about other services they could receive treatment from if not appropriate to be seen at the MIU.