Dorset Healthcare University NHS Foundation Trust

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question 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 had a positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We reviewed a sample of patient safety events and identified the service had investigated incidents appropriately.

The service reported notifiable information via national reporting systems. For example, adverse medicine reactions for people who attended minor injury units (MIUs) for minor illnesses as well as incidents involving people. Staff could tell us what incidents to report and knew how to use the trust’s incident reporting system. Staff recognised and reported incidents correctly when they needed to. Learning from incidents specific to the minor injury units (MIUs) was shared across each MIU site. For example, the service had reported incidents relating to faulty equipment and software to view radiological images, or x-rays at Swanage Hospital. As a result, each MIU run by the Trust also reviewed their servicing and equipment arrangements to ensure these remained in working order and reduce the chance of the same incident occurring at another site.

The senior team at each hospital within the Trust met weekly to discuss aspects of the quality improvement plan and risk register relating to the MIUs. Managers communicated actions taken against each risk via team meetings and education sessions.

The service worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services. The Trust’s minor injury units (MIUs) we visited operated with a walk-in service for the public. NHS 111 could also book appointments for people into the service. Reception staff could check people in the waiting area until a clinical member of staff could review them as part of an initial assessment. When needed, staff could signpost people to other non-emergency services, for example, pharmacy. Staff would also monitor people closely in a private waiting area if they needed an ambulance to transfer them to a hospital’s emergency department.

The service had processes to ensure referrals such as radiological images (x-rays) were managed in a timely way to inform care and treatment. The service provided examples of collaborative working, such as with the local emergency departments to determine the effectiveness of onward referrals to assess and raise concerns with people’s NHS GP service following care and treatment. Systems were designed to ensure continuity of care and safe transitions between services. The service used integrated platforms such as NHS recognised clinical systems, GP Connect, and Summary Care Record to share accurate information.

There were safe systems to ensure people were clinically assessed and treated in a timely way. The service developed systems and clinical pathways to ensure staff had clear protocols to treat people and, where required, referred to external healthcare partners. The service had developed relationships with local organisations to ensure there was feedback on referrals and case reviews for learning. This included providing advice information data sheets and leaflets for self-management following treatment. Information was shared with staff and other healthcare organisations to enable them to deliver care. Delays in onward referral such as emergency departments were monitored, and audits were carried out to ensure the person's own GP had been reliably notified of any urgent primary care actions, in addition to the standard post-event message.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

There were designated safeguarding children and adult leads at the service. There were monthly multi-disciplinary meetings where safeguarding and managing vulnerable people’s care was discussed and these were attended by members of the senior leadership team. Systems were in place to appropriately refer people to the local authorities and information was shared amongst community teams where required. Safeguarding and chaperoning policies were in place and accessible to staff, who were trained appropriately to their role.

We reviewed a sample of people’s records as part of our onsite visit and found clinical records noted how people were to be supported to remain safe. For example, the service coordinated vulnerable people’s care and treatment concerns with their NHS GP practice as part of a multi-disciplinary approach.

The service worked with people to understand and manage risks of their care and treatment holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff triaged all people when they arrived at the MIU and staff discussed potential risk factors with them. Clinical staff then reviewed risk factors with people when they were treating them. If a person presented with an issue the MIU could not provide treatment for, they would refer them to an appropriate service, for example, the local accident and emergency department or to a local mental health service.

There were systems and processes to monitor, escalate and manage deterioration in people’s health. The service carried out audits to review National Early Warning System (NEWS) and Paediatric Early Warning System (PEWS) scores to ensure clinicians responded safely to deteriorating symptoms.

The service used electronic post-event message (PEM) correspondence to share information with in-hours GP practices, which included safeguarding and consultation records.

At this assessment, the service showed improvements had been made to identify risks and early deterioration of symptoms of people in the waiting areas through the implementation of CCTV cameras, with appropriate signage informing people recording was in operation. All waiting areas gave practitioners a clear view of people waiting to be treated to identify risks and early deterioration of symptoms. Staff were trained to support identification and treatment of people with deterioration of symptoms.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service recorded health and safety related risks on their risk register and improvement plan. Equipment specific to the service was regularly risk assessed, tested, calibrated, stored safely and well-maintained, such as fire extinguishers, oxygen cylinders and equipment requiring portable appliance testing.

Fire safety procedures had been managed in line with national guidelines. Fire safety measures were managed and regularly reviewed, such as fire extinguisher servicing; emergency lighting servicing and gas safety checks. All of which was recorded within the service’s fire policy.

The service had a business continuity plan which was monitored and reviewed regularly. Staff environmental risk assessments had been carried out and there was a regular review of these to ensure compliance with UK legislation.

The Trusts’ estate and facility team routinely monitored premises risk assessments and carried out audits to demonstrate compliance. Outstanding actions and risks were shared with the health and safety committee for oversight of each hospital site within the Trust. For example, quarterly meetings were held with representatives, along with authorising engineers, to review electrical installation condition reports and implemented actions advised across all service sites.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff we spoke to said there were enough staff with the right skills on duty and that managers would help if they needed extra support in providing care and treatment. Staff also told us the service ensured staff were supported in their roles through supervision and development through appraisals. The service carried out audits to demonstrate the competencies of interpreting radiological imaging, such as x-rays, as well as prescribing practices for minor illnesses, stings and bites.

Both of the MIUs we visited during our assessment were supported by a combined clinical team covering both sites. Clinical staff comprised of 5 advanced practitioners; 5 nurse practitioners and 3 health care assistants, who assessed, treated or, referred, and safely discharged people presenting with minor ailments and injuries. Staff rotas were completed with oversight of cover where required, so should a clinician be absent at short notice, bank staff arrangements were in place to ensure same-day appointments were covered by another clinician. Improvements had been made since the last assessment relating to the prevention of lone working. Each MIU site now ensured there were at least 2 clinical staff, which may include a Healthcare Support Worker, working during opening hours to prevent the potential risks created by the absence of immediate colleague support. Processes had been implemented to record lone working as formal incidents.

Staff received a formal induction relevant to their role and responsibilities and were supported through ongoing appraisals. There were systems to monitor staff training compliance, and 85.9% MIU staff had completed mandatory training in line with service policy. This data was inclusive of permanently employed staff only and excluded any bank staff, those on maternity or long-term sickness and new starters of less than 3 months employment. There were processes to ensure ongoing training, education, and clinical supervision was provided to support staff in maintaining current skills and competency. In response to the mandatory training completion rates, leaders told us Immediate Life Support (ILS) and Paediatric Life Support (PLS) compliance had been discussed in governance meetings, following recognition of the previous training provider unable to meet the needs of MIU teams. A new provider had been commissioned, with a priority focus on ensuring all staff achieve compliance at the earliest opportunity. All outstanding staff members had courses booked for completion by the end of July 2026.

Recruitment was managed centrally by the Trust’s Human Resource team. All recruitment and HR records were kept in-line with service policy and Schedule 3 requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a review of the Trust’s recruitment checks in relation to 2 members of MIU staff and information was available and up to date in line with service policy.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and were aware of how to share concerns with appropriate agencies where appropriate.

The Trust had an infection prevention and control (IPC) lead along with supporting leads at each community hospital site, with policies and audit checks carried out in relation to cleaning records and hand hygiene. Audits were carried out monthly which demonstrated 100% compliance across both MIU sites we visited. The service provided further education to staff in relation to IPC and re-audits were conducted in line with policy timeframes. Staff were aware of IPC procedures in place to ensure cleaning standards were adhered to, such as bodily fluid spillage kits, Control of Substances Hazardous to Health (COSHH) and Personal Protective Equipment (PPE). The service provided evidence of records to ensure identified risks had been mitigated, such as clinical waste arrangements. Where any IPC issues had been identified, there was a process to identify and allow for remedial actions to be taken against shortfalls.

The service made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the administration and recording of medicines. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Staff followed the Trust’s policy when prescribing and administering medicines. Staff had access to people’s records via electronic record systems which meant they could see what medicines other services had already prescribed the person, to inform safe treatment decisions.

Medicines were stored securely and the service held appropriate emergency equipment and medicines. The service maintained appropriate fridge temperature records where vaccines were being stored, and cold-chain protocols were followed. Staff regularly checked the stock levels and expiry dates for all medicines. Waste medicines were recorded and disposed of appropriately.

During our assessment, we reviewed a sample of people’s care and treatment records, documentation was noted to include sufficient information to support future care planning. The service also demonstrated prescribing formed part of clinical supervision and appraisal processes to improve the quality of care delivered by clinicians and for learning purposes.