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 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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The service was aware of the projected increase in the local populations and was working with partner agencies to address future challenges to MIU service demand. Staff were supported in their roles and told us there was a positive culture.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills and experience to perform their roles. They had a good understanding of the services they managed and demonstrated how clinical staff were working to provide high quality care. For example, routine audits had been carried out to review prescribing, care and treatment plans alongside radiology reporting in line with evidence-based guidance. Leaders were visible in the service and approachable for staff to raise concerns.

Leaders monitored local NHS 111 demand and took action where possible to manage this. They contacted people who could be seen in the MIU to help reduce pressure on urgent care services. This demonstrated leaders were actively using data and information, understanding local healthcare system pressures, and taking action to manage urgent care services effectively.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. The service had established Freedom to Speak up arrangements within the wider Trust organisation, including staff wellbeing champions across all hospital premises. Staff we spoke to were aware of how to raise concerns.

Staff told us they were actively encouraged to speak up and the service had a ‘no blame’ approach to incidents and complaints that supported them to raise concerns. Staff felt involved with service improvements and gave examples of how their feedback had led to improvements. Staff were kept updated when processes had changed and improved.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were available for staff to access. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued. For example, we noted risk assessments were completed to support staff through the use of reasonable adjustments, such as Personal Emergency Evacuation Plans (PEEPs).

The Trust consistently reviewed feedback across all of its sites, including the MIU sites we visited, on processes relating to national equality and diversity frameworks, including the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES). For example, the service had implemented a ‘See ME First’ staff-led initiative, encouraging colleagues to safely challenge discriminatory behaviour and promote a non-judgemental work environment. There was also a zero-tolerance approach to empowering staff to refuse care in instances of discriminatory behaviour or abuse.

The Trust hosted staff pastoral networks including the Diverse Ethnicity Network (DEN), Pride Network and Armed Forces Support Group to enable people to carry out their roles effectively. Staff we spoke to at the MIU sites were aware of these networks.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders supported staff, and all staff we spoke with were clear on their individual roles and responsibilities. The Trust had established governance processes which were appropriate for its MIU services. MIU staff could access all required policies and procedures. Managers held regular service meetings with staff, during which they discussed clinical concerns and emerging risks. They clearly recorded any actions arising from these meetings and ensured they shared these with staff.

There was a clear framework of what must be discussed at a team or directorate level in team meetings to ensure essential information, such as learning from incidents and complaints, was shared and discussed. Staff understood the arrangements for working with other teams, both within the Trust and external, to meet the needs of the people who used the service. Staff understood how to use these arrangements demonstrating clear systems and responsibilities to deliver safe and effective care.

The service had a business continuity plan in place which gave guidance to staff for the preparation of major incidents. Sensitive and confidential information was stored securely in line with digital security standards with relevant information about people recorded in line with privacy, consent notices and general data protection regulations. This included how people’s data was used and choices regarding consent. We reviewed the service’s subject access request processes and management of people’s information and noted them to be in line with Trust policy.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement. Staff had made adjustments to improve coordination of their community healthcare services, including through meetings centred on the care of those at higher risk of hospital admission. As part of system-wide improvement, the service investigated and responded to safety incidents as part of the nationally recognised Patient Safety Incident Response Framework (PSIRF). These included ‘after Action Reviews’ (AAR) and were led by the service with input from multi-agency teams such as NHS111, the local ambulance trust and the local primary care network. These reviews were designed to support shared learning across the urgent and emergency care system.

Leaders told us MIU staff had provided an educational session to children as part of a local school community project to improve understanding of the services provided at the local community hospital, as well as some basic first aid.

We were provided examples of positive outcomes for people who benefited from community projects and local initiatives co-ordinated through the service and the League of Friends Charity. Funding was also available via the charity for staff applications for continuous professional development (CPD), organised by the Trust. For example, staff had attended Community Hospitals Association (CHA) National Conference in April 2026 which covered training topics such as discharge pathways, end-of-life care, and the use of digital monitoring in community clinics.

Another example of partnership working with the League of Friends Charity, was the creation of a voluntary ‘Patient Transport’ service. This was available to assist people in the local community in accessing healthcare services, such as MIU services, who otherwise had no other forms of transport to access their appointments.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged ways of delivering equality of experience, outcome and quality of life for people.

The service carried out a clinical audit programme specific to the MIUs across the Trust, which supported effective oversight of key clinical processes. Areas of audits included record keeping and documentation, sore throat presentations, infection prevention and control, and Ionising Radiation Medical Exposure Regulations (IRMER) compliance. Audits provided insight and identified areas for improvement, particularly in relation to documentation and the use of standardised processes.

The service carried out head injury management audits as a result of learning from coroner’s inquests. The audits were implemented to assess the timeliness and consistency of assessment, management, and record-keeping to people presenting with head injury in MIU settings, in line with national guidelines. The audit reviewed the quality and safety of care and treatment, including the provision of appropriate pain-relief medicines, and the effectiveness of discharge and escalation processes. This included assessing the written discharge advice and the appropriateness of referrals or transfers to the local Emergency Department (ED). The MIUs we visited as part of this assessment reported a 75% compliance rate from the annual audit. The results of this year’s audit highlighted areas for improvement relating to the consistent use of a head injury proforma (a standardised clinical form used by healthcare professionals to systematically assess, observe, and document patients who have experienced trauma to the head). In addition, the use of pain control across the service was another area of improvement identified. The service provided evidence of an action plan it had created in response to the audit, which considered the review of triage assessment processes and escalation triggers, particularly where delays to the assessment of head injuries exceed 15-minute targets.