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 the same.
The service had a positive and inclusive culture that promoted high-quality, person-centred care. Leaders were visible, knowledgeable and supportive and worked collaboratively with staff, patients, carers and partner organisations. Governance systems enabled the service to monitor quality, manage risks and drive improvement. Staff felt able to speak up and contribute to service development, and leaders promoted equality, diversity and inclusion across the workforce and the people who used services. Learning, innovation and partnership working were embedded within the service to support continuous improvement and positive outcomes for patients.
 

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.

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 demonstrated a clear vision focused on maximising people's ability to achieve their full potential. Leaders described a strong person-centred culture where the needs of people with learning disabilities were central to service delivery. Staff consistently described a positive culture and reported feeling valued, listened to and supported by managers. Leaders encouraged staff to consider care from the perspective of patients and carers, particularly when navigating complex health and social care systems. Executive and senior leaders undertook regular visits to teams to promote visibility and identify any emerging concerns or risks associated with closed cultures.
Carer feedback supported this positive culture. Families consistently described staff as compassionate, responsive and committed to improving quality of life. Carers reported feeling listened to, valued and involved in care planning and reviews. Several families described the Community Learning Disability Teams as "wonderful", "supportive" and "always there when needed", demonstrating a culture focused on the needs of people using the service and those important to them.
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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 demonstrated extensive experience and knowledge of learning disability services. Senior managers and clinical leaders had significant clinical and leadership experience, with some having worked within learning disability services for over 20 years.
Staff spoke positively about local leadership and reported confidence in managers. Leaders were focused on developing future workforce capacity through Advanced Clinical Practice programmes, specialist training opportunities and the introduction of new leadership roles. The service promoted professional development and encouraged continuous learning across all disciplines.
Carers also spoke positively about the leadership and expertise within the service. Families praised learning disability nurses, psychologists and psychiatrists for their knowledge, responsiveness and support. Carers described staff as approachable and reported confidence in the team's ability to coordinate care, manage risks and respond effectively to changing needs.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff described an open and positive culture where they felt able to raise concerns without fear of repercussions. During focus groups, staff reported feeling listened to by managers and confident that concerns would be acted upon. Staff spoke positively about local leadership and described managers as approachable and supportive.
The service had an identified Freedom to Speak Up Champion and leaders reported no current concerns relating to the Learning Disability Service had been raised through the Freedom to Speak Up Guardian.
Executive and senior leaders undertook regular visits to teams to engage with staff and identify any emerging concerns or indicators of closed cultures. Compliance with Freedom to Speak Up training within the Learning Disability Service was reported at 94%, demonstrating a strong commitment to promoting an open culture and ensuring staff understood how to raise concerns safely.
Staff identified communication regarding organisational change and changing staff roles as an area for further improvement. But felt they could raise this concern with the service providing evidence of a culture where constructive challenge and feedback were encouraged and welcomed.
Carers similarly reported feeling able to raise concerns and were confident that their views would be listened to and acted upon. Most families stated they had never needed to make a complaint about the service. Where concerns had been raised, carers described prompt responses and positive engagement from staff, reflecting a culture of openness and transparency.
 

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.
The service demonstrated a commitment to equality, diversity and inclusion through workforce initiatives, training and leadership roles focused on race equality and inclusion. Mandatory training included equality, diversity and human rights modules, with compliance at 95% at the time of inspection.
Staff had access to flexible working arrangements and reasonable adjustments where required. Examples included workplace adaptations for Deaf and neurodivergent staff members. Staff completed equality and diversity training and leaders monitored workforce data to identify areas requiring improvement. The service promoted an inclusive culture and sought to ensure staff felt valued and supported regardless of background. The trust ensured there were LGBTQ networks for staff.
Carers described care that was personalised and adapted to meet individual needs, preferences and circumstances. Examples included support tailored to communication needs, autism, mental health needs, physical health conditions and religious beliefs. Families felt staff took time to understand the person and adjust care and support accordingly.

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 the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had clear governance arrangements which supported oversight of quality, safety and performance. Monthly Clinical Lead meetings reviewed risks, incidents, complaints, policies and Trust priorities. Learning from complaints, safeguarding reviews and patient safety incidents was shared through governance structures and team meetings. The service used multiple mechanisms to gather patient feedback, including Friends and Family Test surveys, Easy Read feedback tools and their own IT platform.
Managers had oversight of staff training via their IT systems and dashboards which alerted them if staff mandatory training was overdue.
People with learning disabilities were actively involved in governance through Engagement Forums and Learning Disability Partnership Boards, where they were able to challenge services, contribute to developments and influence decision-making. Governance arrangements also supported partnership working across health, social care and voluntary sector organisations.
The service appeared financially and operationally sustainable, with low staff turnover, stable teams and ongoing recruitment to a small number of vacant posts. Workforce planning included succession planning and leadership development.
Carers consistently reported being involved in reviews, care planning and decision-making. Families described effective communication with staff and felt informed about changes to care and treatment. Several carers reported long-standing positive relationships with the service and highlighted the consistency and stability of support they had received over time.

The service understood their duty to collaborate and work in partnership.They share information and learning with partners and collaborate for improvement.

The service demonstrated partnership working across health and social care systems. Integrated working was supported through joint leadership arrangements with local authority partners and close working relationships with acute hospitals, commissioners, social care and community providers. Staff worked collaboratively to support transitions, hospital admissions, discharge planning and independent living. Learning was also shared through safeguarding boards, partnership boards and multi-agency review processes.
People with learning disabilities and carers were actively involved in service development. Engagement Forums and Partnership Boards were co-facilitated by people with lived experience and provided opportunities for meaningful challenge, feedback and co-production.
Carers described strong partnership working between Community Learning Disability Teams, social care, providers, advocacy services and hospitals and community services. Families valued the coordinated approach and reported that staff worked collaboratively to support transitions, access meaningful activities, develop independence and respond to crises. Carers felt the service worked hard to ensure people remained connected to their communities and support networks.
 

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system.

The service demonstrated a commitment to continuous learning and improvement. Staff described a culture where learning from complaints, incidents and feedback was valued and shared. Examples of innovation included the development of trauma-informed pathways, augmentative and alternative communication initiatives, respiratory and postural management expertise, improved hospital pathways for people with learning disabilities and work to reduce health inequalities through Health Action Groups.
Staff were encouraged to undertake specialist training and higher education, including postgraduate qualifications, Master's degrees and doctoral-level study. Leaders supported innovation and quality improvement projects designed to improve outcomes for people using the service. For example, there was a An Easy Read Group, co-facilitated by people with learning disabilities, had redesigned sections of the Trust website and developed accessible Easy Read resources, demonstrating meaningful co-production in service design.
The service had developed transition houses to support young adults aged 18–25 moving from the family home into more independent living. These provided opportunities to develop daily living skills, confidence and independence before moving into longer-term accommodation.
Staff were developing specialist Augmentative and Alternative Communication (AAC) pathways to improve communication support for people with complex communication needs.
Physiotherapists had undertaken additional specialist training and were developing a local respiratory pathway to improve care for people with learning disabilities with complex respiratory needs.
The service worked collaboratively with acute hospitals to improve the experience of people with learning disabilities through hospital liaison initiatives, including patient alert systems, Easy Read menus, reasonable adjustments and work to reduce missed outpatient appointments. The service was involved in research in collaboration with the University of Southampton to create a new cognitive assessment battery for use in those with a learning disability to support withdiagnosing mild or major neurocognitive impairments
A Pan Dorset Health Action Group, involving professionals, carers and people with lived experience, focused on reducing health inequalities and improving access to healthcare for people with learning disabilities.

Carers provided examples of the service adapting support in response to changing needs and feedback. Families described improvements in wellbeing, stability and quality of life resulting from interventions delivered by the teams. Carers highlighted innovative and personalised approaches to support and felt the service was committed to continually improving outcomes for people with learning disabilities and their families.