Chief Inspector of Hospitals rates Dorset Healthcare University NHS Foundation Trust following comprehensive inspection

England's Chief Inspector of Hospitals has told Dorset Healthcare University NHS Foundation Trust that it must improve the quality of some of its services following an inspection by the Care Quality Commission.

Overall the trust has been rated as requires improvement. Staff were caring, compassionate and treated people with dignity and respect but although the trust provided some good and outstanding services, improvements were needed for services to be consistently safe, effective and responsive.

Dorset Healthcare University NHS Foundation Trust provides health and social care, including mental health and other specialist services, to 700,000 people across the county of Dorset. More than half of the trust’s services are provided in the community, in people’s homes, clinics and schools.

During the inspection in June a team of inspectors and specialists including doctors, nurses, allied health professional, managers and experts by experience visited all the wards in community hospitals and the mental health inpatient units as well as 52 locations where community services were delivered. The team spoke to over 429 patients, relatives and carers and interviewed 624 members of staff and 67 managers.

Full reports on all core services are available on the CQC website. 

Overall CQC found that the services the trust provided varied in their quality. We had particular concerns about some community child and adolescent mental health services and some minor injuries unit.

However, inspectors saw evidence that many significant improvements had been made in services across the trust since the appointment of the new board; the new chairperson and chief executive had been appointed in April 2013, the director of nursing had been in post since August 2014 and a new medical director took up post at the time of the inspection. We found that the leadership team had a clear vision and was passionate and determined to bring about improvements in clinical quality.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), said:

“Our inspection found that there was a variation in the quality of the services provided by Dorset Healthcare University NHS Foundation Trust. We were particularly concerned about the quality of some of the community child and adolescent services and some minor injury units.

“The majority of the trust’s senior management team had only been appointed within the last two years. We were relieved that they themselves had identified many of the problems flagged up by our inspection team and had plans to make improvements. We were also impressed with the good start that the new leadership team had taken and encouraged when the trust responded quickly and positively when we raised areas of concern. It was clear that the leadership team were committed to making improvements speedily.”

“Although we rated the majority of the trust’s core services as requires improvement.  There were two notable exceptions. We observed outstanding care and treatment in both acute inpatient mental health services and the forensic community services.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. We will return in due course to check that the improvements that we have identified have been made.”

Our specific findings included:

• At Weymouth, Portland and Bridport minor injuries units there was a lack of clinical leadership. There was no clearly defined system for triage and clinical assessment of patients arriving at the units. This meant that the service was not assessing and responding to potential risks, and patients could be waiting for some time without clinical assessment, when possibly needing urgent or more acute care and treatment. In addition, there were staff shortages and a lack of an appropriate skill mix across the service, and on occasions agency staff were working alone without adequate support or induction. The trust has assured us that only experienced clinicians would work at the minor injuries units and that if safe cover could not be found the units would close. The opening hours at Portland would be changed and that there would be receptionist cover during all opening hours.
• The child and adolescent mental health services (CAMHS) in Weymouth and Portland and in Bournemouth and Christchurch did not assess risks to young people waiting for assessment or treatment effectively. Teams were unable to meet the waiting time targets because of the number of vacant posts and staff who were on sick leave. The trust responded quickly and positively when we raised concerns about risk assessments process for children and young people. It immediately began a review all waiting lists, caseloads and the risk assessment process, and has kept us updated on the progress.
• In the east Dorset crisis team staffing issues were affecting the team’s ability to provide a robust home treatment service and provide a responsive crisis telephone helpline at night. The trust has also provided assurance that it will address staffing issues in the east Dorset crisis team and ensure services are delivered in line with those in west Dorset.

The Care Quality Commission has identified a number of areas for improvement, including:

• The trust must ensure the protection of patients and staff against the risks associated with unsafe or unsuitable premises.
• The trust must ensure that the storage and recording of medication, including self-administration processes, is safe and secure and must ensure that staff follow its policies for the safe management and administration of medicines.
• The trust must ensure it has enough, adequately experienced and skilled staff to meet the needs of patients and ensure that care records are accurate, complete and contemporaneous.

The reports highlight 41 areas of good practice (practice that goes beyond what we would normally expect to see) including:

• The child and adolescent mental health service ran the wave project, which provided free surfing to young people with mental health problems. The wave project aimed to improve young people’s wellbeing, social skills and mental health while teaching them to surf off the Dorset coast.
• The Dorset working women project in Bournemouth, supported by the sexual health services, provided an outstanding level of care and support. The staff were dedicated in supporting a very vulnerable group of women.
• The Pathfinder service was a satellite of the forensic community team, with many staff working across both services. It was provided as an alternative to hospital treatment (typically in medium or high secure services) for offenders with a personality disorder.
• The reports which CQC publishes today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

On Friday 9 October the Care Quality Commission presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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For further information please contact CQC Regional Engagement Manager, John Scott on 07789 875809 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here (Please note: the duty press officer is unable to advise members of the public on health or social care matters). For general enquiries, please call 03000 61 61 61.