Archived: Trust Headquarters

When detainees arrived in the prison they were asked about any mental health or learning disability needs that they had and underwent an assessment. If mental health needs were indicated at the initial assessment, urgent assessments by a member of the mental health team would normally take place within 24 hours and regular assessments within one week. Detainees we spoke with were positive about the services they received and indicated that their treatment was helping to address their needs.

Detainees told us that after their initial assessment they had been referred to various different services as appropriate. There was a weekly team meeting where new referrals and the care and treatment of detainees were discussed. Other relevant healthcare professionals (as well as prison staff) were invited to these as appropriate. Healthcare staff would also work directly with other community services to ensure that a care and treatment plan within the community was in place before detainees were released.

The CQC inspections demonstrated significant service failings in some areas. These were serious and repeated over time in some areas and there were also service failings across different locations. They raised concerns about the adequacy of the trusts quality assurance and governance processes.

The purpose of this inspection of the trust's headquarters was to assess whether the trust had effective systems in place to assess and monitor the quality of service provision. In undertaking this inspection we considered the five quality domains that CQC plan to adopt during 2013 -14 to inspect NHS trusts. Our inspection used the domains to identify if the trust was well led. Also, to identify whether the trust had systems in place to assure them that their services were safe, effective, caring and were responsive to patient's needs.

We visited the trust over a three day period on 23, 24 and 26 April 2013. We spoke with 24 senior trust staff about their roles and responsibilities and looked at the trust's quality monitoring systems. We met with members of the trust board, which included executive and non executive directors. We also spoke with senior medical, nursing and therapy staff as well as staff who worked in the quality team.

We reviewed a range of documentary evidence which included minutes of sub committees of the board, performance and quality monitoring reports. We looked at the trusts incident monitoring and risk register systems and arrangements for monitoring staff training, supervision and appraisal. We talked to trust staff about how risks were escalated within the trust and about actions taken in response. We looked at how information about risks flowed between the trust board, directorates, wards and teams.

We did not speak to patients directly as part of this inspection. We looked at the systems the trust had in place for seeking patient feedback and acting on it. During the same week, we carried out inspections at seven other locations across the trust where we spoke to patients about the services they received. We have referred to some of the findings of those inspections within this report. Those inspections have also been reported separately via our website.

Overall, we concluded that the systems in place for quality monitoring and for assessing and managing risks to service users and others were not fully effective. The trust had inadequate staffing levels which was the main factor impacting on the quality of patient care. Where staffing levels were sufficient, patients reported higher levels of satisfaction with their care.

The trust wrote to us with the actions they had taken and we found that improvements had been made to the premises.

Two regulated activities were carried on at the prison by Dorset Healthcare University NHS Foundation Trust (the Trust). They were diagnostic and screening procedures and treatment of disease, disorder and injury.

During our two days we spoke with 20 people about their experiences of the healthcare services available to them.

People we spoke with generally expressed a high level of satisfaction. They told us they were able to see healthcare staff quickly. They said they were fully involved in the planning of any treatment they required. They told us that special clinics about health problems such as diabetes or asthma were available to them.

With two exceptions, people we spoke with told us they were always treated with respect by healthcare staff. One person described them as 'good as gold'.

Where necessary the Trust's staff referred people with specific needs to other healthcare professionals to ensure they could be met.

Healthcare staff we spoke with demonstrated commitment to and enthusiasm for their work. They received regular training and had opportunities for professional development.

There were arrangements in place to ensure the Trust's procedures were followed and the quality of the service people received was maintained and/or improved.