Dorset Healthcare University NHS Foundation Trust Evidence appendix Sentinel House Date of inspection visit: Nuffield Industrial Estate 30 April 2019 to 4 June 2019 Nuffield Road Poole Date of publication: BH17 0RB 31 July 2019 Tel: 01202 277000 www.dorsethealthcare.nhs.uk This evidence appendix provides the supporting evidence that enabled us to come to our judgements of the quality of service provided by this trust. It is based on a combination of information provided to us by the trust, nationally available data, what we found when we inspected, and information given to us from patients, the public and other organisations. For a summary of our inspection findings, see the inspection report for this trust. Facts and data about this trust The trust had 19 locations registered with the CQC (on 9 April 2019). Registered location Code Local authority St Ann's Hospital RDY10 Poole Alderney Hospital RDY22 Poole Poole Community Health Clinic RDY62 Poole Pelhams Clinic RDYEE Bournemouth Weymouth Community Hospital RDYEF Dorset Westhaven Hospital RDYEG Dorset Bridport Community Hospital RDYEJ Dorset Forston Clinic RDYEW Dorset Westminster Memorial Hospital RDYEY Dorset Yeatman Hospital RDYFC Dorset Victoria Hospital, Wimborne RDYFE Dorset Swanage Community Hospital RDYFF Dorset 30 Maiden Castle Road RDYFT Dorset 49 Alumhurst Road RDYFX Bournemouth The Junction Sexual Health Clinic RDYGE Bournemouth Linden Community Support Unit RDYKW Dorset Sentinel House RDYNM Poole Blandford Community Hospital RDYX4 Dorset Portland Hospital RDYY1 Dorset Page 1 The trust had 448 inpatient beds across 30 wards, eight of which were children’s mental health beds. The trust did not provide information on the number of acute outpatient, community mental health and physical health clinics that they had per week. Total number of inpatient beds 448 Total number of inpatient wards 30 Total number of day case beds 19 Total number of children's beds (MH setting) 8 Total number of children's beds (CHS setting) 0 Total number of acute outpatient clinics per week Not Provided Total number of community mental health clinics per week Not Provided Total number of community physical health clinics per week Not provided The methodology of CQC provider information requests has changed, so some data from different time periods is not always comparable. We only compare data where information has been recorded consistently. Is this organisation well-led? Leadership The trust board had a number of relatively new executive members who had an appropriate range of skills, knowledge and experience to perform its role. All the executive team except the chief operating officer (COO) were in permanent posts, with a permanent appointment expected to be made in the coming months. The chief executive officer (CEO) had recently been appointed, and was previously the COO. The CEO and trust chair had a positive working relationship which encouraged healthy cohesion and challenge across the board. The CEO had a clear dynamic plan for further leadership development which involved getting the team to work collaboratively and identifying what was needed in terms of coaching and development. We saw good evidence of integrity throughout the board and senior leadership team. The trust considered and reviewed leadership capacity on an ongoing basis. The chair had recruited strong and experienced non-executive directors (NED’s) with a range of experience including finance. Other NEDS had Legal, Logistics and Procurement, Journalism and medical sciences backgrounds. The NED’s did not have a clinical background but were fully able and confident to escalate and challenge clinical issues through the executive team. There was a clear feedback loop throughout the board and the executive team which reflected empowerment and maturity. The Board had relevant financial expertise across the executives and non-executives. Executives had a sound understanding of the trust’s financial position and areas of opportunity. The director of finance and strategic development was an experienced director of finance with previous NHS and private sector experience, and had been in post since September 2016. Fit and Proper Person checks were in place and the files were well ordered and well managed. We did see that the trust chair had not signed off all the files, however this was immediately rectified once this was fed back to the trust. Page 2 The executive board had one (14%) black and minority ethnic (BME) member and three (43%) women. The non-executive board had no (0%) BME members and three (38%) women. The trust had created a leadership structure that had an identified lead for mental health services and community health services. There was an ongoing programme of board visits to services which were welcomed by the staff teams. The trust senior leadership team were visible and approachable. Leadership development opportunities were available, including opportunities for staff below team manager level, and we considered the development opportunities and drive for excellence through development exemplary. Leadership development opportunities included three core programmes: • Aspiring leaders (bands 4-6 who wish to develop into leadership roles) • Essential leaders (band 7 plus who want to build on knowledge and skills) • Senior leaders (directors and their direct reports. Helped to lead change and improvement). This was an outstanding piece of work, with further opportunities for staff at all grades to develop and take on leadership positions. In addition, the trust sent one member of the finance team on the HFMA developing talent programme every year and the deputy director of finance and head of finance encourage staff to attend other HFMA events utilising the trusts credits appropriately. The trust had recently amended their training support package for those studying for professional accounting qualifications. This had resulted in more staff enrolling on courses, especially junior staff studying to become AAT qualified. The trust had a leadership forum which included operational and support services senior managers. This group nurtured collaboration between teams and met at least once a quarter to discuss issues such as cost improvement planning (CIP) and transformational schemes. The trust leadership team had a comprehensive knowledge of current priorities and challenges across all sectors and took action to address them. There was a good level of accountability from pharmacy management to support governance and patient safety throughout the trust. Medicines safety risks were identified, actioned and shared appropriately within the trust and with external partners. Learning actions from medicines incidents and audits were shared across the trust. Recent growth in the pharmacy team meant that clinical pharmacy support was more widely available across the trust in community teams, inpatient wards and mental health services. The pharmacy department had a senior leadership team that supported and led the department. There was a pharmacy workforce plan and structure which allowed for development and succession. Pharmacists were trained to be independent prescribers and advanced clinical practitioners. The chief pharmacist was part of the Dorset-wide medicine optimisation transformation group, along with leads from other NHS trusts in the county, head of medicines optimisation at Dorset CCG and the local pharmaceutical committee to represent community pharmacy. Vision and strategy The trusts vision and values were: ‘To lead and inspire through excellence, compassion and expertise in all we do’. Page 3 The vision was that Dorset HealthCare would lead and inspire both locally and nationally. The ambition was to inspire patients, partners, local people and professionals alike, by achieving excellent clinical outcomes, supporting people with compassion and kindness, and by being experts in their roles. They were also guided by a clear statement of purpose. This purpose set out what they did and why they do it, and helped everyone to feel part of the same organisation when they delivered such a diversity of services. The purpose was: • To provide integrated healthcare services to empower people to make the most of their lives • We care when you’re unwell, we support your recovery and we give you the knowledge and confidence to stay as healthy as possible. The values were: • Working together for patients • Respect and dignity • Commitment to quality of care • Compassion • Improving lives • Everyone counts • Commitment to learning The Trust had a 5-year strategy (2015 to 2020) called “better every day” which set out clear strategic objectives including financial sustainability and the links to the Dorset Clinical Services Review (CSR). The trust was currently reviewing the strategy and engaging with all stakeholders including staff and the public. The trust established a transformation programme in November 2017 aligned with the delivery of the trust strategy. This programme implemented the strategy and reported delivery progress including any issues with projects to the trust board on a quarterly basis. The trust was fully engaged in the local strategy and had excellent relationships with partners and was working closely on how to improve pathways of patients across different providers, including the development of an integrated care system (ICS) involving five organisations and led by the trust. There also was a robust process for the development and monitoring of CIP, which included working closely within the