Dorset Healthcare University NHS Foundation Trust has been told that it must improve the quality of some of its services following an inspection by the Care Quality Commission.
The trust has joined the ranks of those around the country rated as “requires improvement”, following an inspection in June.
There were particular concerns about some community child and adolescent mental health services (CAMHS) and some minor injuries unit, said the CQC in its latest inspection report.
The trust provides health and social care, including mental health and other specialist services, to 700,000 people across Dorset.
“We were particularly concerned about the quality of some of the community child and adolescent services and some minor injury units”
Overall, CQC found that the services the trust provided varied in their quality, but highlighted that staff were caring, compassionate and treated people with dignity and respect.
Specific findings included that at Weymouth, Portland and Bridport minor injuries units there was a lack of clinical leadership and no clearly defined system for triage or clinical assessment.
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 told the CQC that only experienced clinicians would work at the minor injuries units in future and that if safe cover could not be found the units would close.
The child and adolescent mental health services in Weymouth and Portland and in Bournemouth and Christchurch did not assess risks to young people waiting for assessment or treatment effectively due to the “number of vacant posts and staff who were on sick leave”.
The CQC noted that the trust responded “quickly and positively” to the concerns and immediately began a review all waiting lists, caseloads and the risk assessment process.
Meanwhile, in the east Dorset crisis team staffing issues were affecting the team’s ability to provide a “robust” home treatment service and a “responsive” crisis telephone helpline at night.
The CQC also said the trust must improve “unsafe or unsuitable” premises, ensure the storage and recording of medication was safe and secure, and that staff followed its policies.
The trust must also 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”.
Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals (and lead for mental health), said: “There was a variation in the quality of the services. We were particularly concerned about the quality of some of the community child and adolescent services and some minor injury units.”
“We were impressed with the good start the new leadership team had taken and encouraged when the trust responded quickly and positively when we raised areas of concern”
But he noted that most of the trust’s senior managers, most of whom had been appointed within the last two years, including the director of nursing who had been in post since August 2014.
They had identified many of the problems flagged up by inspectors and made “a good start” and were committed to making improvements “speedily”, said Mr Lelliott.
He added: “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.”
Other areas of good practice identified included the trust’s wave project, which provided free surfing to young people with mental health problems.
In addition, the CQC highlighted the Dorset working women project, which it said provided an outstanding level of care and support to a “very vulnerable” group of women in Bournemouth.