Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• 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

The teams had a shared vision, strategy and culture. Staff knew and understood the vision, values and strategy of the Trust and how they related to their role and team. Staff understood equality, diversity and human rights which were actively promoted within the teams. Leaders had the skills, knowledge and experience to lead effectively and did so with integrity, openness and honesty. Local leaders were visible and approachable however, staff did not know who senior Trust leaders were apart from the Chief Executive Officer. The Trust valued diversity in their workforce and took action to review and improve the culture of the organisation in the context of equality, diversity and inclusion. Leaders involved and engaged with staff to shape services and create a more equitable and inclusive organisation. The governance systems within the service had improved since our previous inspection. There were now clear responsibilities, roles and systems of accountability. Information from audits and feedback from people and staff were used effectively to monitor and improve the quality of care. Staff worked in partnership with other services. They shared information and learning with partners and collaborated for improvement. Staff and leaders had a good understanding of how to improve the service. There were processes in place to ensure that learning happened when things went wrong but also from examples of good practice.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff understood the values, vison and strategy of the Trust. Staff knew how this related to their role in providing care and treatment for people. Staff were familiar with the values and qualities required by the Trust and managers used these in supervision and in appraisals to reflect on their practice. The Trust trained staff in equality, diversity and human rights. Staff understood equality, diversity and human rights and how this related to the provision of safe, compassionate care.

Staff told us that team managers were visible and approachable. They said they listened, were caring and driven to do the job well to meet the needs of people who used the service. However, apart from the Chief Executive Officer who had visited the services staff were unaware of who the Trust directors were. Staff said the culture within the teams was good and more junior staff had been supported by team managers to be heard and all staff in the team worked together.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff said the morale in the team was good. They said staff all supported each other and worked as a team in a positive way for the people who used the service. Staff said managers were very approachable, made time for everyone and check in to see how staff were. Staff told us that managers were responsive and supportive of their health needs. Managers ensured reasonable adjustments were in place to support staff to work. Staff with protected equality characteristics said they felt part of the team and al staff felt included and diversity was valued in the service. Staff told us they were confident to raise any concerns. Staff said they knew how to contact the Trust Freedom to Speak Up Guardians and felt confident of a positive response from them.

The Trust had policies on Equality, diversity and human rights and trained staff in this. The Trust told us at time of this assessment that over 92% of staff had received training in this across the service. Leaders ensured there were effective and proactive ways to engage with and involve staff. The Trust had equality networks for staff with protected characteristics. This encouraged staff to meet, have an impact on policies and procedures and be involved in the recruitment of staff.

Staff told us they were involved in audits. These were reported back to the community clinical governance committee so they could be used to manage and deliver good quality care and treatment. Staff said the risk register is an item on business meeting agendas and any one can raise an item to be added. Some staff said they could add items to the risk register. Staff said they received feedback from audits. Staff told us there had been a recent audit of the duty system in the teams. This showed staff had to deal with some queries which were not appropriate to the duty roles and based on this some guidance was circulated. Managers said they completed audits and from these they provided feedback to staff to improve the service. Where needed extra training was provided to staff and procedures updated to improve the quality of care. Team managers used ‘dashboards’ to monitor staff training, management supervision and appraisals.

Since our previous inspection the governance processes had improved. The audit programme included audits of: Community Treatment Orders, Clozapine monitoring, medicines management, care records & infection prevention and control. Clinical leads completed monthly audits of 10 randomly selected care records & fedback their findings to the nurses to improve the quality of care. The Trust wide audit tracking system was being tested by senior nurses & matrons. The plan was to put all audits on this system to ensure clear roles, systems of accountability & good governance. At each team there was an infection prevention and control (IPC) lead. They were responsible for completing audits which included monthly observation of staff hand hygiene. They submitted this to the Trust IPC team, so there were clear roles, systems of accountability and good governance. The Trust risk register for the community mental health teams clearly defined risks, how they were managed, who was accountable and timescales in which they were to be reduced or action taken to remove the risk. Risks include the transformation of the service, the appointment of new roles & the creation of the Neighbourhood Mental Health Teams (NMHT). The Trust had positive feedback from people who used this service and planned to use this to improve services. They were piloting at Longbridge CMHT a multidisciplinary triage hub. This allowed for a joint triage of all professionals to ascertain the right next step for the service users right at the front door. Step down meetings had commenced to identify service users suitable for step down. Through this review they had identified 515 service users who could be stepped down from using the CMHT service to a NMHT. The Trust now planned to pilot this at other teams. Other risks included doctor vacancies & recruitment, the use & development of care records & waiting times for psychological assessment & treatment. There were clear roles, responsibilities and actions.

Staff said they worked with other services to ensure that people had continuity of care. Staff said they shared information and learning with partners to improve the service. Staff said they engaged with people in the local communities and partners to share learning and look at ways to improve the service for the people living there.

The Trust led the Provider Collaborative in the local Integrated Care Board (ICB). Staff were represented in regular oversight and surveillance meetings with the ICB.

Staff said they used feedback from people who used the service to make improvements where needed. They also celebrated positive feedback which they put on the teams ‘Excellence board’. Staff said they were looking at the duty system in the team as to how this could be improved, what works well and what needed to change. Managers said they shared lessons learned with the team, but this included reassurance for staff to ensure that learning was implemented safely. Managers said if improvements or changes to processes were not sustainable, they raised this. Staff told us about quality improvement projects they were involved in. This included tracking when people had collected their prescriptions. We found this was an improvement from our previous inspection. Staff were asked for their ideas as to how to improve this and were encouraged to lead the projects. Staff told us how they discuss complaints and learn from them. One staff said, “Every complaint is a learning curve.”

The Trust had processes in place to ensure that learning happened when things went wrong but also learnt from examples of good practice. The Trust were engaged in the NHS England Patient Safety Incident Response Framework (PSIRF). This is an approach to develop and maintain effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. The Trust used this approach and reported on it through the various committees to ensure there is continuous learning and improvement in the organisation.