Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We rated caring as requires improvement. We assessed five quality statements. Most people were treated with kindness, empathy and compassion. Their privacy and dignity were generally respected. However, group activities were not always suitable for people with protected characteristics such as autism and there was a blanket policy around nursing staff supervising family visits. There were some concerns around staff not listening to or responding positively to patients and examples of staff sleeping whilst on shift.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most patients said they were treated with kindness, dignity and respect by staff and that their privacy particularly around phone calls was respected. People felt that staff listened to them and communicated with them appropriately, in a way they could understand. Most patients felt that staff knew and understood them, including their preferences, wishes, personal histories, backgrounds and potential. People believed that staff would respond to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. People were assured that information about them would be treated confidentially. However two patients said they were not treated with fairness and respect by staff and that their privacy was not respected. One patient said staff did things to deliberately provoke them and one patient said they were being intimidated by a peer and had not been supported by staff in relation to this.

One member of staff commented that staff respect people's privacy and two members of staff commented that staff treat patients with respect. Three ward managers and two members of staff said patients were able to make phone calls in private.

There was team of advocates from MIND who cover the Edenfield centre. There was good promotion of advocacy on the wards with leaflets and posters available to patients. The advocacy engaged with over 90% of the patients and said that this was having a positive impact on patients. Advocates were routinely invited to CPA’S and these took place regularly. Patients were also invited to their CPA’s and other meetings about their care, treatment and discharge planning. Staff made a private room available for advocates to meet with patients and senior managers were responsive to concerns raised by patients and advocates. The independent seclusion review panels were regularly taking place in line with the mental health act code of practice and advocates were invited to attend these and represent the voice of the patient.

We carried out staff and patient observations on the wards and saw that the majority of interactions were good. However, the radio for staff emergency response sat unattended in the nursing station for 10 minutes on one of the wards. During that time staff may have been unaware of being contacted to respond to an emergency. We visited one ward out of hours and competed a SOFI, which is an observation of interactions between staff and patients. We observed good interactions throughout.

Patients that we spoke with were generally satisfied that they were treated as individuals. They were supported with their protected characteristics such as language, religious or dietary needs and patients said they had been able to personalise their bedroom. Five patients said they were supported to stay in contact with their families and/or friends Four patients said that staff are trained to listen and they felt well supported in relation to their protected characteristics.

Staff described how people were supported in relation to their protected characteristics. staff said that people were supported to be involved in their care. staff said patients had regular 1:1 sessions with their named nurse. A ward manager outlined the person-centred support provided to an autistic patient on the ward.

We did not see sufficient evidence to demonstrate that blanket restrictions were only imposed where necessary to meet the needs of the patients and maintain the safety of patients and staff or that they were being kept under regular review when imposed. For example, not all wards were able to provide a copy of their blanket restrictions register and, where this was available, there was no evidence to show the blanket restrictions were being regularly reviewed and removed where no longer required. We also identified blanket restrictions, for example relating to searches and access to the lounge TV, which were not documented on the relevant ward’s register. There was a blanket policy around nursing staff supervising family visits. Carers said that regardless of the fact that risk assessments did not suggest that there loved one posed a risk, staff always sat in on family visits. We saw person centered and individualised care when carrying out the SOFI observations on the wards. We saw that care plans were personalised, holistic and recovery focussed. We saw evidence of patients individual needs being identified such as a patent with autism, a patient wishing to focus on wellbeing and access the gym. Patients’ own views and wishes were reflected in the documentation.

Staff received training in equality, diversity and human rights. Compliance was at 98% at the time of the assessment. The trust had an up to date equality and diversity policy in place and this was regularly reviewed. Staff supported patients to attend places of worship in line with their faith and spiritual leaders attended the wards to see patients. There were prayer rooms available off the wards. Patients’ dietary needs were met as they could chose meals such as halal, kosher, vegan and gluten free from the menu. Staff booked interpreters for patients for whom English was not their first language and there were easy read leaflets and information available to those patients who needed this. We saw evidence of patients individual needs being identified such as a patent with autism, a patient wishing to focus on wellbeing and access the gym and a patient with communication needs. Patients’ own views and wishes were reflected in the documentation.

People told us that they were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. Patients gave examples of positive involvement including attending Senior Leadership Team meetings and participating in recruitment processes. Six patients said they had access to sufficient leave from the hospital. Patients told us that they were able to make phone calls in private and most felt involved in their care. Improvements had been made as a result of patient feedback and there was a patient empowerment group. We saw that patients’ bedrooms were personalised.

Staff we spoke with told us that there was a variety of activities available to patients and support available in relation to peoples protected characteristics. Community meetings were held regularly and people had a choice of diet, flexible meal times or could progress to making their own food. Staff escorted patients out into the local community for those who had leave. A ward manager gave a positive example of a community engagement project with a local football club involving multiple patients. Patients were supported and encouraged to maintain their relationships with friends and family. Relatives visited patients and there was access to visitors rooms of the wards to facilitate this. Staff supported patients with shopping items and budgeting in order to promote their choice and independence. However some members of staff said staffing pressures sometimes prevented them from facilitating patients' chosen activities and/or leave. There were blanket restrictions on some wards, for example the gardens being locked at night, television being turned off and supervised family visits.

We observed the service promoted people’s independence, so they knew their rights and have choice and control over their own care, treatment and wellbeing. We saw people being supported to access activities of their choosing both on and off the wards. Patients had access to their personalised bedrooms during the day and safes in their rooms to store valuables securely. People on the low secure wards had keys to their own rooms. People on all wards had 24/7 access to hot and cold drinks and snacks. We observed the food service at lunchtime on Keswick ward - multiple choices were provided and dietary requirements were catered for. There was a Caribbean event planned on Borrowdale ward and staff told us that cultural and celebration events are held at the Recovery Academy/Patterdale Centre.

The service had a number of processes in place to ensure people had choice, independence and control. There were regular community meetings and patient empowerment meetings held within the service. People with escorted or unescorted leave could access education and activities at the Patterdale Centre and the Recovery Academy. The Recovery Academy was open to patients with escorted and unescorted leave – patient forum, therapy kitchen, discussion groups, acupuncture, education, reading group/library, IT suite. However, we did not see sufficient evidence to demonstrate that blanket restrictions were only imposed where necessary to meet the needs of the patients and maintain the safety of patients and staff or that they were being kept under regular review when imposed. For example, not all wards were able to provide a copy of their blanket restrictions register and, where this was available, there was no evidence to show the blanket restrictions were being regularly reviewed and removed where no longer required. We also identified blanket restrictions, for example relating to searches and access to the lounge TV, which were not documented on the relevant ward’s register and restricted access to vapes.

Patients gave mixed feedback about staff responsiveness. Nine people spoke positively about the support they received from staff on the ward. Generally, people felt listened to and said that staff responded to them promptly and positively when they were distressed or needed help and guidance. One person said they were well supported in relation to their dietary needs. Another person said they were well supported in relation to their physical healthcare needs. Three people said that staff did not always talk or listen to patients and one person said that night staff sometimes slept during their shift.

Staff we spoke with shared concerns about how the service is able to respond to patients’ immediate needs. One ward manager and two members of staff said concerns had been raised about staff sleeping during night shifts. Staff raised additional concerns around colleagues using their phones on the ward rather than supporting patients, colleagues refusing to do things when asked by patients and bank staff sitting in the office at night rather than interacting with patients. This was escalated to managers.

We carried out six separate periods of observations of staff with people whilst we were on the wards. This was using the SOFI framework which is used for observing and reporting the quality of care experienced by patients. Most of the interactions were positive. However, on a few occasions we saw that interactions were limited and that staff were watching television or talking amongst themselves only. One SOFI was completed out of hours.

There were enough staff who were generally adequately experienced and trained and were visible in communal areas. Staff routinely had one to one sessions with patients and we saw from our observations of care that staff engaged with patients and that interactions were generally positive. Staff were available to give advice and guidance on a range of issues, including mental and physical health, side effects and other issues such as patients’ rights and concerns about care and treatment. Staff could escalate physical or mental health concerns to the psychiatrist if required in order to support urgent patient need. Staff responded promptly to call bells as and when required.

Staff that we spoke with had mixed views on workforce wellbeing and enablement. Most ward managers and staff said they felt safe on the ward and that they felt valued at work and were well supported. Two ward managers and five members of staff said their stress levels at work were low. Two members of staff said they had opportunities for specialist training and/or career development. One ward manager said that there had been no bullying or harassment concerns raised by staff on their ward. However, five members of staff said they did not feel well supported as an employee and were experiencing work related stress. One staff member said they had to complete six continuous hours of observation and two staff said they did not feel safe at work. Other concerns raised included poor staff retention, unfair recruitment processes, poor induction and a lack of career development opportunities. Three ward managers and five members of staff reported being injured at work.

There were a number of ongoing processes to support staff including a room provided off the wards as a safe space, wellbeing days, and individual supportive sessions. Wellbeing champions were identified for each ward and managers had an open door policy. Leaders said there were improved opportunities for career development for staff due to cultural changes and the equality and diversity sub-group – supported staff e.g. with experiences of racism from patients. There had been a shift to a supportive rather than punitive HR culture. Leaders also said they were improving systems for supporting NHSP (temporary staff.)