Greater Manchester Mental Health NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as requires improvement. We assessed six quality statements. Staff assessed people, but risk assessments were not all up to date. Care plans on most of the wards did not contain, clear, accurate up to date information including the absence of physical healthcare monitoring and a lack of monitoring for patients prescribed clozapine. This meant that the care and treatment provided did not always meet peoples’ needs. Staffing pressures meant that staff were moved between wards and this impacted on patient care. Staff did not always work effectively together when assessing people’s needs and did not always share information to maintain continuity of care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that they were not always involved in the planning of their care. Other patients said that they felt involved with their care and that it was reviewed at regular MDT meetings. However, three patients said that they had no involvement with their care plans and two patients said that staff didn't listen to them.

Staff told us that they assessed patient needs by ensuring that care plans were regularly reviewed and by holding multi-disciplinary team meetings at which patient care was discussed and reviewed. Ward managers described how people's needs relating to protected characteristics were assessed to ensure appropriate support is provided. Three ward managers and six members of staff said that people's physical healthcare needs were assessed on admission and regularly reviewed.

There was a range of processes in place to assess patient need. These included risk assessments, care plans, observation records and reviewing blanket and individual restrictions. However compliance with this varied between the wards on Keswick, Ferndale, Silverdale and Rydal ward. We reviewed 32 risk assessments across all of the wards. Of those, 24 had been regularly reviewed and updated after incidents. We found that care plans on some of the wards did not contain, clear, accurate up to date information including the absence of physical healthcare monitoring in 12 cases and a lack of monitoring for patients prescribed clozapine . There was no patient centred clozapine care plan in five out of 10 sets of records where we would have expected to see this. Diabetes blood monitoring checks were not carried out as per the care plan for four patients and we found one patient who had a diagnosis of diabetes and had no care plan relating to this. Olanzapine post-injection monitoring was not documented as being completed as per the patient’s care plan in two out of two sets of records that we reviewed where the patient had received this. Care plans were incorrect in relation to the medication details (dose/monitoring frequency) in six cases.

Patients told us that they received care, treatment and support that is evidence-based and in line with good practice standards. Patients said they were receiving regular occupational therapy support, regular sessions with a psychologist and access to support for their substance misuse. Three patients said their care was reviewed and progressed at regular MDT ward rounds. However, one patient said they were not getting adequate care for their physical health issues.

Staff said that patients had access to occupational and psychological therapies and that people's care was regularly reviewed by a multi-disciplinary team including medical, nursing and therapy staff Staff said that systems were in place for monitoring people's physical health during their admission. However managers said the monitoring data showed some gaps in physical health monitoring and two members of staff said that staffing pressures impacted on patients participating in all their therapeutic activities and s17 leave.

Multi-disciplinary team meetings took place weekly and patients were invited to attend these. A range of disciplines attended including the psychiatrist, named nurse, occupational therapist and psychologist. A new electronic system had been introduced to support staff with recording physical observations and calculating/actioning NEWS2 scores. The psychology team had been involved in developing the new model of care and, in particular, improving the trauma-informed care provided and reducing unnecessary restrictions on patients . One to one sessions between the patient and named nurse took place regularly and patients could ask to increase this if required.

Patients told us that when they are due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Five patients told us that they were well supported in relation to their discharge including partnership working between ward staff, community mental health teams and social care providers. One patient said the ward staff were working with substance misuse support providers in the community to ensure they received the support they needed for their substance issues. We spoke with 13 carers and most said that the communication from staff needed to be improved. They were not always made aware of care, treatment and medication changes. Two carers did say that communication from staff was good and that they felt involved in their loved ones care. The patient empowerment group was taking place and patients had input into the agenda for this.

Staff told us that the service worked in partnership with other wards, community services and the local safeguarding teams. The trust shared learning with other services and brought in learning from other organisations. Care plans were stored electronically and were accessible to all staff. Staff said that there was patient representation at the senior leadership meetings and that patients could make suggestions about the services then along with at the ward community meetings.

Duty managers knew all of the patients and staff on the ward. They coordinated weekly staff response simulations and were available to give advice to staff on the phone. We spoke with the advocacy team who regularly visited the wards. Advocates met with patients monthly. Advocates were involved in independent seclusion reviews and they said that senior staff were responsive to concerns and complaints raised by patients .

There were a variety of processes in place to support staff teams and services working together. All staff attended their ward handovers at the beginning of each shift except the allocated security worker who was receiving security handover. Information was shared on patient activities, mental state, medication issues, any leave taken, discharge planning progress. However there was limited information on patient specific risks shared on Keswick ward. On Delaney ward the handover was very brief and it was unclear which staff were allocated to which tasks. Handover discussion did not include discussion on ligature points or observation levels. There were Morning meetings which supported patient involvement, discussion of activities, ward maintenance issues, planned leave and there was an interpreter present to support one patient. Staff meetings were held regularly and staff discussed incidents, security/ligature risks, urine drug screening outcomes and the dates of forthcoming events. MDT meetings took place weekly and were attended by all disciplines and community based staff. There was a comprehensive discussion of patient’s risks and needs and clear evidence of a recovery focused approach including steps towards discharge clearly articulated. The MDT showed good partnership working with community teams. The seclusion review panel meetings were attended by members of the multi-disciplinary team, the advocate to reflect the patients’ voice and the NHSE case manager via Microsoft teams.

People gave mixed views on whether they were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Most patients said they had access to nutritious food which met their needs and four patients said they had 24/7 access to drinks and snacks .Two patients said they received support and advice on healthy living from ward staff. Patient records showed that patients were given support with dietary needs, health and exercise. They were offered smoking cessation and there were mindfulness sessions held on the wards. There was a gym on the hospital site for those patients with leave to attend it. All patients were able to access the GP and the dentist. However two patients said they did not have access to nutritious food which met their needs, One patient said they did not have sufficient access to fresh air and one patient said they were not able to access the gym as often as they wished as insufficient staff were trained to support them with this.

Staff described how patients on their ward had access to healthy lifestyle support including smoking cessation. staff said there was a variety of nutritious food available for patients. Two ward managers said there were less issues with patients smoking on the ward and that smoking incidents had significantly reduced. However two members of staff on Dovedale ward said that a lot of the patients slept during the day and were awake at night and did not describe any attempts made by staff to support people with healthier sleeping habits. Two other members of staff said there were issues on their ward with patients vaping in communal areas

There were processes in place to support patients to lead healthier lives. These included smoking cessation groups and products, support from a dietician in order to make healthier food choices, access to the on site gym and walking groups. Staff routinely monitored and recorded patients physical health. Staff provided patients with information on their care, treatment and side effects and patients could also access the recovery college to undertake a variety of courses to support their education and wellbeing The advocates supported patients to raise issues including access to healthy food, access to fresh air and access to the gym.

Patients told us that they were supported with towards meeting the outcomes in their care plans. They had access to ADL kitchens and were supported with budgeting and shopping in working towards achieving some independence. Patients were aware that there was a step down service and said that staff supported them to work towards being ready for this.

Staff told us that they used nationally recognised outcome monitoring scales (e.g. HoNOS) to monitor and improve outcomes. No concerns were raised by any of the staff we spoke with in relation to this quality statement.

There were effective approaches to monitoring people’s care and treatment and their outcomes. Staff held regular MDT reviews and used recognised rating scales such as HoNOS (Health of the Nation Outcome Scales) to assess patient risk and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale).This is a self- assessment tool for measuring the side effects of anti-psychotic medication .

Patients said that staff explained their rights to them. This was done and repeated in a way that patients could understand. Patients said that their care and treatment was explained to them and we saw in most records that consent to treatment was gained. Thirteen patients said they has access to an independent mental health advocate and they could seek support with their care and treatment including consent. Seven patients said they were happy with the information given about their medication and one patient said they had access to an interpreter to support them in understanding their care. We saw that consent and Mental Health Act authorisation was documented in records. However three patients said that they didn’t feel that staff listened to them.

Six ward managers and 14 members of staff described the arrangements for independent advocates to visit the ward regularly and support patients. Ward managers and staff outlined the support in place for people with protected characteristics, which may impact their ability to give informed consent to their care. Three ward managers and six members of staff gave examples of how staff complied with the Mental Health Act, for example in relation to restrictive practices, medicines and giving people information about their rights.

Staff routinely explained patients rights to patients. If they were not understood then staff would make further attempts until they were assured that they had been understood. Patient records showed that consent to treatment was recorded in all but two cases and mental capacity assessments were in place for those patients that may have lacked capacity. Of the staff that we spoke with, eight members of staff were not able to describe the underlying principles of the Mental Health Act and 13 members of staff were not aware of the main provisions of the Mental Capacity Act.

Staff received mandatory training in the Mental Health Act and the Mental Capacity Act. Mental Health Act was at 89% compliance and Mental Capacity Act was at 88% compliance at the time of the inspection. The independent mental health advocacy service routinely visited all of the wards and provided support to all patients that requested it.