Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We rated responsive as requires improvement. We assessed seven quality statements. People did not generally experience discrimination and staff worked to provide equity in access to care and treatment. In some but not all cases staff made reasonable adjustments where required and listened to people’s concerns to improve the service. Some people had not been involved in their care and on some wards patients did not have their needs met around spirituality and faith. People were impacted by language barriers and in some cases, peoples concerns and complaints had not been adequately addressed.

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.

Six patients said they felt involved in planning their own discharge from the hospital and two patients said they had been offered a copy of their care plan. However four patients said they did not feel involved in their care and three patients said staff did not listen to patients GMMH patient feedback patient-centred care responsive

Four ward managers described measures in place to ensure people were supported their protected characteristics, for example language needs or disability. Two ward managers and five members of staff gave examples of how people are involved to ensure that their care meets their individual needs. One ward manager described how staff created individualised care for autistic patients which met their needs. However, one ward manager said there was no multi-faith room on their ward so patients could only access this if they had leave and another member of staff said patients did not have access to spiritual support on the ward.

There was no consistency across the different wards in how care plans were structured. Some care plans (ten out of thirty) did not evidence patient and/or carer involvement or include a rationale for the lack of involvement and six out of 29 patients told us that did not feel involved in their care planning. The trust was rolling out a new system of care plan templates which was an improvement but this was only in place on two of the wards we visited. The service was aware of people’s protected characteristics and made adjustments to ensure that the most appropriate care and treatment was provided. This included culturally appropriate food. Patients were able to personalise their bedrooms.

There were processes in place to support patients to be at the centre of their care and treatment choices. MDTS were held weekly and patients and their carers were invited to attend. We saw that most care plans showed evidence of patient involvement and that staff held regular one to ones with patients. Risk assessments were completed on admission and regularly reviewed including after incidents. Out of the 25 risk assessments reviewed, 16 showed patient involvement.

There was mixed feedback from patients regarding their experience of care provision, integration and continuity. Three patients were happy with the support they received on working towards discharge from the hospital. However, two patients on Silverdale ward raised concerns about the proposed relocation of all patients on this ward to Eskdale ward and said they did not feel staff were listening to them about this. Two patients said they were feeling stuck and were not being adequately supported to progress towards discharge.

Ward managers described the systems in place to ensure that patient flow was not delayed. Improvements had been made to the admissions and discharge processes. There were effective systems to support communication with patients' community mental health teams and the internal transfer process from the medium-secure wards was working well. However, two members of staff said the clinical teams needed to be more streamlined to increase continuity of care for patients. There had been recent changes to the process of allocation of consultants so that each consultant now had two wards to support the streamlining.

Advocates said that care programme approach (CPA) meetings were held regularly and they could attend. Staff supported patients with internal moves between wards and with discharge to other services .

Care delivery was planned at handovers, morning meetings and huddles. There were MDT team meetings held weekly including communication with the community teams and across wards on the forensic service. There were no current referrals into the service as they were closed to admissions. Patients moved between wards on the low secure service.

Staff provided patients with information on their care and treatment. Ten patients were happy with the information they had received about their medicines and two patients said they had been offered a copy of their care plan. Two patients said they were offered a tour of the ward when they were first admitted. One patient said they were given written information about the ward on admission. However, one patient had not been given information on their medication and another had not been given information about the ward that they had been admitted to.

Staff provided information to patients in a range of different formats. This included giving printed information and leaflets and verbal information, advice and guidance, Staff also told us that patients were offered copies of their care plans. Staff showed us the notice boards on the wards which contained leaflets and posters on a variety of different topics such as medication, the mental health act and patient rights including rights to appeal and lists of local solicitors.

Information was shared at the weekly MDT, daily at handover, at regular staff meetings and at the patient’s community meetings. Patients were generally provided with information and shown around the ward on admission. There was access to translation services and leaflets were available in an easy read format. Staff could request leaflets in other languages if this was required for a patient. However we attended several handovers which were very brief and lacked information regarding changing patient risks.

We spoke with 14 patients who all said they had access to independent advocacy support and seven patients said they were aware of the process for complaining about their care. Five patients said community meetings took place regularly on the ward, along with a patient empowerment group. Patients said that they generally felt involved in their care and that positive changes had been made as a result of patient feedback. However, five patients raised concerns about language barriers due to some international staff having limited English or talking in their first language between themselves on the ward. Four patients said they did not feel adequately involved in their care and three patients said they had complained about their care and had not received a response to their complaint and/or action had not been taken to address the issues leading to their complaint.

Staff that we spoke with said an independent advocate regularly visited the ward to support patients. Four ward managers and five members of staff said community meetings regularly took place on the ward. Seven ward managers and seven members of staff gave examples of carer involvement events which had taken place and described the systems in place for involving carers and relatives.

We observed that community meetings took place regularly, were attended by patients and minuted. Patients had the opportunity to make suggestions and they received feedback on actions taken by the trust regarding previous discussions and requests. Patients were routinely invited into their multi disciplinary meetings and other meetings about their care and treatment. They were part of the discussion about their care and treatment, including medication, side effects and fture planning around transfer or discharge. Patients could also seek support and representation from an independent mental health advocate.

There was a senior leadership team (SLT) meeting to review complaints and concerns and identify themes and trends. Thirteen formal complaints had been received over the last 12 months. A variety of different themes were identified including staff attitude, restraint , seclusion, observations and communication. Recommendations, learning points and actions were identified because of the themes identified. Advocates from MIND attended SLT meetings, facilitated the patient empowerment group and had daily contact with the wards.

Two patients said they did not think they were treated fairly by staff regarding a meeting that they were due to attend. The meeting was held in a staff area so the patient representative and patient said they had to attend a patient experience meeting remotely as this was held in a non-patient area of the hospital.

Six ward managers and one member of staff described the measures in place to support people with their protected characteristics. Staff said that their ward was fully accessible to wheelchair users and patients had access to spiritual support on the ward. One ward manager said patients did not have access to a multi-faith room on the ward.

All patients had access to advocacy and the advocacy service was engaged with 90% of the patients within this service. There were advocacy posters on all of the wards. Staff supported patients to access advocacy and provided a private room to ensure that meetings were confidential.

There were processes in place to support equity of access. Staff supported patients in relation to their protected characteristics. Wards were wheelchair accessible and there were disabled bathrooms available to patients. Care plans were person centred and reflective of patients’ specific needs.

Five patients said they were able to contribute their views at community meetings on the ward. One patient said they were able to access an interpreter and another patient said they were supported in relation to their protected characteristics.

All patients had access to support from the independent mental health advocate GMMH staff feedback equity in experience. Six ward managers and one member of staff outlined the support offered to people in relation to their protected characteristics. Wards were fully accessible to wheelchair users. Language barriers were supported with the use of interpreters and information was translated into other languages. There were also easy read leaflets for patients who needed them.

An independent advocate regularly attended all of the wards and 14 patients confirmed that they had received support from the advocacy service. The service used the Health of the Nation Outcome Scale (HoNoS) to measure and manage patient risk. Collation document processes

Seven patients were happy with the support they were receiving to work towards discharge from the hospital. Four patients gave positive feedback about the Recovery Academy and two patients said they were able to take part in education and/or volunteering during their time on the ward. However, one patient said they did not feel adequately supported in relation to their discharge planning.

Ward managers told us that improvements had been made and there were systems in place for proactive discharge planning. There were effective arrangements in place for engaging with patients' community mental health teams. One ward manager and three members of staff said patients were able to access the Recovery Academy .There was a system for monitoring patients' length of stay.

Staff assessed patients’ capacity regarding decision making using the mental capacity act and always checked consent to treatment under the Mental Health Act. We saw evidence of the use of these processes in patient records. However, some ward managers were not engaged with or aware of the drivers for improvement at the trust, for example previous CQC findings or the recommendations from the Shanley review.