Manchester University NHS Foundation Trust

We have not rated this service before. We rated it as good because:

We had not previously inspected this service. We rated it as good because:

• End of life care services were planned, organised and delivered well.
• The service had a clear vision and strategy which had been developed with the involvement of staff and external partners.
• Services were safe and well managed.
• Care was delivered by competent practitioners who considered the needs of all patients and families in their care.
• Staff provided a range of treatment and care for patients based on national guidance and best practice.
• Staff were caring and demonstrated compassion and kindness to patients and their families.
• The approach to end of life care was multi-disciplinary with all partners working together to support patients at the end of their lives.
• There was 24-hour cover for end of life services. Patients were triaged according to need.
• Care given was holistic, feedback from patients and their relatives described exemplary treatment and care.
• Training was available for staff to support their communication skills in dealing with patients at the end of their lives.
• Patients records were electronic in most areas and for those areas that were still using paper records had plans in place to become paperless.
• Safeguarding processes were in place and the trust were working closely with a neighbouring mental health unit.
• There were governance processes in place and risk was managed appropriately.
• Staffing levels were reviewed daily in all three localities, however the service in the Central region had only one band 6 nurse who was on secondment and an interim band 8 nurse. There was a business plan in place for an investment from a National cancer charity which would enable the service to recruit more staff.

This service has not been inspected before. We rated it as good because:

• Staff were qualified and competent to carry out their roles. They were encouraged to complete mandatory training, and this was actively monitored. There were systems in place to ensure patients were protected from abuse or neglect. Premises and equipment were clean and hygienic and used dental instruments were sterilised according to nationally recognised guidance. The service had a good track record of safety and there were systems and processes in place to reduce the risks associated with the carrying out of the regulated activities.
• Staff provided treatment, advice and care in line with nationally recognised guidance. The service used skill mix effectively through the use of dental therapists and dental nurses with extended duties. They monitored patient outcomes to ensure they were following nationally recognised guidance. Staff worked with other healthcare professionals to ensure patients received the best possible treatment. Staff were aware of the importance of obtaining and recording consent and were aware of their responsibilities under the Mental Capacity Act 2005 and the principals of Gillick competence.
• Staff cared for patients with compassion and kindness. We observed positive interactions between staff and patients throughout the patient journey. Patients told us that staff were professional, friendly and supportive.
• The service took into account patients’ individual needs. Most clinics were fully accessible for wheelchair users or those with limited mobility. They had access to a wheelchair tipper, bariatric couch and a hoist. Translation services were available for patients who did not have English as a first language. The appointment system met patients need and there were arrangements for patients requiring emergency treatment both in and outside normal working hours.
• There was a clearly defined management structure. Managers had the right skills to support high quality sustainable care. There were systems in place to develop management to ensure management remains strong. Systems and processes were in place to manage and mitigate risks to the service. Staff engaged with patients, other healthcare professionals and external stakeholders in order to continually improve the service.

However:

• The process for ensuring all medical emergency equipment was available and in date was not effective.

We have not previously rated this service. We rated it as good because:

• Staff had the appropriate skills and experience to provide effective care and treatment. Staff could access mandatory training and the department had good compliance rates.
• Staff understood their roles and responsibilities to protect patients from abuse. Staff had access to safeguarding training, policies and procedures and compliance rates for safeguarding training were good.
• The trust had measures in place to manage infection risk. Premises were visibly clean, tidy and well maintained with good access to cleaning materials.
• The service managed risk well and completed risk assessments for each patient.
• The trust arranged for good G.P. and pharmacy cover across the three locations.
• The trust knew how to monitor safety and the service used the information to make improvements. The trust was open and honest about safety information.
• Patients received food and drink according to their individual requirements and likes and dislikes. Staff monitored fluid and food intake and assisted patients to eat and drink where required.
• Patients were asked about their pain levels and staff aimed to keep patients comfortable.
• The trust was very good at multidisciplinary working with different types of staff working together to achieve aims and objectives and meetings the needs of patients.
• Staff knew what to do if patients were not able to consent to their care and treatment and the trust ensured good access to training, policies and procedures around mental capacity.
• Patients and their relatives and carers told us that staff were caring and took account of their emotional needs. Staff included patients and their carers in care and treatment planning.
• The trust placed importance on planning and providing services to meet the needs of the local people. The trust had measures in place to record experiences and feedback to develop the service.
• The service took account of patients’ individual needs and focussed on ensuring the care and treatment supported patients to be as independent as possible.
• People could access the service when they needed it with therapy available across seven days.
• The service had a good record for dealing with queries and concerns. The service treated concerns seriously, investigated concerns and learned lessons from the results. The trust shared the results with staff.
• The vision of the trust for inpatients care was clear and staff at all levels knew what the vision was and were engaged. The trust looked at different ways to engage both patients and staff and understood the importance of doing so to improve and develop the service.
• The trust learned from things that went wrong, and were open and honest when they did.
• The trust maintained a positive culture. All staff we saw spoke highly of working for the trust and were happy in their work.

We had not inspected this service previously. We rated it as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service managed patient safety incidents well and staff recognised and reported incidents appropriately.
• All services we visited held a daily safety huddle where caseloads, patients at risk, incidents and staffing were monitored.
• The service was developing fully integrated clinical pathways in line with national guidance.
• The service participated in research projects with local universities to improve evidence based practice and patient outcomes.
• The service made sure staff were competent for their roles and supported staff to undertake training and modules at degree level with the local universities.
• Staff from different professions and services worked together as a team to benefit patients.
• The service was working well towards fully integrating teams and staff acknowledged the evident benefits to patient care.
• Staff cared for patients with compassion, dignity and respect. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• Services were developed and reviewed to ensure they were responsive to the needs of the community.
• The service had a range of fully integrated health and social care teams delivering services across the community.
• The service had a range of nursing and therapy teams providing specialist clinics for patients in vulnerable and complex circumstances.
• The service had a clear vision for community services. Staff actively supported and promoted the vision.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service demonstrated a good culture of identifying and reporting risks.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

• The community health services for children, young people and families directorate provided staff with training in safety systems, processes and practices and this was monitored by the trust. Completion rates for mandatory training were mostly positive.
• The trust had an infection, prevention and control policy which was available to all teams in the directorate. Training rates were high and audits were done to ensure compliance to the policy.
• From to , staff within the directorate reported no serious incidents. Incidents were reviewed and monitored.
• Evidence based policies and national guidelines were used across the directorate, these included guidance from the National Institute for Health and Care Excellence.
• Staff in the directorate understood the relevant consent and decision-making requirements of legislation and how this related to young people.
• We observed staff of all professions in the directorate acting with compassion and respect towards patients and families. We observed staff explaining treatment and staff talked to patients continually providing reassurance.
• The staff teams across the directorate understood and met he needs of local people. The directorate had started to develop systems so that staff could be deployed effectively in high and low population areas.
• The staff in the directorate were aware of the diversity of populations and the challenges faced by some of its communities. Staff had access to multi-lingual sources such as translation services to support patient care.
• The directorate leaders had the skills, knowledge and experience to guide and lead staff. Managers had acted upon concerns relating to staffing pressures across services.
• Senior leaders in the trust and the directorate had a vison which focused on connectivity with other services to promote well-being. The directorate prioritised stability of services and safety of patients.
• Staff in the directorate told us that the culture of the organisation was positive. Staff felt valued and listened to and management structures had promoted a staff voice in the organisation.

However;

• Whilst training rates were good overall across the directorate, training rates in some mandatory areas needed to improve.
• The directorate was relatively new and lacked maturity and we found some significant challenges in achieving some key performance indicators including waiting times.
• Staff in some teams in community health services for children, young people and families’ directorate told us that that whilst vacancies were low, they experienced capacity issues because of increasing demand and complexity of caseloads.
• In some parts of Manchester, numbers of the directorates staff were working in areas where families disproportionately experienced higher than average rates of poverty, poor nutrition, obesity, smoking, domestic abuse and poor mental health. Staff told us this had a direct impact on the complexity of caseloads.

We had previously not inspected this service for this provider. We rated it as good because:

• The service was well staffed. Staff managed risk effectively. Staff completed patient risk assessments on admission and updated these regularly. The environment was subject to regular checks. A ligature risk assessment was in place. Actions to mitigate or remove risk were in place. Staff knew how to identify potential safeguarding concerns, and the action to take in response.
• A multidisciplinary team of staff provided care to patients. Staff completed and updated assessments of patients, and developed care plans from these. Care plans were detailed and holistic. Staff and patients completed a range of rating scales and outcome measures that were used to inform treatment. There was excellent physical health care. Patients’ physical health care was routinely assessed, monitored and treated when required. There was excellent physical health care. Patients’ physical health care was routinely assessed, monitored and treated when required.
• Staff treated patients with compassion and kindness. Patients and carers were involved in decisions about their care and treatment. Patients and carers were able to give feedback on the service they had received. Patients and carers we spoke with were positive about the service.
• The service had an admission criteria and a referral pathway. Referrals were managed in a timely manner. Discharge planning began from the point of admission. Staff supported patients with activities outside the service, such as work, education and family relationships.
• Managers promoted a positive culture that supported and valued staff. Staff we spoke with were positive about their jobs, the service and the care they provided. Staff were able to give feedback on the service and were involved in service development. There were effective systems and processes in place to drive quality improvement and safety. The service supported innovation and research.

We had not previously inspected this service under this provider. We rated the service as outstanding because:

During our inspection we found:

• Patient risk assessments were brief, not all sections were completed. Risks identified at assessment did not have subsequent guidance for staff in the form of risk management plans.

• Patient alarms were only located in two bathrooms and patients/visitors did not have access to alarms in other locations of the ward.

• The service could not always comply with same sex accommodation guidance, this had occurred once in the previous year.

• Controlled drugs on the premises were not checked in accordance with local procedures.

• Blanket restrictions were in place, patients could not access their bedrooms or bathrooms during the day without staff assistance. No individual plans or rationale for this were in place

• Staff did not have guidance on reducing restrictive practice, procedural support was not in place

• Identified environmental risks on the ligature risk assessment did not have associated action plans and were not included on the services risk register.

However:

• All ward areas were clean and well maintained and staff followed local infection control procedures.

• Electronic rostering was used to support staff management and staffing was reviewed regularly to ensure there was enough staff with the relevant skills to deliver safe patient care.

• All incidents were recorded on the electronic incident recording system; these were reviewed regularly to monitor themes and incident analysis. The trust had an open and transparent culture to reporting incidents and learning from incidents. Lessons learnt from incidents were shared across teams and staff described changes to policy and practice in response to lessons learnt

• Systems were in place to ensure that child safeguarding was fully integrated into local systems and practices.

• There was an established governance structure with a defined hierarchy of reporting and decision making within the service.

• There were clear systems of accountability and senior managers were actively involved in the operational delivery of the service. Processes and systems of accountability were in place and performance management and quality reporting was clearly set out.

• Performance issues were escalated and discussed at relevant governance forums and action taken to resolve concerns.

• All staff we spoke with were positive about their roles and were passionate about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments.

• The service was committed to improving the services on offer and continually improving the quality of care provided to patients.