Manchester University NHS Foundation Trust

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 8 care records during the assessment.

Staff completed a comprehensive mental health assessment of the young people in a timely manner at, or soon after, admission. Joint assessments took place of new referrals.

Staff assessed young peoples’ physical health needs in a timely manner after admission. Records showed ongoing physical health monitoring taking place.

Staff did not always develop care plans that met the needs identified during assessment. The care plans were not created in the electronic care record. They were completed on a shared drive and printed off. Staff used a template care plan with generic phrases for the physical and psychological healthcare and wellbeing care plan. Care plans were written in the first person but not in language that the young person would use, for example “the graded plan will include a weekly session off the ward with the nursing team to support my independence off the ward.” There was a sensory processing and sensory preferences care plan which was a tick list, with the aim of the young person ticking which applied to them, including what might help. However, these were not individualised, for example “I may need time to regulate when I become overwhelmed. If this is needed staff will support me to develop a plan” there were no examples of what would be helpful for that particular young person. The document also included unhelpful phrases, for example “I only eat certain foods, picky eater” for young people with eating disorders, this phrase would not be helpful with their relationship with food.

Care plans stated they should be reviewed 2 and 6 weekly, but we saw examples of care plans that had not been reviewed since 15 October 2025, which was approximately 12 weeks. This meant staff were not reviewing care plans at the stated frequency.

A young person’s autism care plan referred to having a hospital passport completed, to help explain to staff how best to support them, but that was not completed and in their file. This meant staff were not provided with information of how best to support them.

Care plans were not always signed by the young person and their family. It was difficult to see the involvement of young people in their care plans. Two young people said they were not involved in creating the care plan and one young person said their care plans were individualised.

Care plans did not include specific goals that were measurable for young people.

There were 4 young people who were autistic. Their care plans did not consistently include appropriate reasonable adjustments for their individual needs and preferences.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the young people. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). Family therapy was provided as recommended by NICE Guidance NG69 Eating disorders: recognition and treatment. Other psychological therapies provided included Eye Movement Desensitisation and Reprocessing (EMDR), dialectical behaviour therapy (DBT) and music therapy.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed. There were 2 bedrooms that were accessible for young people with mobility needs which included an ensuite bathroom, hospital beds and space for a wheelchair and a hoist and other equipment that maybe required.

The dietician assessed young peoples’ needs for food and drink and created a plan with young people, this included nutritional supplements where required.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. These included medicine audits, CCTV audits, care plan audits and nasogastric (NG) Feed audits.

The team included or had access to the full range of specialists required to meet the needs of young people in the service. The team included doctors, nurses, occupational therapists, psychologists, dietician and physiotherapist. However, there was a full-time social worker vacancy.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the young people. The staff team had worked in the service for several years and were skilled and knowledgeable about the needs of the young people. They had also contributed to the Pervasive Arousal Withdrawal Syndrome (PAWS) Practice considerations for the management of PAWS collective opinion piece. This document was created in conjunction with colleagues from other NHS Trusts in England and experts by experience.

Managers provided new permanent staff with an appropriate induction. All staff attended the corporate induction, we saw new staff that were shadowing more experienced staff within the team. There were induction processes for different roles. We saw the band 6 induction process included a timetable to include shadowing opportunities of relevant meetings. The nurse induction included the passing of nasogastric tubes for administering feeds. The senior nursing assistant induction process included checklists to work through what was relevant to the role and included the location of emergency equipment and how to respond in an emergency. However, the nursing assistant induction pack was secondary specialist care acute hospital focused and not mental health focused, for example “To check bedside suction daily and report any concerns.”

There was a new starter competency pack which included an induction checklist and assessment of competence in the required skills.

Study days took place for the team, which included sessions relevant to the young people. The December 2025 study day included Pervasive Arousal Withdrawal Syndrome (PAWS), refeeding syndrome and family systemic work.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. A spreadsheet was in use to monitor the frequency of supervision. The percentage of staff that received regular supervision was 100% for the multidisciplinary team and 81% for nursing staff.

Managers ensured that staff had access to regular team meetings. Minutes showed these took place on average every 2 weeks.

The percentage of staff that had had an appraisal in the last 12 months was 92%.

Mental Health Act

Mental Health awareness training was 100% compliant, Mental Health Awareness level 2 was 98% compliant.

Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were. The administrator was based on the ward and was approachable for the team.

The provider did not always have relevant policies and procedures that reflected the most recent guidance. The policy for the prevention and management of missing patients including adults, children and young people, dated June 2024 referred to notifications that were required to be submitted to CQC “Patients who are detained under the MHA may be taken back to the hospital by an appropriate trained member of staff employed by MFT. This power covered in Section 18 of the Mental Health Act. This must be reported to CQC as the Trust are obligated to inform when patients detained to a section of the MHA go missing from care.” This did not reflect the requirements as services only have to inform the CQC when a patient is detained in a secure service. We informed the relevant staff of this during the assessment.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. These were available via the staff intranet.

Young people had easy access to information about independent mental health advocacy. This was displayed on the notice board in the ward.

Staff explained to young people their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We saw rights were available in different languages for young people who required this.

Staff ensured that young people were able to take Section 17 leave (permission for young people to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of young peoples' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

We scored the service as 2. The evidence showed some shortfalls. The service did not always share their assessment of people’s needs from shift to shift. However, theservice worked well across teams and services to support people. They shared their assessment of people’s needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. Ward rounds took place weekly for all young people. We observed that all the multidisciplinary team attended reviews for young people and provided updates on the young person’s progress. The young person’s family and external support teams were present at the meeting too. Feedback from young people included that they had not been provided with all the reports prior to the meeting, which meant they were not able to fully prepare for the meeting and prepare questions for the meeting.

Staff did not always share information about young people at handover meetings within the team (for example, shift to shift). We reviewed the handover documentation and found that the handover did not include risk and observation levels for every young person. This meant new staff joining the ward would not be fully informed of the young people’s needs. However following feedback from the assessment, the service changed the handover format to anSBAR format (situation, background, assessment, recommendations).

The team had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). Meetings showed the involvement of external professionals in the care of the young people.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported young people to live healthier lives – for example, through participation in smoking cessation schemes, support with nutrition, managing cardiovascular risks, and monitoring the exercise and exertion of young people to ensure this was not excessive.

Ward activities helped promote a healthy lifestyle for young people – for example daily walking groups, relaxation, access to the sensory room, craft activities and board games to occupy the young people and distract from the urges to purge following meals.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff reviewed young people’s treatment on a weekly basis, this included progress with nutrition, weight gain, engagement in therapy and education.

Staff used recognised rating scales to assess and record severity and outcomes. Staff were involved in the creation of sensory profiles for young people.

Staff used technology to support young people effectively (for example, for prompt access to blood test results). Physical health monitoring was thorough and comprehensive. The service used the National Paediatric Early Warning System for observation and escalation.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable young people to make their own decisions, this included discussions in reviews and one to one discussions with staff on the ward. Staff developed accessible communication aids with the young people. This included bespoke communication cards about needing to talk, flow charts about the impact of purging and excessive exercise, and visual timetables for self-care tasks. Care plans and social stories had been created about nasogastric feeds and individualised to the young person with what was helpful for them.

The Mental Capacity Act applies to young people aged 16 or over. Young people aged 16 or over had their capacity assessed, however it was difficult to locate in the care record.

For young people detained under the Mental Health Act, staff explained their rights to them. The advocate spoke on behalf of a young person in their review and raised the topics and questions that the young person wanted addressing.

Parents were informed of the treatment being provided and had weekly meetings with their lead consultant to discuss progress and explore questions.