Pennine Care NHS Foundation Trust

Updated 19 June 2026

This assessment gave the trust an overall rating of good for its leadership, culture and governance. There were no breaches of regulation although there were a few areas where the trust should make some improvements. We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust using our current framework.

Pennine Care NHS Foundation Trust provides mental health, learning disability, and autism services to people across Greater Manchester and the surrounding areas. They serve a population of 1.3 million and their vision is a happier and more hopeful life for everyone in their communities.

They employ approximately 4700 staff and deliver care from 88 different locations in six boroughs:

• Bury
• Glossop
• Oldham
• Rochdale
• Stockport

• Tameside

The trust has an annual budget of £350 million.

The trust provides 11 services within our assessment service groups (ASGs).

• Community based mental health services for adults of working age
• Mental health crisis services and health based places of safety
• Child and adolescent mental health wards
• Forensic inpatient and secure wards
• Acute wards for adults of working age and psychiatric intensive care units
• Wards for older people with mental health problems
• Long stay or rehabilitation wards for adults of working age
• Community based mental health services for older people
• Substance misuse services
• Community learning disability services
• Specialist community health services for children and young people

The well-led review followed assessments of the following frontline services. The initial assessment of the trust’s services was triggered by the age of the trust’s ratings. We assessed six front line services from November 2024 onwards.

The ASGs we assessed included:

• Community based mental health services for adults of working age
• Mental health crisis services and health based places of safety
• Wards for older people with mental health problems
• Child and adolescent mental health wards
• Acute wards for adults of working age and psychiatric intensive care units
• Forensic inpatient and secure wards

We undertook these assessments to ensure we had a thorough understanding of a range of services provided by the trust ahead of our well-led review. Across services, we found assessments identified committed and caring staff, generally positive team cultures and examples of effective Multi-Disciplinary Team (MDT) working, alongside clear opportunities to strengthen consistency in risk assessment, person‑centred care planning, governance arrangements and workforce capability.

• Acute and Psychiatric Intensive Care Units (PICU) services were rated Requires Improvement, with a Section 29A Warning Notice issued to drive rapid improvement in safety, medicines management and oversight.
• Older People’s wards were rated Requires Improvement and needed further development in personalised care and staffing stability.
• Adult community mental health services and crisis teams were rated Requires Improvement and demonstrated strong engagement but experienced capacity and access pressures.
• Forensic services were rated Good with targeted compliance and estate actions required.
• Inpatient Child and Adolescent Mental Health Services (CAMHS) were rated Good and showed notable improvement in leadership and therapeutic culture despite ongoing environmental, staffing and discharge challenges.

Since these assessments, the trust has responded with timely action plans to address the findings and support improvement.

During this assessment we undertook a visit to the trust’s headquarters from 24 February to 26 February 2026. We carried out interviews with more than 25 members of the trust’s leadership team, including the chief executive, trust chair, executive medical director, chief operating officer, executive director of nursing, quality and healthcare professions, and executive director of finance. We also held interviews with non-executive directors.

During the assessment we also:

• ran focus groups with; trade union leads, staff network leads, governors, and service user and carer groups
• spoke with trust leads for equality diversity and inclusion, use of force and reducing restrictive practice, patient safety and safeguarding
• observed a public and a private board meeting
• observed a range of trust meetings and committees which including performance and finance committee, quality committee, and the people and workforce committee
• observed a meeting of the trust Board of Governors
• wrote to stakeholders including local authorities, NHS England, the police and the Integrated Care Board (ICB) to seek feedback about the trust.

Updated 16 June 2025

We carried out an assessment of Pennine Care NHS Foundation Trust’s (PCFT) mental health crisis services and health-based places of safety (HBPoS) from 14 – 24 October 2025. The mental health crisis services and HBPoS form part of the trust’s mental health services in the community. This assessment was completed as part of CQC's Adult Community Mental Health Programme. We also assessed community-based mental health services for adults of working age as part of the programme. The programme of assessments contributes to CQC's commitment to assess the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive assessment of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well-led.

PCFT is part of the Greater Manchester Integrated Care System (ICS), and its mental health crisis services and HBPoS provide care and treatment to a population of over 1.2 million people living across 5 local authorities; Bury, Rochdale, Oldham, Tameside and Stockport. PCFT covers a diverse area, with all 5 local authorities being more ethnically diverse than the national average, with higher proportions of people from an Asian or Asian British background than average. Oldham has the highest proportion of people from an Asian or Asian British background, at just under a quarter of the population. In the Index of Multiple Deprivation, Rochdale local authority ranks in the 10% most deprived local authorities nationally, whilst Tameside and Oldham rank amongst the 20% most deprived local authorities. Deprivation is linked with poorer health outcomes. The 2021 Health Index scores indicate that Stockport had better health than across England in 2015. The remaining local authorities had worse health than the rest of England in 2015, with Rochdale and Oldham experiencing the worst in the ICS. Stockport was the only local authority with life expectancy greater than the national averages for males and females. All local authorities have higher proportions of people aged 0 to 17 years than the national average, and lower proportions of people aged 18 to 64 than the national average. Data from 2023/24 showed Tameside had rates of emergency admissions due to self-harm higher than the national average for males and females, though suicide rates were lower than the national average for both males and females. Bury and Rochdale both had higher rates of suicide for males and females than the national average.

Crisis and home treatment teams (HTTs) are specialist teams of mental health professionals including nurses, doctors, social workers, psychologists, occupational therapists, and support workers who provide short term support to people experiencing a mental health crisis. They aim to prevent admission to hospital by providing treatment and support to a person in their own home. These teams offer a range of therapeutic interventions including assessment, crisis intervention, medication management, therapy, and support for carers. They can help people manage and resolve their crises while minimising disruption to their lives. They may also support inpatient discharges to reduce length of hospital admissions.

At the time of our assessment, PCFT was not commissioned to provide a full crisis assessment service, and only routinely delivered a HTT offer in each locality, which was not always available 24 hours a day, 7 days a week. The trust was in the process of implementing its community services transformation and had submitted a crisis services expansion proposal to the Integrated Care Board (ICB). The proposal sought to secure investment to support the future delivery of a Crisis Resolution and Home Treatment Team service which would meet national guidance recommendations. If approved, this would include a 24-hour, 7 day a week urgent response assessment service which would meet NHS England guidance that very urgent presentations should receive a face-to-face assessment within 4 hours, and urgent presentations within 24 hours.

PCFT’s mental health crisis and health-based places of safety service include 5 HTTs and 3 HBPoS. The main functions of the HTTs include crisis intervention to prevent hospital admission, supporting discharge from inpatient services, and discharge follow-up for people leaving inpatient services who do not require ongoing support from community mental health services.

A health-based place of safety (HBPoS), also known as a 136 suite, is a designated space within a hospital or other health facility where individuals detained under Section 136 of the Mental Health Act can be safely assessed. People can be detained in a place of safety for up to 24 hours, allowing for the necessary assessment.

The service also included a 111 Option 2 for Mental Health service, delivered in partnership with another mental health NHS trust.

PCFT’s HTTs and HBPoS are:

• Bury HTT
• Heywood, Middleton and Rochdale HTT
• Oldham HTT
• Stockport HTT
• Tameside HTT
• Royal Oldham Hospital HBPoS
• Tameside General Hospital HBPoS
• Fairfield General Hospital HBPoS

The trust also operated a local 24/7 Mental Health Helpline which closed on 3 November 2025. People who use services could continue to access urgent mental health support by calling NHS 111 Option 2.

The teams were managed as part of locality care hubs within area networks. South Network included Tameside care hub and Stockport care hub. North Network included Heywood, Middleton and Rochdale care hub, Bury care hub and Oldham care hub.

During the assessment we visited 3 HTTs (Bury, Heywood, Middleton and Rochdale, and Stockport) and all 3 HBPoS. We also visited the 24/7 Mental Health Helpline, and NHS 111 Option 2 teams.

We last inspected PCFT’s mental health crisis services and health-based places of safety in 2019 when we rated it requires improvement. In 2019 we identified 4 breaches of the regulations in relation to having sufficient staff to provide services safely, providing staff with management supervision, safe medicines management, and ensuring staff comply with the requirements of the Mental Health Act (including the completion of Mental Health Act documentation fully and ensuring patients have their rights explained to them when detained under section 136).

At this assessment, we identified 2 breaches of the regulations in relation to staffing levels, training and supervision, and governance (including the completion of Mental Health Act documentation and ensuring patients have their rights explained to them when detained under section 136). The service still did not always ensure it deployed enough suitably trained and supervised staff to provide safe care and treatment. The service still did not ensure staff complied with the requirements of the Mental Health Act, including the full completion of Mental Health Act documentation and ensuring patients had their rights explained to them. Governance processes were not always effective.

However, the service was no longer in breach of regulations related to medicines management.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 29 September 2025

We assessed the child and adolescent mental health ward at Pennine Care NHS Foundation trust from 11 to 12 November 2025. The Mental Health Hospital was initially registered with CQC in December 2010 to deliver the regulated activities: Assessment or medical treatment for persons detained under the Mental Health Act 1983 and Treatment of disease, disorder, or injury. The service had a controlled drugs accountable officer.

We visited Hope Ward as part of the assessment:

Hope ward was a child and adolescent mental health ward. The service provided tier four child and adolescent mental health services delivered in specialist inpatient settings. The care focused on children and young people who had severe or complex mental health conditions that could not be adequately treated in the community or who needed extended assessment or treatment. The child and adolescent mental health inpatient services provided by Pennine Care NHS Foundation trust were currently in one setting. The Hope Unit is a 12-bed unit that opened in 2008. It provided acute psychiatric inpatient service for patients aged 13 to 18, in an appropriate age environment. The unit provided intensive assessment and treatment for patients with mental illness or psychiatric disorder for which enhanced community treatment was no longer viable or safe. These included patients detained under the Mental Health Act.

At this assessment we identified one breach of regulation in relation to staffing in the child and adolescent mental health ward.

At this assessment we assessed 1 assessment service group; Child and adolescent mental health wards, where we assessed 33 quality statements.

We rated the service as Good.

Updated 1 October 2025

The assessment of the forensic wards was completed on 4-6 November 2025, due to an aged rating. The service was last inspected in June 2016, when it was given a rating of good.

The forensic ward inpatient services were located in two units. Prospect Place was in Rochdale and Tatton Unit was in Tameside. Prospect Place could accommodate 47 male patients. There were three wards at Prospect Place. The Engagement and Assessment ward had 15 beds; Recovery and Intervention ward had 15 beds and Social Inclusion ward had 17 beds. The Tatton Unit had one ward only with 16 beds.

Each ward had its own admission and discharge criteria. Patients were generally admitted to the assessment ward at Prospect Place. Throughout the course of their inpatient stay, patients usually moved to the recovery ward and finally the social inclusion ward prior to discharge from Prospect Place. Patients were moved between the wards at Prospect Place and could be transferred to the Tatton Unit depending upon their needs. The Tatton Unit provided slower placed, longer term care for patients. Admissions were prison transfers and from acute inpatient units including psychiatric intensive care units.

At the last inspection in June 2016, the service was rated as good. There were no regulatory breaches but we asked the trust to improve mandatory training compliance, menu choices, availability of Mental Health Act staff, access to the garden at the Tatton Unit and the availability of exit interviews for staff who were leaving the service.

We found that most areas had been improved, however some of the essential mandatory training courses were below the trusts’ rate of compliance; there was a vacancy for a Responsible Clinician which was impacting on patients; supervision at the Tatton unit was low, the seclusion room at the Tatton Unit had inadequate temperature controls and there was opened but unlabelled medication in the clinic room at the Tatton Unit. There was a lack of access to face to face training on learning disability and autism, which was a challenge across all Greater Manchester Trusts. Compliance with the learning disability and autism on line training was at 100%.

At this assessment we found 2 breaches of regulations. These were Regulation 18 Staffing and Regulation 15 Premises and Equipment.

We have asked the provider for an action plan in response to the concerns found at this assessment.Mental Health Act and Mental Capacity Act Compliance Summary

Training compliance in the Mental Health Act was at 70% across all four wards. This was below the providers target of 90%.

Staff that we spoke with 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 the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were and how to contact them.

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

At the time of the assessment, 74% of staff had received training in the Mental Capacity Act.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff were able to talk about this confidently during the assessment.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards (DOLS). Staff were aware of the policy and had access to it on the staff intranet.

Staff took all practical steps to enable patients to make their own decisions. This included encouraging patients to attend their meetings, discussing care and treatment in one to one sessions and including them in the development of their care plans.

Updated 16 June 2025

We carried out an inspection of Pennine Care NHS Foundation Trust’s (PCFT) community-based mental health services for adults of working age from 14 – 24 October 2025. The community-based mental health services for adults of working age form part of the trust’s mental health services in the community. This inspection was completed as part of CQC's Adult Community Mental Health Programme. We also inspected mental health crisis services and health-based places of safety as part of the programme. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well-led.

PCFT is part of the Greater Manchester Integrated Care System (ICS), and its adult community mental health services provide care and treatment to a population of over 1.2 million people living across 5 local authorities; Bury, Rochdale, Oldham, Tameside and Stockport. PCFT covers a diverse area, with all 5 local authorities being more ethnically diverse than the national average, with higher proportions of people from an Asian or Asian British background than average. Oldham has the highest proportion of people from an Asian or Asian British background, at just under a quarter of the population. In the Index of Multiple Deprivation, Rochdale local authority ranks in the 10% most deprived local authorities nationally, whilst Tameside and Oldham rank amongst the 20% most deprived local authorities. Deprivation is linked with poorer health outcomes. The 2021 Health Index scores indicate that Stockport had better health than across England in 2015. The remaining local authorities had worse health than the rest of England in 2015, with Rochdale and Oldham experiencing the worst in the ICS. Stockport was the only local authority with life expectancy greater than the national averages for males and females. All local authorities have higher proportions of people aged 0 to 17 years than the national average, and lower proportions of people aged 18 to 64 than the national average. Data from 2023/24 showed Tameside had rates of emergency admissions due to self-harm, higher than the national average for males and females, though suicide rates were lower than the national average for both males and females. Bury and Rochdale both had higher rates of suicide for males and females than the national average.

PCFT’s community-based mental health services for adults of working age include 10 community mental health teams (CMHTs), an assertive outreach team in Stockport, 5 early intervention teams (EIT), 5 neighbourhood mental health teams (known as Living Well) and 4 access/response teams. Across PCFT these are:

• Tameside South CMHT
• Tameside West CMHT
• Tameside North CMHT
• Stockport East CMHT
• Stockport West CMHT
• Oldham CMHT
• Rochdale West CMHT
• Rochdale East CMHT
• Heywood Middleton CMHT
• Bury CMHT
• Bury EIT
• Heywood, Middleton and Rochdale EIT
• Oldham EIT
• Stockport EIT
• Tameside and Glossop EIT
• Oldham Access Team
• Rochdale Response Hub
• Stockport Access Team
• Tameside and Glossop Mental Health Open Door
• Bury Living Well
• Heywood, Middleton and Rochdale Living Well
• Oldham Living Well
• Stockport Living Well
• Tameside and Glossop Living Well

The teams are managed as part of locality care hubs within area networks. South Network includes Tameside care hub and Stockport care hub. North Network includes Heywood, Middleton and Rochdale care hub, Bury care hub and Oldham care hub.

During the inspection we visited 8 sites (Heywood, Middleton and Rochdale EIT, Heywood and Middleton CMHT, Stockport East CMHT, Stockport Assertive Outreach, Oldham EIT, Bury CMHT, Tameside North CMHT, Stockport EIT). These sites included the following teams:

• community mental health teams,

• early intervention teams,

• assertive outreach,

• and various medicines clinics.

At the time of our inspection, the trust was in the process of implementing its community services transformation. The transformation focused on achieving greater consistency in the delivery and quality of care across the trust, whilst also achieving the aims of the NHS Community Mental Health Framework to have a greater focus on preventative healthcare in localities. Before the transformation, CMHTs had been integrated with the local authority. CMHTs had split from the local authority less than a month before the time of our inspection.

We last inspected PCFT’s community-based mental health services for adults of working age in 2016 when we rated it requires improvement. We identified 2 breaches of the regulations in relation to staff mandatory training compliance and incomplete and/or out of date care records and assessments. At this inspection, we identified 3 breaches of the regulations in relation to ensuring people who used services who were under Community Treatment Orders were made aware of their rights, governance, and staffing levels, training and supervision. However, we identified improvements in quality of care records and timeliness of assessments.

We have asked the provider for an action plan in response to the concerns found at this inspection.

Updated 11 April 2025

• We carried out the assessment for Pennine Care NHS Foundation Trust acute wards for working age and psychiatric intensive care units on 24, 25 and 26 June 2025.
• We carried out the assessment in response to concerns raised about the service and due to the length of time since the service was last inspected.
• Pennine Care NHS Foundation Trust acute and PICU services had 12 wards across 5 locations including 10 acute wards and 2 psychiatric intensive care units. The locations we visited at this inspection were: Stepping Hill hospital in Stockport; Fairfield General Hospital in Bury; Tameside General hospital in Ashton-under-Lyne; Birch Hill hospital in Rochdale and Royal Oldham hospital in Oldham.

We visited the following wards as part of our assessment:

Arden ward - male acute ward with 24 beds

Norbury ward – female acute ward with 23 beds

Woodbank psychiatric intensive care unit - female ward with 7 beds

North ward – female acute ward with 23 beds

South ward – male acute ward with 22 beds

Saxon ward – male acute ward with 23 beds

Taylor ward – female acute ward with 22 beds

Walkerwood psychiatric intensive care unit – male ward with 10 beds

Hollingworth ward – male acute ward with 18 beds

Moorside ward – female acute ward with 18 beds

Oak ward – male acute ward with 22 beds

Aspen ward female acute ward with 22 beds

We gathered information from people using the service and their loved ones, staff and managers, other stakeholders and carried out our own observations. We reviewed a range of documents including care records, policies and procedures. We looked at 33 quality statements.

We rated the service as Requires Improvement. We found 4 breaches of the regulations in relation to safe care and treatment, premises and equipment, good governance and staffing.

• Staff did not always identify risks to people's health and safety or mitigate them where identified.
• Patients did not always have care plans which were person centred and relevant to their needs.
• Staff had not always received supervision or relevant training. Staff were mostly compliant with mandatory training, but compliance levels for role essential training were low.
• Physical health monitoring had not always been carried out consistently.
• Complaints and incidents were not always investigated in a timely manner.
• Governance systems and audits were not always effective in identifying or addressing areas for improvement.

However

• There were mostly sufficient staff to provide patients with 1 -1 time and to support patients to take their section 17 leave.
• Patients had their rights explained to them in a way they could understand and had access to advocacy where needed. All detained patients were referred to an independent mental health advocate.
• Most patients told us that staff were respectful, caring and provided support when they needed it.
• Staff mostly felt supported by leaders and felt they could speak up about any concerns they had.

Action we have taken

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Mental Health Act and Mental Capacity Act Compliance Mental Health Act

Not all staff had received training in the Mental health Act the Code of Practice and the guiding principles. 46% of staff had received Mental Health Act training.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its code of practice. Staff knew who their Mental Health Act administrators were and the provider had relevant policies and procedures that reflected the most recent guidance and staff could access these when they needed to.

Patients had easy access to information about independent mental health advocacy, detained patients were automatically referred for independent mental health advocacy support. Staff explained their rights under the Mental Health Act to patients, in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. The service displayed a notice to tell informal patients that they could leave the ward freely. Staff stored copies of patients' 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.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff carried out regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Staff had a good understanding of the Mental Capacity Act, in particular the 5 statutory principles. 58% of staff had had training in the Mental Capacity Act.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards. There were 4 deprivation of liberty safeguards applications made in the last 12 months to protect people without capacity to make decisions about their own care.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regards to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service had arrangements to monitor adherence to the Mental Capacity Act. Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

Updated 27 September 2024

Pennine Care NHS Foundation Trust was formed in 2002 as a mental health trust. The trust has an income of approximately £280 million and employs more than 4,300 staff. Pennine Care NHS Foundation Trust provides inpatient, community and specialist mental health services across the areas of Bury, Heywood, Middleton and Rochdale, Oldham, Tameside and Glossop and Stockport to a total population of 1.3 million people, providing care to over 70,000 people in 2023/24.

The trust provides 150 different services including:

• Acute mental health wards for adults of working age
• Community based mental health services for adults of working age
• Long stay/rehabilitation mental health wards
• Child and adolescent mental health wards
• Child and adolescent mental health community services
• Forensic/low secure mental health wards
• Mental health wards for older people
• Community based mental health services for older people
• Mental health crisis services and health-based places of safety
• Community based mental health services for people with a learning disability
• Substance misuse services
• Adult social care - respite services at Cambeck Close

The trust also provides mental health services for military veterans across the whole of Greater Manchester, working in partnership with other trusts which cover Lancashire, Cheshire and Merseyside.

This assessment covered the mental health wards for older people only. It was a responsive assessment which was triggered due to concerning information we received about several of these wards between June and October 2024 from complaints, whistleblowing concerns and notifications from the trust. The assessment included an on site inspection of all 9 of the trust’s wards for older people which took place on 4, 5, 6 and 7 November 2024. We gathered information from patients and their loved ones, staff and managers, other stakeholders and our own observations of care. We reviewed a range of documents including care records, policies and procedures. We looked at 28 quality statements.

We rated the service as requires improvement. We found 5 breaches of the Regulations in relation to person-centred care and involvement of patients, consent to care and treatment, patient safety, governance and staffing.

Care plans did not usually show how care was centred on the individual or that their views and the views of their carers and close relatives had been taken into account in a meaningful way. Due to vacancies in occupational therapy teams and other pressures on ward based staff, patients did not always have access to a good range of meaningful and health-promoting activities on the wards. Where patients lacked the capacity to consent to their care and treatment this was not always formally assessed for specific decisions in line with the expectations of the Mental Capacity Act and records of decisions taken in patients’ best interests did not always show how this process included the safeguards required by the Act. Where risks relating to specific aspects of people’s care had been identified, for example relating to falls or specific health conditions, they did not always have clear plans of care setting out how these risks would be mitigated.

The trust’s governance systems, for example records audits, did not always have the capacity to identify shortfalls in people’s care and some areas of care, for example compliance with the Mental Health Act and Mental Capacity Act were not subject to any documented quality monitoring process at the time we inspected. Although the wards were usually staffed to safe levels, we saw a high use of temporary staff to cover vacancies, staff sickness and enhanced clinical need on the wards and the systems for induction and training of temporary staff did not always ensure that staff were familiar with the wards and the needs of the patients they were caring for. Substantive staff were not always up to date with their mandatory training and supervision sessions. The mandatory training for staff did not always fully equip them to meet the needs of the patients they were caring for, for example many staff caring for people living with dementia had not received any dementia awareness training as this was not a mandatory training module at the time we inspected.

However, the wards were usually safe and clean and staff complied with infection prevention and control best practice such as handwashing and use of personal protective equipment. Patients had access to the equipment they needed to be safe and to maintain their independence, such as mobility aids. Clinic rooms were kept clean and tidy and medicines were stored safely. Patients had access to the medicines they needed to support their mental and physical health. Much of the care we observed was compassionate and patients told us that staff generally treated them well and were able to meet their needs. Levels of physical restraint and other restrictive practices such as seclusion were low. Staff usually complied with the requirements of the Mental Health Act and patients detained under the Act were aware of their legal rights. Patients had access to medical care when they needed it and were able to participate in weekly reviews of their care at multi-disciplinary ward rounds. Patients had access to independent advocacy on all wards and accessible information about the service was displayed and made available in introductory packs when they were admitted. Staff and patients told us they were aware of how to raise concerns and said they would feel safe to do this if needed. There were governance systems in place which ensured that shortfalls in care quality were usually escalated to the trust’s Board of directors via appropriate sub-committees so action could be taken at an organisational level to improve.

Action we have taken

We have asked the provider for an action plan in response to the concerns found at this assessment relating to patient safety, governance and consent to care and treatment.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

Updated 9 December 2016

Pennine Care NHS Foundation trust adult community provides services across six Greater Manchester boroughs or local authorities. Bury, Oldham, Rochdale, Heywood, Middleton and Trafford.

Adult services are commissioned by four clinical commissioning groups (CCG’s). Bury; Oldham; Rochdale, Heywood and Middleton and Trafford. Services are configured to match the CCG locations.

Adult nursing and therapies services provided by the trust includes:-

• district nursing
• palliative care
• physiotherapy
• audiology
• podiatry
• speech and language therapy
• weight management service
• wheelchair services
• occupational therapy
• nutrition and dietetics
• tissue viability
• community enhanced care services
• services supporting the management of long-term conditions such as pulmonary rehabilitation, expert patients, vascular diseases and cardiac rehabilitation.

Overall rating for this core service Requires Improvement

We rated this service as requires improvement because.

• Insufficient numbers of staff had completed Mental Capacity Act and Deprivation of Liberty Safeguard training.

• Efforts to integrate Trafford services into the main body of the organisation were ongoing.

• Staff said and minutes of meetings also indicated that at the time of the inspection Trafford staff felt isolated from the rest of the Pennine Care NHS Foundation trust.

However

• The trust ensured care and treatment was based on best practice guidance.

• The trust promoted and encouraged staff involvement with local and national patient outcome audits.

• The trust frequently monitored the quality of the services provided.

• Patients rated the trust highly and evidence indicated they felt involved in planning their care and were satisfied with the standard of care.

• There were innovative services provided by the trust, for example the chronic obstructive pulmonary disease advisory service.

• Processes and systems were in place to ensure lessons were learnt from incidents and complaints.

Updated 9 December 2016

We rated the community children, young people, and families services (the services) at the Pennine Care NHS Foundation Trust (the trust) as good.

This was because: -

Care and treatment across the children, young people and family’s services was provided in line with national and professional guidance and evidence based practice. Staff across all four of the boroughs (Bury, Oldham, Heywood Middleton and Rochdale, and Trafford) treated children and young people as individuals and involved them in their care and, when appropriate, in decisions about their care. Although not all services were open seven days a week, individual services worked flexibly to provide additional clinics in the evenings and weekends. To bring services closer to the local population clinics and appointments were provided in local children’s centres.

Staff were familiar with the trust’s incident reporting policy and understood their responsibilities to report safety and clinical incidents. People were told when things went wrong, and learning from incidents was shared at local levels within teams and boroughs, and across the organisation through emails, written bulletins and newsletters.

Reporting systems were in place to protect people from harm, abuse and neglect, and staff understood where they could obtain further advice on safeguarding issues. We saw evidence of referrals being made to other professionals and multi-agency teams when staff had concerns about children’s safety.

Staff were competent and passionate about the care and treatment they provided to children, young people and families, and there was effective multidisciplinary working within teams. However, some services we visited were experiencing capacity challenges, and longer waiting times, because of increased demand for their services. Plans had been put in place to improve waiting times in the affected services. Although we were told about one internal waiting list used in the children’s services in Heywood, Middleton and Rochdale, overall the plans put in place by services were showing evidence of improvement in waiting times as a result.

A new electronic computer system was being introduced across the trust, and there was varied progress towards the implementation of this across the services and boroughs. However, technology was used well to engage children, young people, and families with services. This included the introduction of Chat Health by the school nurse service, which enabled children and young people to book appointments with school nurses and ask health related questions. The Sugar3 (Sugar Cube) mobile phone app helped children with type 1 diabetes monitor and self-manage their condition. Plans were in place for all the services to develop a text messaging telehealth service called Florence (FLO). This was to help patients at home benefit from motivation and prompting; questions or education; or to report symptoms and home measurements.

Leaders of the services recognised the ethnically diverse population within each borough, areas of deprivation, and specific health issues affecting their communities. The services worked with the local community to ensure health visiting services met the cultural and religious needs of the local community. Although translation services were available throughout the services and boroughs, we saw little evidence of public health information being displayed in other languages in the treatment centres we visited.

There was good public engagement by the services through local patient forums and support groups. Carers and parents spoke positively about staff and the care provided to their children.

However,

There was a risk to the safety of people who used the school nurse service for vaccinations. This was because the service could not guarantee the ‘cold chain’ (ensuring an appropriate temperature range) for the storage and transportation of vaccines and medications as maximum and minimum storage temperatures were not recorded. Vaccines and medications stored outside the recommended temperature range may not be effective.

The Oldham children’s nutrition and dietetics service did not maintain accurate, complete, and contemporaneous records in respect of each service user. Records were of poor quality and did not always indicate what actions staff had taken following previous reviews of children within the service. This increased the risk that children were not kept safe because they may not receive continuity of care.

Care and treatment provided by the Heywood, Middleton and Rochdale speech and language therapy and occupational therapy services were not always provided in a timely way. This was due to high demand for the service and increasing caseloads, leading to long waiting times for treatment.

Staff understood and engaged with the trust’s strategy and vision; however, some staff were unsettled by the pace of commissioning and tendering changes, and were concerned about the future

Although some services were working towards agreeing consistent treatment pathways and procedures across borough boundaries, some staff told us they did not feel the boroughs worked together.

Updated 28 January 2019

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

• Staff had the qualifications, skills and experience to keep patients safe. They had access to training to support their roles.
• Systems and processes were in place to deal with patients becoming acutely unwell.
• Staff reported incidents and accidents, these were investigated and acted upon to reduce the chance of re-occurrence.
• Infection control procedures were in line with nationally recognised guidance.
• Staff were aware about issues relating to safeguarding and there were systems in place to refer children and vulnerable adults.
• Staff provided care and treatment based on nationally recognised guidance.
• There was an effective skill mix at the service to assist with the ever-increasing complexity of patient. Staff worked together as a team and with other healthcare professionals in the best interest of patients.
• The service was proactive to improve the oral health of the local community.
• Staff understood their responsibilities under the Mental Capacity Act 2005 and with regards to Gillick competence.
• Staff cared for patients with compassion. We observed staff treating patients with dignity and respect.
• Feedback from patients was positive. They told us staff were friendly, caring, informative and helpful.
• The service considered patients’ individual needs. Clinics had been adapted to ensure they were accessible for all patients.
• The appointment system met patients’ needs.
• The service dealt with complaints positively and efficiently.
• There was a clearly defined management structure. Managers had the right skills and abilities to provide high quality sustainable care.
• There were systems and processes in place for identifying risks and planning to reduce them.
• Staff engaged with patients and other healthcare professionals to continually improve the service.

However:

• Recommendations from the routine test of an X-ray machine had not been identified or actioned.
• Audits of X-rays did not reflect nationally recognised guidance and was not dentist specific.
• Communication between teams was not consistent. Managers did not always know about risks relevant to the dental service.

Updated 9 December 2016

Overall rating for this core service Good lWe rated Community inpatients at Pennine Care NHS Foundation Trust as good.

This was because:

• Incidents were reported through effective systems and lessons learnt or improvements made following investigations were shared.
• The wards were visibly clean and spacious across both of the sites we visited.
• Staff followed good hygiene practices and the trust had policies and procedures in place.

• There were good systems for handling and disposing of medicines.
• There was good evidence of multidisciplinary team working with regular meetings held to review patient’s ongoing development and needs.
• Care provided was patient centred and patients were involved in their care and planning individual goals. Patients were observed receiving compassionate care and their privacy and dignity was maintained.
• Staff were proud about their work and told us they felt supported and part of the team.
• Staff had access to information they required, for example diagnostic tests and risk assessments.
• Staff were aware of their role and responsibilities around the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.
• Best practice guidance in relation to care and treatment was followed.
• Community inpatient service participated in National Audit of Intermediate Care audit and local audits and action plans formulated following the results of audits.

However,

• Planned staffing levels on some of the units during the night were not always sufficient; however bank and agency staff were used on a regular basis to support safe staffing levels.
• Overall compliance with mandatory training for the majority of staff was below trust target. The trust target was 95%.
• A small number of staff across the units had attended Mental Capacity Act and deprivation of Liberties training.
• Not all staff had access to clinical supervision provided by the trust.

Updated 9 December 2016

Overall rating for this core service Requires Improvement

We have rated this service overall as requiring improvement. This is because:

• Bury specialist palliative care nursing team did not have sufficient staff to provide a timely service to patients at the end of their life. There was no consultant in specialist palliative care, which meant that highly specialist advice and support regarding complex symptom control was not available throughout the trust.
• Systems or processes were not sufficiently established and operated to effectively ensure the trust was able to assess, monitor and improve the quality and safety of end of life care.
• There was no trust wide method of categorising end of life care incidents and complaints to monitor themes and share learning across the trust.
• The trust had not implemented individual plans of care for end of life patients in each of its geographical location at the time of the inspction.
• There was no structured end of life care training plan or register of training to ascertain the skills of staff in different roles and teams.
• There was no trust wide strategy or vision for end of life.

Updated 28 January 2019

This was the first rating inspection of the Urgent care services.

We rated it as requires improvement because:

The service had put some systems to manage risk so that safety incidents were less likely to happen. However, these were recently developed and were not yet embedded sufficiently to provide the service with assurance that can recognise risks and take appropriate action in a timely manner.

The leadership, management and governance of the walk-in centre did not always assure the delivery of high-quality and person-centred care. There had been a recent review of the governance arrangements which had brought about strengthening of the vision and strategy for the future development of the service.

Systems and processes to ensure staff learned from the incidents and complaints to improve their practice were not consistent to provide appropriate learning for staff. This issue was being addressed as part of an improvement plan.

Staff did not consistently receive suitable supervision or mandatory training to meet their job roles. There was inconsistency noted from staff in their involvement in meetings and awareness of support from senior managers.

Systems were in place to ensure patients were safeguarded from abuse and harm.

Staff involved and treated patients with compassion, kindness, dignity and respect.

Patients could access care and treatment from the service within an appropriate timescale for their needs.

The facilities and premises were appropriate for the services that were delivered.

The service took account of patients’ needs and choices.

There was now a focus on improvement and learning in the team.

Updated 9 December 2016

We rated specialist community mental health services for children and young as GOOD because:

• Staff managed patient’s risks. There was a proactive approach to managing patients on waiting lists. This meant staff were able to identify changes in risk and prioritise urgent cases.

• There were processes in place to support safeguarding and the management of patients at risk. There were good links with local safeguarding bodies.

• Patients had access to a range of psychological therapies in line with National Institute for Health and Care Excellence guidance.

• There was a multidisciplinary approach to the delivery of care. Staff groups worked together to meet the needs of patients.

• Patients and parents were involved in decisions about their care and treatment. Feedback from patients was positive. We observed patients being treated in a respectful manner and with a caring and empathetic approach.

• Patients and parents were able to give feedback on the care they had received and input into decisions about the service.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents and complaints were shared across the service.

However

• Not all staff were receiving regular managerial supervision. The service did not collate information on compliance with supervision. This meant that the service could not be assured that staff were supported in their role.

• There were waiting lists in place in two teams. Some patients had not been seen within the 12 week to assessment and 18 week to commencement of treatment targets.

• Whilst morale in the Bury and Oldham Healthy Young Minds teams was good. Staff told us that morale at Trafford Healthy Young Minds was mixed. The Trafford team was going through a process of organisational change. Some staff told us they did not feel engaged with the trust or with the change process.

Updated 9 December 2016

We rated Pennine Care NHS Foundation Trust community mental health services for people with learning disabilities as good because:

• A range of high quality, person-centred therapeutic interventions were being delivered to patients to support them to achieve improved independence and wellbeing.
• Interactions between staff and patients demonstrated personalised, collaborative, recovery-oriented care planning.
• Patients who had been assessed as being at risk of crisis had clear crisis plans.
• All staff had a good understanding of the principles and application of the Mental Capacity Act
• Staff attitudes and behaviours were responsive, respectful and caring.
• Staff were using innovative methods to involve patients in their own care.
• Services routinely supported patients to get involved in staff recruitment. This was underpinned by a detailed trust policy.
• The Oldham service was facilitating a supported internship for a person with a learning disability.
• Teams had made efforts to engage people from minority ethnic communities. The team in Oldham had developed a set of easy-read pictures and symbols for patients from a South Asian background.
• Teams had a strong identity and were committed to helping people with a learning disability achieve improved independence and wellbeing.
• Managers attended directorate governance meetings, and received regular feedback on their teams’ performance.
• Two of the teams had audited themselves against the National Learning Disability Professional Senate specification for learning disability teams.
• The learning disability directorate participated in the Greater Manchester plan to transform care for people with learning disabilities.
• Teams had been able to raise their concerns about confidentiality in the bases to their senior managers.

However,

• Seven of 32 case records checked did not include a risk assessment, and 15 others did not include a full risk assessment.
• In two of the locations, patients and carers needed to walk through or past staff desks to get to the interview rooms. This made it difficult to protect confidentiality.
• Interview rooms were not soundproofed.
• The joint protocol between mental health and learning disability services in Stockport did not cover the home treatment team and on-call psychiatrist. This meant that patients may need to go to accident and emergency to access a mental health crisis service.
• Learning disability, psychiatry and mental health teams kept separate care records. This meant that staff did not have easy access to all of the information they needed to be able to deliver safe and effective care.
• An audit of antipsychotic prescribing in people with a learning disability identified that there was no documented evidence of side-effect monitoring in around half of care records.
• Two of the teams did not employ the full range of professional disciplines recommended by the national specification for community learning disability teams.

Updated 9 December 2016

We rated community-based mental health services for older people as good because:

• There were safe lone working arrangements in place when staff visited patients’ homes. Staff had reasonable caseloads so staff could keep patients safe. Referral information was coordinated and actioned quickly. Care plans had crisis care plans to inform patients and carers on what to do in crisis. Patients’ records contained comprehensive risk assessment. Staff were kept up-to-date with good mandatory training uptake.

• There was effective multidisciplinary working in most teams. Staff completed life story work with patients with dementia to enable them to provide person centred care. There was good interagency working including with voluntary and third sector organisations. Staff took action to ensure that patients’ physical health needs were monitored and treated. There were good systems to ensure the Mental Health Act was followed where patients were on a community treatment order. Staff had a good understanding of the Mental Health Act and Mental Capacity Act despite this not being required mandatory training.

• Patients were highly complimentary about the care they received. Records showed support workers going the extra mile to support patients. There was significant service user involvement and community engagement in Stockport, including people with dementia providing peer support and post diagnostic support to people with a recent diagnosis of dementia as well as being involved as partners in staff training.

• Access into the services was coordinated through a single point of entry in each locality. There were no waiting lists to receive an assessment or receive treatment. The teams were meeting the targets expected of them. There were specialist workers within some teams such as an early onset dementia team in Stockport and a specialist vascular dementia worker in Bury. There were proactive contact with Black and minority ethnic communities to promote the work of the teams, improve referrals and for health promotion. There were low numbers of complaints and these were well managed.

• Staff understood the trust’s vision and values. Teams were well-led by committed managers and staff felt respected and supported by managers. Effective managerial operations meetings took place where incidents were discussed, team performance was reviewed and staffing and sickness in teams was considered. There was a commitment to service improvement and extending services to meet the needs of different patient groups.

However:

• There were unsecure records at the offices in Bury which was a shared building with non-trust staff working in the building. The trust took action to address this immediatley following the inspection.
• There were issues with informing patients on a community treatment order about the availability of the independent mental health advocacy service and ensuring the legal certificate to provide treatment to a community patient was kept with the medication card.
• Records did not always contain full details of the legal safeguards when decisions were made on behalf of incapacitated patients such as the extent of any lasting or enduring power of attorney decisions and the conditions and Deprivation of Liberty Safeguards authorisations.
• Staff in the Bury team did not always request interpreter involvement for more routine appointments when the patients’ first language was not English.
• The trust did not provide any steer around how each team could evidence or develop services in line with the trust’s three quality priorities for 2015/16.

Updated 9 December 2016

We rated Pennine Care NHS Foundation Trust as good because:

• Patients had an ongoing risk assessment and a comprehensive assessment of their needs. Patient involvement in their care planning was variable. However, this was improving following the introduction of “My Shared Pathway”, a nationally recognised person centred care planning tool developed collaboratively by patients and professionals.

• The multidisciplinary team routinely reviewed patients’ care. Patients had a care programme approach (CPA) meeting every six months.

• There were rehabilitation and discharge care pathways for patients that lasted from two to five years. Some patients with complex or treatment resistant illnesses were in hospital for longer. However, staff continued to engage with them to work towards moving on from the service, but outside the pathway timeframes.

• Patients had their physical healthcare needs met.
• Staff were familiar with the principles of least restrictive practice. This was an ongoing piece of work, but restrictions within the service were under review. These balanced least restrictive practice against risks presented to patients and other people.

• Medication was managed and administered correctly. Some patients administered their own medication and there were clear stages for patients to work through at their own pace.

• The environment was clean and maintained. Environmental risk assessments had been removed, and risks to patients had been removed, or were mitigated against.

• Managers and senior clinicians met regularly and reviewed information about the safety and quality of the service. This included reviewing incidents and complaints, in addition to new initiatives and guidance. When actions were required, action plans were followed up at the meetings. Information was passed to ward staff through team meetings, emails and supervision.

• Staff had completed most of their mandatory training.

• The Mental Health Act and Mental Capacity Act were implemented effectively.

• Psychology input was provided on all the wards, but was a limited resource so focused on providing support and advice to staff, with one or two sessions with individuals and groups.

• There was an occupational therapy or technical instructor on all the wards. They provided an activity programme, and the occupational therapists carried out assessments of patients.

• There were nursing and health care assistant vacancies. These were filled by bank and agency staff, and there was ongoing recruitment.

• All patients had their own room. Some wards had ensuite bathrooms and others had shared facilities. Patients had access to food and drink, and some patients prepared their own meals.

However:

• Patients had an ongoing complaint about the lack of choice and poor quality of the food on some of the wards. External companies supplied meals.

Updated 9 December 2016

We rated substance misuse services as GOOD because:

• The building was clean and well maintained. There was good provision of facilities including consultation rooms and group rooms. A range of information was available to clients in the waiting room.

• Staff assessed clients’ needs and risk on admission to the service. Assessments were comprehensive and reflected in treatment plans.

• The service employed staff and volunteers with lived experience of addiction. This was in line with the recommendations of the Strang report (2012).

• There were strong links with external services and the local recovery community. Clients were encouraged and supported to develop recovery capital and access support.

• Staff were knowledgeable around safeguarding and understood trust policies and procedures in this regard. There were good links with local safeguarding bodies.

• Staff treated clients with respect and understanding. Feedback we received from clients was positive. Clients were actively involved in decisions about their care and treatment. Support groups were run for family members and carers of clients.

• There was a process in place to report adverse incidents. Staff knew how to report incidents and there was a process to launch a formal investigation where required. There was evidence of learning from incidents.

• Senior management was a visible presence. Performance monitoring was in place.

However:

• The introduction of a new service model had caused low staff morale. The new model was in response to changed funding levels. Staff had been consulted and invited to submit their own proposed service models.

• Compliance with clinical supervision and annual appraisal was either low or hard to evidence.