Mersey Care NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service had a shared vision and strategy that was communicated well to staff. Staff understood the organisational values. Leaders were experienced in providing community mental health services. They were visible at the services and were pro-active in engaging with staff at all levels. Staff said they felt confident to raise concerns if they identified poor practice. The service had effective systems for clinical governance and made very good use of data in clinical decision making. Staff engaged well with GPs, crisis teams and other organisations that supported people in the community. We found no breaches of regulations in relation to this key question.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff said they felt their colleagues reflected the trust’s values well. They described a culture within their teams of respect, enthusiasm and collaboration.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. The trust’s leadership team had created a strategic framework and operational plan that were underpinned by the values of continuous improvement, accountability, respect, enthusiasm and support. These values were displayed on notice boards and publicised through the trust’s communications with staff. Throughout the inspection, staff demonstrated these values.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. The strategic priority for the service, over the past four years, had been the implementation of the NHS Community Mental Health Framework. This framework was based on five principles including the provision of an intervention-based service, patients having a name key worker, holistic and personalised care, better support for carers and ensuring the service is responsive to patients’ individual needs. Senior managers said there had been positive engagement from staff.

Medicines management staff we spoke with felt engaged with the trust’s medicines strategy and could see how their role supported delivery of key objectives, aligned with the trust’s ‘perfect care’ goals. They spoke positively about how the medicines management team supported community mental health services and had come together following a period of organisational change.

Leaders had the skills, knowledge and experience to perform their roles. Staff spoke positively about their managers and senior leaders. They said that managers reflected the values of the organisation. Similarly, staff were well respected by the senior leadership team.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders were visible in the service and approachable for patients and staff. Staff spoke positively about work with managers based at the services. Senior leaders had sought ways to communicate with staff. For example, they had set up open forums through the video conferencing facilities and set up a page on their intranet site with updated information about the transformation to new ways of working.

Leadership development opportunities were available, including opportunities for staff. Many people we spoke with had worked for Mersey Care for a long time. Staff in senior roles had often begun work in more junior posts within the trust. The trust had recently introduced the role of nurse consultant that included the role of approved clinician under the Mental Health Act.

All staff said they felt able to raise concerns. The trust had introduced a comprehensive ‘Raising Concerns Policy’ and a ‘Freedom to Speak Up’ strategy. Staff said they were aware of the role of the freedom to speak up guardian and the process for whistleblowing. All staff said they would feel confident to raise concerns with their manager if they identified poor professional practice or poor attitudes towards patients. Between April 2024 and March 2025, there had been 25 matters reported to the freedom to speak up guardian across the community mental health services for adults of working age. Of these, 8 concerned behaviour and attitudes, two related to bullying and harassment and 15 related to worker well-being.

The freedom to speak up service was widely publicised on the trust’s intranet and in staff offices.

There were equality and diversity champions within the service. For example, there were staff champions for neurodiversity and learning disabilities, along with culture and belonging ambassadors. Staff networks included an ability first network, armed forces network, LBGTQ+ network, a multi-ethnic colleague’s network and a women’s staff network.

Staff were able to apply to work flexibly. There were flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. A framework for these arrangements was set out in the trust’s flexible working policy.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. The trust monitored equality data through the Workforce Disability Equality Standard (WDES) and the Workforce Race Equality Standard (WRES). Data showed that 9% of staff had a disability or a long-term health condition. Approximately 9% of staff in clinical roles were from ethnic minorities. The trust had action plans to address inequalities identified in the WRES and WDES data.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. A governance meeting for the mental health care division was held each month. These meetings followed a standard agenda covering clinical outcomes, risks, CQC engagement, feedback from safety huddles, peoples’ experiences of using services and quality improvement. Themes and trends in incidents were monitored through the divisional safety huddles and governance meetings. The meeting was attended by the deputy director for community mental health, who passed information on to service managers for each of the teams.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. The trust held a mortality review group meeting every two months. The meeting included a review of all investigations into the deaths of people using services, as well as reviewing relevant policies and procedures. The trust board ensured oversight of this meeting through the quality committee.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, the service conducted a monthly care plan audit. This involved a review of 10 care plans selected at random. The service conducted a similar audit of depot medication charts. Services also conducted a self-inspection audit of the CQC’s key questions.

Staff maintained and had access to a risk register. There were five operational risks on the trust’s risk register that related to community mental health services. These related to achieving targets for treatment times, waiting times for psychology, vacancies for consultant psychiatrists and physical health monitoring. Each of these risks was assigned an impact score. A target date was set for this score to be lowered. There were three entries on a specific risk register for medicines management relating to oversight of prescribing and potential shortage of medicines.

The services had plans for emergencies. The trust had a business continuity plan for community mental health teams. This included instructions on what staff should do in the event of a loss of electricity, loss of heating and loss of staff due to exceptional sickness. It also included instructions on how to respond to a cyber-attack. The plans clearly set out the triggers for escalating these matters, action staff should take and details of the senior managers responsible.

The service used systems to collect data that were not over-burdensome for frontline staff. Managers had effective systems to ensure they had sufficient oversight of the services. Digital dashboards enabled staff and managers to monitor caseloads and waiting times. These dashboards could identify people who had missed appointments or had not been seen for some time. Managers found that the key performance indicators (KPI), such as the frequency of physical health checks, were a quick way of checking that services were doing what they needed to do. Managers also had easy access to data showing compliance with supervision, mandatory training, waiting times and appointments.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Information governance systems included confidentiality of care records. The trust had an information governance policy. It included details of how services were required to ensure confidentiality of care records.

Following organisational change, a revised governance framework for medicines management supported clinical delivery. For example, the clozapine steering group supported standardisation and improved prescribing of clozapine. Systems for the initiation and monitoring of clozapine were now aligned across the trust. Good progress had been made with revising and aligning medicines management procedures across the community teams. For example, policies for the prescribing and supplying of long-acting injections were overseen by the medicines management policies and procedures group.

Directorate leaders engaged with external stakeholders, such as commissioners and Healthwatch. The trust commissioned nine voluntary and community sector organisations that worked to improve opportunities for people with mental illness. The service held a quarterly meeting with all of the organisations to discuss themes and trends within their work. During these meetings, staff from the voluntary and community organisations presented performance data, as well as case studies showing examples of how their services had a positive impact on peoples’ lives. The service submitted regular monitoring reports to NHS England in accordance with contractual requirements. The mental health care division held a dedicated patient experience and engagement meeting that included an update on participation and engagement. Consultant psychiatrists and team managers attended multi agency public protection arrangements (MAPPA) meetings.

A trust specialist secondary care mental health medicines management team was embedded into primary care services to review patients’ mental health medicines, so that patients could be managed within primary care services where appropriate.

The trust worked with the Integrated Care Board (ICB) to capture data to support medicines optimisation across the interface between services, especially around high-risk medicines, managing medicines shortages and standardisation of clinic letters to GPs. Joint work with the ICB and a neurology specialist trust was ongoing to identify patients prescribed Valproate (a medicine used both in mental health and in neurology), to ensure that the required safety measures were in place and prescribing was reviewed by an appropriate specialist.

Staff participated in national audits relevant to the service and learned from them. For example, early intervention services participated in an annual audit conducted by the National Clinical Audit of Psychosis (NCAP). The audit reviewed a random sample of 100 patient records in relation to timely access, family interventions, physical health, employment and psychological therapies. The services scored well in all areas except for employment support. The service reviewed and updated the provision of employment support to address the concerns identified in the audit. The trust also participated in national benchmarking audits to support continuous improvement in prescribing practice. For example, the trust achieved 80% compliance (National sample 75%) with the Prescribing Observatory for Mental Health audit standards for monitoring patients prescribed Lithium. Following this, an action plan was put in place and completed to support further improvement.

There was a commitment to continuous development of medicines audit, and use of digital solutions to provide greater oversight and assurance of systems for delivery of medicine optimisation. For example, the trust used dashboards to oversee performance in the management of medicines requiring additional monitoring such as valproate, lithium and high dose antipsychotic prescribing.