Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection of Reaside we rated this key question requires improvement. At this assessment the rating has remained requires improvement. We identified a breach of the regulations in relation to staffing at Reaside.

At both services all staff knew what incidents to report and how to report them. Staff were able to give us examples of learning from incidents. Safety and continuity of care was a priority throughout people’s care journey. Staff understood safeguarding and how to take appropriate action to safeguard people from harm and abuse. Staff assessed people’s risks, so they knew how to manage them.

At Reaside there were safe staffing levels and skill mix, however; staff were not always deployed effectively. Staff received training appropriate and relevant to their role. However, there was further improvement needed in training in immediate and emergency life support at Reaside.

Since our previous inspection at Reaside, work had been done to improve the ward environments and to protect people as much as possible from the risk of infection. The trust had responded to the Section 29A Warning Notice issued and all immediate work was completed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All staff knew what incidents to report and how to report them. Staff reported all incidents that they should report.

Staff received feedback from investigation of incidents through email or verbally, both internal and external to the service. Staff met to discuss the feedback.

Staff at Reaside were able to give us examples of learning from incidents and how changes were made to improve medicines administration following an incident.

Staff at FIRST were able to give us examples of learning from incidents and how they shared learning with other services involved where appropriate. Staff demonstrated that the focus following incidents was always on what can do to prevent happening again. There was evidence that changes had been made, for example, staff had a lone working device that was implemented following an incident.

Staff were debriefed and received support after incidents. Staff at FIRST had debrief meetings with the psychologists in the team.

Safety and continuity of care was a priority throughout people’s care journey. Staff at Reaside had information about people’s needs before they were admitted and said they had time to read this. Health care assistants told us they did not attend people’s meetings with the multidisciplinary team but could see the minutes of these on people’s electronic records. At FIRST there was a collaborative, joined up approach to safety that involved the person, their relatives’, staff and other partners in their care. Partners included local housing associations and charities, supported living providers, social workers, probation and prison services. This included referrals, admissions and discharge, and where people are moving between services. Staff had fortnightly referral meetings with the FIRST multidisciplinary team and this included Reach Out case managers where appropriate. Staff had adapted the referral form to improve this. In these meetings staff discussed new referrals, progress of existing referrals, new assessments and those people out of area to be repatriated to the West Midlands under the FIRST community caseload. Staff said they tried to support people at least 6 months before their discharge from hospital and look to identify any barriers or needs on discharge.

At Reaside we observed the ‘morning huddle’ on the first day with the ward managers and members of the multidisciplinary team. Staff discussed people’s risks from the previous night if they had changed, if there were people in seclusion and when reviews of this were needed and planned for a person being admitted that day. Staff shared information in shift handovers where all staff attended before the shift started. They discussed people’s key risks and any changes to these.

At FIRST staff were aware of the risks to people across their care journey and were effective in identifying and managing these risks. Staff had ‘morning huddles’ where they raised any concerns and discussed any potential risk issues. From these they prioritised and planned care delivery to ensure safety. Staff told us how they worked with other agencies if a person did not attend an appointment. They contacted the person, all agencies working with them and their family to ensure the person’s safety and risks were reduced. Care and support were planned and organised with people, together with partners and communities to ensure continuity. Each person in the community had an allocated team and knew who to contact as needed. Providers of supported accommodation were aware of how to contact the community team.

Staff understood safeguarding and how to take appropriate action to safeguard people from harm and abuse. Staff at Reaside knew what and how to report and understood the different types of abuse that could occur in the hospital including between people who used the service. People told us they felt safe and knew who to speak with if they had any concerns.

Staff at FIRST knew what and how to report and understood the different types of abuse that could occur in the service. They gave examples of how they had dealt with recent safeguarding incidents. This included incidents where people were exploited in the community and how the team worked with other agencies to support and protect people.

There were effective systems, processes and practices to make sure people were protected from abuse. Staff at FIRST spoke about the need to ask questions and be curious if they suspected abuse, they shared concerns in the multidisciplinary team meetings, shared learning from safeguarding incidents and could access safeguarding supervision.

There was a commitment to taking immediate action to keep people safe from abuse which included working in a collaborative way. At Reaside during our visit a person told us about an allegation of abuse. We discussed this with managers who took immediate action to report this to the safeguarding team and safeguard the person from harm. A member of staff from the trust safeguarding team visited the next day to discuss with managers and ensure appropriate action was taken.

FIRST staff were aware of the trust multi agency public protection arrangements and had access to these to refer to on the staff intranet.

At Reaside we reviewed 7 people’s records which showed that people’s risks were assessed. 2 of 10 people told us they were not aware of their risk assessment and had not been involved in it. 6 of the risk assessments showed these were regularly reviewed with the person at their multidisciplinary team meeting and were reviewed and updated after incidents. However, 1 person’s records showed their assessment of risk of violence had not been updated since June 2024.

Restraint at Reaside was only used as a last resort. When restraint was used it was proportionate to the risk and followed best practice. The trust trained staff in restraint and staff were aware of each person’s observation levels. Records showed staff managed people’s risks in a positive way that protected their rights and dignity.

At Reaside most people told us that when restraint was used which was not often it was only used as a last resort and followed best practice. However, 1 person said when they were restrained staff could have approached it in a better way.

Staff at FIRST assessed people’s risks, and people and staff understood them. Staff told us that they discussed people’s risks with them and their family, if appropriate, when assessing them and reviewing them. They discussed people’s risks at their weekly clinical team meetings to ensure they had a robust overview of each person’s risks. Staff had a discussion with a debrief where there had been any incidents of people displaying risky behaviour. People told us they were involved in their risk assessments and knew how to contact the team for support when needed. Each person had a safety plan for out of hours support and who to contact in the team.

Staff gave us examples of how they ensured risk assessments were person centred and proportionate. They told us how they considered all the risks a person may present and not wholly related to their health needs but also social and housing needs. We observed staff supported a person to manage the risks of taking their own medicines which was done in a person-centred way.

Records showed detailed risk assessments and management plan, formulation of the person’s risk, they involved the person and their family and were regularly reviewed. It was clear from the records reviewed that staff understood the person’s risks.

Staff understood people’s risks which included the risks if they disengaged from the service. They understood which other services they may need to communicate with and individually assess people’s risks. Staff said they would look at the reasons why a person had disengaged and if there were any barriers to them contacting the service.

Staff managed risks to themselves well and told us how they worked as a team to ensure their safety and that of the people they were visiting. They had robust lone working arrangements.

We only assessed this quality statement at Reaside as people were not seen at the FIRST premises we visited. The environment at the St Andrews FIRST site was managed by St Andrews Healthcare and not the trust.

Since our previous inspection at Reaside work had been done to improve the wards. The trust had responded to the Section 29A Warning Notice issued and all immediate work was completed. Improvements were made to bathroom and shower areas. There were plans to replace some bathrooms and showers completely and this work was out to tender. Ligature risks were assessed and reduced.

There were now effective arrangements to monitor the safety and upkeep of the premises. The trust had doubled the number of maintenance staff available to support Reaside. However, the trust acknowledged that were numerous issues related to the estate which directly affected care and availability of a safe environment for people using the service. The trust was aware the maintenance problems were recurrent, that there are no ensuites, the size of the wards were less than recommended, there were issues with infrastructure and drainage and the building is no longer fit for purpose. The trust had developed a 2-year and 5-year plan. This plan identified how much money was needed each year for maintenance, and capital for the environment to be of sufficient quality and safe to function as a medium secure unit.

People told us improvements had been made however, 3 people told us that things were not always repaired quickly, and it sometimes took months for repairs to be done. It was not clear if people were referring to past experience when they said repairs took months as we saw evidence that repairs were completed more quickly than at our previous inspection.

At Reaside there were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care to meet their needs. However, staff were not always deployed effectively. The chief nurse was leading the work on staffing. Staffing levels were reviewed and compared to other similar services. They found there were adequate staffing levels on the wards, but staff still reported there was insufficient staff. The chief nurse was also leading a piece of work linked to culture, which included the approach to care delivery. This work included all staff and people who use the service and reviewed what a good day feels like for people and staff. Some early changes were being made to the structure of the day. Commissioners had provided funding for additional health care assistants;14 were in post and 7 were waiting to start, The trust were recruiting for a further 5 posts and bank staff were covering these posts in the interim.

At Reaside people gave us mixed feedback about staffing and how this impacted on their leave. 3 people told us they had their escorted leave cancelled due to lack of staff. 1 person said the hospital was always understaffed. Staff told us that generally staffing had improved and most times people had their leave. We observed staff adapting the shift to accommodate a person being admitted and another person in seclusion and escalating this to the senior manager on site. Staff told us and we observed that when bank staff were used these were regular staff who knew the service. Bank staff had training and had access to group supervision.

There were appropriate staffing levels and skill mix at FIRST to make sure people received consistently safe, good quality care to meet their needs. Staff told us that they did not use bank staff and there were enough staff to respond to risk so they could increase visits if a person needed this. The teams had 6 staff members who had recently started, however they were not fully staffed. The trust had recruited into additional vacant positions and were waiting for staff to go through recruitment checks and be offered start dates.

Staff received training appropriate and relevant to their role. They received support to develop, improve services and where needed, professional revalidation. Compliance in training in immediate and emergency life support at Reaside had improved since our previous inspection. However, emergency life support (ELS) training was only at 72% compliance on Avon ward. The trust target was 85%. Training in immediate life support (ILS) had improved however compliance with this was low on 2 wards: 61% on Severn ward and 73% on Dove ward. Managers had recognised this and booked staff to attend these courses. Managers were also having a monthly quality forum meeting with the matrons, starting 6th June 2025 and ILS/ELS training will be a standard agenda item to ensure improvements in these areas are sustained.

Staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop, improve services and where needed professional revalidation. This had improved at Reaside since our previous inspection. 87% of staff had an appraisal and 83% of staff had received management and clinical supervision with sessions scheduled to increase compliance further. There were fortnightly staff meetings with the minutes emailed to all staff.

Staff at FIRST said they were well supported and had debriefs after incidents, regular team meetings and supervision. Staff were able to access art therapy for their clinical supervision. They also had reflective practice sessions and ‘case busting’ sessions where they discussed a person they supported and how they could ensure as a team they were providing appropriate support and care.

FIRST managers allocated caseloads, and staff were happy with these. Staff said they were supported by the team to manage people on their caseload and were able to seek advice from other team members to ensure people received safe, good quality care to meet their needs.

We only assessed this quality statement at Reaside as people were not seen at the FIRST premises we visited. The environment at the St Andrews FIRST site was managed by St Andrews Healthcare and not the trust.

Since our previous inspection improvements had been made to protect people as much as possible from the risk of infection. New panelling was installed in shower and bathrooms which was easy to clean and reduce mould. Flooring had been replaced or repaired in shower rooms. Carpets had been removed and replaced with flooring that was easier to keep clean. The cleaning schedule and checks had been increased. Staff on all wards completed hourly checks to ensure the bathroom environment was clean and ready for use.

We observed that some furniture had been replaced. However, we observed some furniture was ripped but managers told us more new furniture had been ordered, and they were awaiting delivery of this. The trust told us this had now been replaced.

People told us the wards were clean, and staff helped them to clean their bedrooms if they needed support with this.

The trust trained staff in infection prevention and control.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.