Birmingham and Solihull Mental Health 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

At our last inspection at Reaside we rated this key question requires improvement. At this assessment the rating has remained at requires improvement.

Since our previous inspection governance systems had been strengthened to assess and identify risks to people who used the service at Reaside. However, they had not been effective in identifying the risks we found at this inspection.

Staff were aware of the trust values and their role in achieving them.

At Reaside they had started work on improving the culture. Managers showed us their plans to involve staff and people who used the service in this. Since our last inspection the management team had changed, and some staff told us this had improved the leadership.

FIRST staff said they were well supported in their roles. Staff in the teams told us of several quality improvement initiatives they were involved in to improve the service for people who used it.

All staff were aware of the trust Freedom to Speak Up process and how to use it.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff at Reaside told us they were aware of the trust values and knew how their role helped in achieving them.

Managers told us about the ‘Culture of Care’ work that had started at Reaside. This is based on NHS England’s co-produced evidence-based standards for inpatient care to ensure a safe, compassionate, needs based culture of care. However, most staff we spoke with on the wards lacked knowledge and understanding of this. There was information about it displayed on the wards and some ward managers had attended a meeting where this was launched. Managers showed us that this work had just begun and provided minutes of meetings where it was discussed that co-production work was needed with staff to ensure this was driven by staff and people who used the service.

FIRST staff were aware of the trust values and strategy. They knew how their role helped in achieving them and this was discussed during supervision sessions with their manager. Staff told us that managers demonstrated a positive, listening culture that promoted trust and understanding between them and people using the service. They said the team culture provided opportunities for learning and improvement. Staff had been supported by the trust to do nurse training and apprenticeships.

FIRST had regular staff surveys and staff said feedback was encouraged. From surveys staff knew the outcomes and any actions taken to improve the service. Every 3 months the teams met together. A quarterly newsletter for FIRST was produced which shared the results of the staff survey and action plans and progress.

Since our previous inspection in August 2024 the leadership team at Reaside had changed, and most staff said matrons and managers were more visible on the wards during the day but not often at night.

There were regular safer staffing meetings chaired by the chief nurse where supervision, finance including bank and agency usage, bank staff reduction plan, vacancy data and staffing reports were discussed. The minutes showed open discussions, so the chief nurse was appraised of issues at ward and team level.

Staff in FIRST said that the team managers were supportive, visible, capable and compassionate. They said team managers and the multidisciplinary team managers led by example. Managers were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role.

Staff at Reaside were aware of the trust Freedom to Speak Up process and said that Guardians visited the hospital regularly. They said that they knew how to raise concerns.

Staff in FIRST were aware of the trust Freedom to Speak Up process and were confident they would be listened to. Staff were confident to raise any issues with their managers also as they felt respected by their responses.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Since our previous inspection of Reaside in August 2024, we found that governance systems had been strengthened to assess and identify risks. A lot of improvements had been made to the environment. There were clear governance, management and accountability arrangements. This included the development of a maintenance reporting system that all staff could access, and which provided a ‘live’ report of where jobs were at and the priority of jobs following an agreed framework. Staff from the estates team were aligned to the trust and Reaside governance structures and attended the clinical governance meetings. This gave them an understanding of the performance and risks to the quality of the service. The trust had recognised the environment at Reaside was not fit for purpose and were pursuing plans to build a new medium secure service. However, in the interim they had plans to refurbish and ensure the environment was clean and well maintained. The governance arrangements were not always effective as they had not identified the risks we found at this inspection at Reaside. These were insufficient staff trained in emergency and immediate life support and people were not always involved in their care planning and care plans did not include all of people’s assessed needs.

FIRST staff understood their role and responsibilities in the governance, management and accountability arrangements. They completed a range of audits to ensure risks to the quality of the service were safely managed. Staff completed annual training on the integrity and confidentiality of data and records management systems and all documentation was electronic.

Staff and leaders engaged with people who used the service at Reaside, and some people said they were involved in forums within the trust where they were asked for their views about care provision and service development. 1 person told us they were an expert by experience and their views were listened to in forums. They provided feedback to other people in community meetings. However, 2 people said they were not involved and staff thought this could be developed further.

FIRST staff and leaders worked in partnership with key organisations to support care provision. They met with local substance misuse services where they arranged a conference to share ideas and learning. They supported other services to improve the referrals to the teams and ensure they knew where to refer to. Staff developed their relationships with accommodation providers and housing services to ensure people were appropriately placed.

FIRST staff worked in partnership with the commissioners and were more involved with their shared service specification to support care provision, service development and joined-up care.

FIRST staff worked with people who used the service to identify new or innovative ideas that could lead to better outcomes for people. Staff set up an events committee through the service user forum to celebrate different celebrations. They looked at cultural dates and events and provided opportunities for people to celebrate. They produced a newsletter which gave people information about events as well as updates and news about the service. People who used the service were involved in staff training and recruitment. People were involved in the development of the new building where the service was to be based.

Staff at Reaside had started a carers forum to involve relatives of people who used the service more in improving the service. There were leads for this on each ward.

Managers had started the ‘Culture of Care’ programme at Reaside. This had only recently started at the time of our inspection and not all staff were aware of this.

FIRST staff had a good understanding of how to improve the service. Staff were supported to prioritise time to develop their skills around improvement and innovation. They had monthly quality improvement meetings monthly where they were updated on current projects and identified areas of improvement in collaboration with people who used the service. They had an away day last year and looked at team dynamics and how they wanted to develop as a team over the next year.

Staff spoke about several quality improvement initiatives within FIRST. This included a Clozapine (anti-psychotic medicine) clinic where people could go to the clinic for their blood tests, the blood testing machine gave results immediately so people could take their medicines and not have to wait around. They also had a machine that staff could use in people’s homes by a finger prick test to give people their medicine. There was also a physical health clinic to make sure people’s physical health was monitored and they had their annual physical health check. They reviewed their referral forms and referral meetings were increased from 3 monthly to weekly. They introduced new referral documentation and acceptance letter. They now only send out appointment letters 4 weeks before and hope this will reduce people forgetting to attend. They were looking at people’s access to debt advice, trauma informed care and ensuring staff are trained and reviewing readmission to inpatient services to see if more could be done to reduce them and see if there are times these can be avoided.

FIRST had a ‘Learning disability and Autism pathway’ to ensure they are providing more specialist provision. Staff were reviewing how they could capture the needs of people on the pathway better to offer better care.

FIRST staff ensured that people using the service, were involved in developing and evaluating improvement and innovation initiatives. They were setting up a community hub that people could access to prevent social isolation. People who used the service were involved in producing training for staff and providing information to share with other people prior to leaving hospital.

Staff and leaders engaged with external work, including research. They presented at the Royal College of Psychiatrists meeting a proposal to share the FIRST model with other areas. The service is part of a collaborative and shared their processes and procedures.

A newly qualified preceptorship project took place to encourage newly qualified staff to work in forensic community roles, addressing the challenges of recruiting nurses and providing development opportunities. This preceptorship program included introducing 3 newly qualified Band 5 staff into the workforce, guiding them through a newly developed competency programme over 18 months, leading to Band 6 substantive positions in the future. The programme includes monthly preceptorship meetings, monthly management meetings, and promotes peer support among preceptors.