Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained the same.

This meant people did not always feel well-supported, cared for or treated with dignity and respect. Staff did not always treat patients with compassion and kindness. Not all staff understood the individual needs of patients. Staff were not always responsive to patient’s immediate needs.

The service was in breach of regulation 9 for person centred care.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Staff did not always treat patients with kindness, compassion and dignity. On Eden PICU we reviewed an incident description from an incident that occurred the day before our visit. The incident description included concerning and subjective language used by staff to describe the patient’s behaviours. Examples included accusing the patient of “dishonesty and manipulation”, “creating a threatening atmosphere” “using vile language” and “demonstrating defiance”. We asked 26 patients across all wards if staff treated them with kindness, compassion and dignity. On Eden acute ward, 4 of the 5 patients responded negatively, with 1 describing staff as bullies, 3 saying staff were not kind and 1 of those 3 also told us staff use their phones on duty and some staff spoke in a language other than English. However, we received positive responses from 20 patients, including comments that staff were caring, friendly, approachable, kind and supportive. A patient on Eden PICU told us the ward was “a great place to heal and the staff are lovely”. During our ward visits we observed staff acting with kindness and compassion towards patients. On George ward we observed the MDT assessment of a new admission. The RC made good eye contact with the patient and offered reassurance throughout that the ward will support them and help them get through their current difficulties.An external professional told us that staff treated them well and with respect.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff did not always meet patients personal, cultural, social and religious needs. We asked 9 patients across all wards if staff met their individual needs. On Eden acute ward, 1 patient, who was Muslim, said staff gave them ham. A patient on Larimar ward who was vegetarian said staff gave them chicken. A patient on Eden PICU said they were not provided with food that met their cultural needs. However, 6 other patients told us staff met their religious and cultural needs.

Staff treated patients as individuals, considering any relevant protected equality characteristics. On Eden PICU staff supported a patient to attend their place of worship. Staff on Larimar ward supported patients who also had a learning disability or autism. The trust Learning Disability and Autism lead supported the team with this. The transforming care team was also involved and ensured Care and Treatment Reviews (CTR’s) were completed as required.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients were supported to have choice and control over their own care. Patients were able to access outdoor space, drinks and snacks. Patients were allowed their own phones, unless there was a specific risk.

Patients were supported to maintain relationships and networks that were important to them. Patients had access to their friends and family while they were using the service. We asked 11 patients if they were able to see their family and all said yes. Wards had visiting facilities to support family and friends visits to patients. The trust advised that they had set visiting hours, however, they offered flexibility where required. All wards offered flexible visiting times to accommodate family schedules.

Not all patients had access to activities and the local community to promote and support their independence, health and wellbeing. Staff were not providing a full range of activities for patients on all wards. We observed a lack of staff engagement with patients and a lack of activities being provided on Eden acute ward and George ward. Patients on Eden acute and George wards told us they were bored. We reviewed community meeting minutes on Eden acute ward. There were 7 sets of minutes available with sporadic dates going back to 2024. The minutes were sparse and generic with limited actions. The meetings focused on rules of the ward. One recurring theme from patients was dissatisfaction with a lack of activities and there was a recurring action for staff to assist in activities on the ward. The activity timetable displayed on the ward was dated August 2024. We reviewed 93 sets of minutes for community meeting minutes on George ward held between 1 December 2024- 31 May 2025. Each set of minutes included a section for activities on offer for that day. We found 27 days where no activities were offered. The trust’s patient council meeting reported that lack of activities was a common theme from patients.

However, 13 patients across the other wards described how activities helped them. A patient on Eden PICU was full of praise for the activity worker and 2 other patients told us the activities helped their wellbeing. We observed an activity session facilitated by the activity worker on Eden PICU. Patients were supported to create mosaics. The activity worker provided activity books to patients unable to attend the session. Staff on Eden PICU facilitated a ‘Unicorn day’ earlier in the year. On Saffron ward we observed informal activities taking place throughout the day and staff told us they organised lots of activities to help create a positive atmosphere. On Lavender ward we observed lots of activities on offer; arts, crafts and a box of hope and recovery. The activity area was relaxed, with calming music and refreshments on offer. Four patients were engaging with activities and 1 patient told us they really enjoyed it as it helps their recovery. Other activities on offer across the wards included pottery, baking, gym session, walks, table tennis, movie nights and smoothie making. Staff supported patients on George ward to access Recovery College sessions. Senior leaders told us that wards could now book an extra staff member if they had no activity worker on shift to ensure patients had access to activities.

We scored the service as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff were not always alert to patient’s needs. We asked 8 patients across 3 wards if staff responded to their immediate needs. On Eden acute ward 3 of the 4 patients asked said no and they were always waiting. A patient on Larimar ward told us staff did not respond when they needed them. During our visit to Eden acute ward we observed patients waiting to go on leave for hours, patients kept knocking on the office door, staff would then tell them they were going on a break and couldn’t take them. A patient on the ward told us this was normal and happened all the time. Staff on George ward raised concerns about non regular staff not being responsive to patient’s needs. Two patients on Eden PICU raised concerns that the number of patients requiring higher level of staff observations meant there were not enough staff to respond to the needs of other patients. However, on Larimar ward we observed staff responding quickly to patients requests and 3 patients on Eden PICU told us staff responded to their immediate needs.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Patients received safe, effective and person-centred care as the provider recognised and met the wellbeing needs of staff. These included the necessary resources and facilities for safe working, such as regular breaks and rest areas. We spoke with 17 staff in different roles across all wards who all said they were well supported by their managers. This included 3 students on placements who were complimentary about the welcome and support they received from leaders and colleagues. One staff told us how they were supported with reasonable adjustments that enabled them to continue in their role. Leaders told us about avenues of support available to staff including employee assistance, occupational health, flexible working arrangements and access to reflective practice sessions. However, staff on Saffron ward were concerned about their colleagues who had been injured by patients. They told us the ward manager had been very supportive following the incidents.

Patient’s experience of the service was driven by a culture that normalised good wellbeing through inclusivity, active listening, and open conversations. This enabled staff to do their job well and to be well. Staff told us they received regular supervision and their managers were approachable. Larimar ward manager told us the trauma informed care team attended the ward to support staff debriefs after incidents. We spoke with a lead psychologist who said staff can access psychology support on the phone 24/7. They said staff could also access a mental health hub for support which included up to six one-to-one sessions. However, on Eden acute ward, we witnessed a bank nurse expressing annoyance with colleagues who were trying to support each other. We raised this with local leaders.