Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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

Staff assessed and reviewed patient’s care needs with them. Staff from different disciplines worked together as a team to benefit patients. Staff encouraged patients to make healthier choices to help promote and maintain their health and wellbeing. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This service scored 71 (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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff involved most patients in the assessment of their needs. We spoke with 5 patients across Eden acute ward and Eden PICU and asked them if staff involved them in assessing their needs. Four said they were involved but 1 patient on Eden acute told us they didn’t have a care plan.

Staff assessed patient’s needs using a range of assessment tools to ensure their needs were reflected and understood. We reviewed 8 care records and found staff completed detailed assessments of patient’s needs in 7. Staff had not completed this for 1 patient on Eden PICU. On Eden acute ward we reviewed care records for 2 patients. Staff assessed the physical healthcare needs of each patient. For 1 patient we saw evidence of OT and OTA input including completion of Model of Human Occupation Screening Tool (MOHOST). Staff recorded physical observations for patients in the records reviewed and detailed levels of support patients required, for example, leave arrangements and observation levels. Staff routinely reviewed patient’s care needs. On Larimar ward we reviewed an audit of care records completed a few days before our inspection visit. The audit indicated staff reviewed all patients’ care plans within the last month.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Patients did not always receive care, treatment and support that was evidence-based and in line with good practice standards. Leaders did not always ensure sufficient psychology input on Eden PICU, Eden acute ward, George acute ward (Northcroft) and Larimar acute ward (Ardenleigh). Staff told us there was 1 psychologist allocated to the three wards at Northcroft hospital. We found insufficient psychology input on Eden PICU. Staff told us there was no psychologist allocated to support the ward, staff said a psychologist popped in occasionally. Patients on Larimar ward had reduced access to psychology as the psychologist was only able to visit for 1 day each week. Leaders told us they would like to offer more psychology input. They described the current offer as basic. All wards had access to psychology input for MDT’s ward rounds, group work and drop in ‘taster’ sessions. Patients had limited access to 1:1 clinical psychology sessions. Psychologists would refer patients for longer term psychology support in the community following discharge. Psychologists were clear with ward teams about what they could offer and advised them to prioritise what is needed for their patients. However, we were told that patients were able to access group work including emotional coping skills (with sessions on relaxation, self soothing, visualisation and trans diagnostics) and coping with suicidal thoughts. All wards, apart from George ward, had occupational therapist input. 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 OT and psychology interventions for that day. We found on 72 out of 93 days there were no OT or psychology interventions offered. However, on Saffron ward we saw an OT display board in the communal areas detailing OT interventions/activities available for patients.

Staff met patient’s physical health needs. On Larimar ward we reviewed care records for 5 patients. We found evidence of staff supporting patients with physical health concerns in all records reviewed. Examples included supporting a patient with a cancer diagnosis, diabetes management and monitoring of a patient with a low white blood cell count. Staff on Larimar ward facilitated weekly ‘Women’s Wellbeing’ clinics for patients. On Lavender ward we saw evidence of physiotherapy input for a patient who needed this. On Eden acute ward we observed the ward round for a patient where attendees discussed the patient’s physical health and frequency of physical health observations required. On Eden PICU we saw evidence in patient’s records of physical health being monitored. George ward manager told us the trust physical health lead attended the ward to provide training for staff on National Early Warning Scores (NEWS).

We spoke with 14 patients across all wards about whether their care and support met their needs, including nutrition and hydration needs. Nine patients answered positively, including 2 patients on Larimar ward who told us their psychology sessions were really good. Five patients raised concerns that their needs were not always met in relation to food options (3), lack of therapy (1) and access to leave (1).

Mental Health Act

• 95% of staff received training in the Mental Health Act.
• Staff were trained in and 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 implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy. We saw details of advocacy support displayed on wards. Staff recorded requests for advocacy input in patient care records. Patients and staff knew about the advocacy service and told us advocates visited the wards weekly. We observed the advocate visiting some of the wards during our site visit.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We saw evidence of this in care records reviewed. We spoke with 5 patients across Eden acute ward and Eden PICU. Four patients told us staff explained their rights. One patient on Eden acute said they didn’t understand their rights.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• 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.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• The Mental Health Act team did regular audits to ensure that the Mental Health Act was being applied correctly.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver patient’s care, treatment and support. Staff were continually updated on patient’s changing needs through handovers, risk huddles and MDT meetings. Staff were able to access trust record systems for patient information.

Plans for transition, referral and discharge considered patient’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Saffron ward manager told us they sometimes cared for patients who were homeless. In these situations, they linked in with third sector providers who supported with housing needs.

When patients received care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering people’s care and treatment and staff worked collaboratively to understand and meet patients’ needs. Staff held regular and effective multidisciplinary meetings. On Larimar ward we reviewed care records for 2 patients which evidenced discussions between the ward, trust leads and other services to decide on whether the patients required alternative specialist placements. We spoke with an advocate for some of the wards who said the ward administrators sent the weekly ward round schedule to them so they could plan their ward visits and attend ward rounds to support patients. The Responsible Clinician (RC) for Eden acute and George acute wards showed us the doctors handover form that was updated following MDT meetings to ensure all required actions for the medical team were carried out.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. We asked 6 patients across Eden acute ward and Eden PICU if staff supported them to live healthier lives. Five patients gave positive examples, including staff supporting them with healthier diets, access to the gym and access to activities. One patient on Eden acute said they had not been supported with this. Saffron ward manager told us all patients had individual physical health prescriptions. For patients with no specific physical health concerns checks were done weekly. Some patients with physical health conditions would be checked daily or more frequently if required. Doctors assessed patient’s physical health as soon as possible after admission and referred patients to external specialists for specific health needs. The tobacco dependency team attend the ward to speak with patients, there was a gym upstairs which patients accessed via referral to the gym instructor. Patients had access to physiotherapy and chiropody. An external substance misuse service visited to support patients.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were effective approaches to monitor people’s care and treatment and their outcomes. The trust had recently implemented Dialog+ across the Acute and PICU wards we visited. Dialog+ is a therapeutic intervention designed to improve communication between patients and clinical staff. Dialog+ includes a questionnaire for patients to complete, which measures their quality of life and care experience across 11 areas. We saw this had been completed with most patients across the wards we visited. We reviewed an acute inpatient service evaluation completed by the psychology team. This looked at the aspects of group therapy patients found the most and least useful with the aim of improving the experience and outcomes for patients. In addition, the trust evaluated the impact of specific workshops, including coping skills and suicide prevention.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Most patients understood their rights around consent to the care and treatment they were offered. We spoke with 5 patients across Eden acute ward and Eden PICU. Four patients told us staff gained consent from them and explained their rights. One patient on Eden acute said they didn’t understand their rights.

There were systems and practices to ensure that patients understood the care and treatment being offered or recommended. On George ward we observed the MDT assessment of a new admission. The RC explained the patient’s rights to them. The RC gained consent from the patient to speak with their partner and gather more information and to talk to their partner about the patient’s care plan.

Where necessary, people with legal authority or responsibility could make decisions within the requirements of the Mental Capacity Act 2005. This included the duty to consult others such as carers, families and/or advocates, where appropriate. Saffron ward manager told us advocates visited the ward twice a week. They said patients are asked if they would like to be referred for one-to-one advocacy support during the admissions process. The advocate also visits and makes themselves available to any patient who wishes to speak with them. We reviewed the ‘Independent Mental Health Advocate’ (IMHA) report that detailed a total of 29 advocacy cases were opened across the wards we visited between 1 January 2025- 31 March 2025.

Patient’s capacity and ability to consent was taken into account, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. We found evidence of patient’s capacity being assessed in the care records reviewed. However, on Saffron ward staff had not completed a consent to treatment form for a patient recalled under a Community Treatment Order. We raised this with staff who completed it straight away.