Birmingham and Solihull Mental Health NHS Foundation Trust

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated well-led requires improvement. At this assessment the rating stayed the same. Leaders did not always have the skills, knowledge and experience to perform their roles. Governance processes did not always operate effectively. Performance and risk were not always managed well. The service did not always value diversity in their workforce.

The service was in breach of regulation 17 for good governance at the service.

This service scored 57 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders ensured there was a shared vision and strategy and that staff in all areas knew, understood and supported the vision, values and strategic goals. The trust shared their 5-year strategy. The trust’s vision was to improve mental health wellbeing. This was underpinned by 3 core values; compassionate, inclusive, committed. To deliver these the trust identified 4 strategic priorities; clinical services, people, quality and sustainability. We reviewed the trust’s ‘Local Leadership Teams Strategy Sessions’ for June 2025. This outlined the trust’s approach to a refresh of the strategy for 2025/26. The approach was tailored to local needs, widespread and inclusive and coproduced with experts by experience. Local leaders and most staff we spoke with demonstrated understanding of the strategy and how it applied in their work.

Staff and leaders ensured that the vision, values and strategy were developed through a structured planning process in collaboration with people who use the service and staff. We reviewed the trusts approach to their refreshed strategy which included multiple visits to all trust sites, forums for staff and engagement with patients and experts by experience.

We scored the service as 2. The evidence showed some shortfalls. Leaders did not always embody the culture and values of their workforce and organisation. Leaders did not always lead effectively.

Leaders did not always have the experience, capacity, capability and integrity to ensure that the organisational vision could be delivered, and risks were well managed. We were concerned about how well risks were managed after identifying breaches of regulations in relation to staff not always managing risks effectively, staff not always following medicines management procedures, a lack of activities, ineffective leadership on some wards and staffing not always meeting the needs of patients. We identified friction between some staff on the wards with less effective leadership.

Most leaders at every level were visible and led by example, modelling inclusive behaviours. Staff spoke positively about most local and senior leaders, including telling us about visits from members of the executive team. The trust reported senior leaders, including the chief executive, executive directors and non-executive directors, carried out 23 visits across the wards between 1 December 2024- 31 May 2025. However, we had concerns about the local leadership at 2 of the locations we visited, which we shared with senior leaders who took immediate action to address. Staff at one location told us senior leaders didn’t visit to support them following a serious incident.

High-quality leadership was sustained through safe, effective and inclusive recruitment and succession planning. We spoke with a deputy ward manager who told us they were previously a HCA and were supported by the trust to complete their nurse training, which they wouldn’t have had the means to do themselves. Following the on site inspection, the trust advised they recruited 3 additional matrons and 2 had commenced in post to ensure improved oversight of quality.

Leaders were alert to any examples of poor culture that may affect the quality of patient’s care and have a detrimental impact on staff. Leaders spoke about implementing ‘’special measures’ on wards where there were concerns about quality of patient care. The trust advised wards would be put on enhanced monitoring when quality and safety concerns were identified. Three of the wards visited had been on enhanced monitoring prior to our visit. Leaders took immediate action to address concerns we raised about behaviours we observed affecting patient care.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Leaders actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promoted the value of doing so. The trust advised there were 3 Freedom to Speak up Guardians (FTSUG). They told us all Guardians were up to date with the National Guardians Office training and as such were included in the national registry of Freedom to Speak Up Guardians. The trust shared how they used themes from staff speaking up and other sources to identify wards where improvement initiatives were required. The trust shared findings following a drop-in clinic facilitated on 2 of the wards by one of the FTSUG. The trust were able to ensure local leaders took appropriate action to address the concerns raised. The trust reported 10 other concerns raised between 1 December 2025 and 31 May 2025 and detailed actions implemented to address.

Most staff spoken with were confident that their voices would be heard. However, 2 staff on different wards, told us they felt any concerns raised were brushed under the carpet. We reviewed staff survey results shared by the trust and only 20% of staff on Eden PICU were confident that any concerns raised would be addressed by the trust.

We scored the service as 2. The evidence showed some shortfalls. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders did not always take steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work. We reviewed staff survey results shared by the trust for the wards visited. We found only 51% of staff agreed that the trust acted fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age. This was lowest on Larimar ward at 47%. Only 55% of staff agreed that the trust respected individual differences.

However, we reviewed the trust’s Workforce Race Equality Standards (WRES) data as of 31 March 2025. The trust target was to achieve 40% staff from ethnic minority backgrounds in Band 8a roles and above. This was at 30%, an increase from 24% reported in 2023. Board membership was made up of 47% colleagues from ethnic minority backgrounds. The data evidenced staff from ethnic minority backgrounds were more likely to experience discrimination and only 51% believed the trust provided equal opportunities. The trust action plan included rolling out specific initiatives designed to support the growth and career progression of individuals from underrepresented groups, strengthen reporting and governance, and provide additional training and support. The WRES helps organisations demonstrate how they are addressing race equality issues in a range of staffing areas. Leaders told us that Larimar ward staff experienced higher levels of racist abuse from patients than other wards, they said the trust were taking this very seriously and the Equality and Diversity team were piloting a scheme to reduce racist abuse to staff.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

There were not always clear and effective governance, management and accountability arrangements. Staff did not always understand their role and responsibilities. The trust did not always operate effective systems and processes to make sure they assessed and monitored their service against regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended).We were concerned that governance and oversight processes had not identified potential breaches of regulations 9 (person centred care), 12 (safe care and treatment) and 17 (good governance). Staff at Northcroft and the Zinnia Centre reported a lack of senior leadership presence on the wards, particularly after serious incidents. There were inconsistencies in the application of trust policies and procedures, for example, the frequency and recording of testing the anti-ligature door alarms, the issues identified with medicines management despite audits being completed and a lack of action to reduce the high use of prone restraints.

We reviewed the trust risk register for their acute and PICU wards. There were 3 red risks identified. These relating to insufficient bed capacity to meet demand, patients being placed out of area and emergency access to a location we did not visit for this inspection. The lack of psychology input for patients was rated as a moderate risk. The risk of patients obtaining drugs was rated as moderate. The risk of using bedrooms to seclude patients was rated low. There was no risk included in relation to the high use of prone restraint.

Leaders did not always implement recognised standards, best practices or their equivalent to improve outcomes for patients. The trust had not ensured sufficient psychology input and this was included on their risk register and rated as a moderate risk.

However, ward managers told us they and their deputies completed regular audits, including audits of care plans and patients’ involvement. Staff were emailed with any actions required from the audits and these were reviewed in team meetings. We reviewed monthly trust clinical governance committee meeting minutes from 1 December 2024- 31 May 2025.These were usually attended by the Chief Nurse, Clinical Directors, Head of patient Safety and heads of nursing. We reviewed monthly Acute care clinical governance committee meetings from 1 December 2024 – 31 May 2025. These meetings were attended by the clinical director for acute care, team managers, associate directors, nursing staff, MDT staff, matrons, patient participation lead, pharmacy and MHA office. These meetings evidenced concerns at ward level being discussed and actions agreed to address.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies. We saw evidence in meetings minutes and the trust’s strategic plan of collaboration with partners in the health and care system. The trust was part of the ‘Birmingham and Solihull Sustainability Transformation Partnership’ that brings together local health and social care organisations to manage the health of the population collectively, and deliver better health and care within the resources available through joint planning and programmes of work.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Eden PICU was an accredited member of the National Association of Psychiatric Intensive Care Units (NAPICU). NAPICU isanot-for-profitmulti-disciplinary organisation dedicated to developing and promoting the specialty of psychiatric intensive care services. They focus on improving patient experience and outcome, as well as promoting staff support and development.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Staff and leaders did not always have a good understanding of how to make improvement happen. We identified multiple breaches of regulations relating to person centred care, safe care and treatment and good governance that had not been acted on by staff and leaders.

Staff and leaders engaged with external work, including research, and embedded evidence-based practice in the organisation. The trust told us they were involved in the following research projects; Culturally Appropriate Advocacy Evaluation: Mental Health Act Reform; I-Care; Staff Perceptions of Out of Area Placements for Personality Disorders. The trust also advised they were part of the recently launched National Culture of Care: Staff Care and Development Quality Improvement (QI) programme. The programme is designed to support inpatient ward staff to create psychologically safe, caring, and relationally strong ward environments. Through site visits, reflective practice training, supervision, coaching, and skills-based development, the initiative aims to foster a sustainable culture of positive informal interactions and high-quality care. The trust’s Quality Improvement team hosted a ‘QI Week’ event at Northcroft to give staff the opportunity to be involved with QI initiatives. The trust reported the following QI projects were competed at the acute and PICU wards, ‘Choking risk in adult acute inpatient’ and ‘the Gatekeeping process’. This process was reviewed and improvements implemented including medical input at bed management meetings and the attendance of HTT at ward rounds. The acute and urgent QI team were leading on a QI approach to delivering the actions and improvements needed following an incident investigation on Saffron ward. Another ongoing QI project was looking to reduce the use of out of area beds.