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

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 good. At this assessment the rating has remained as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all patients on admission, ensuring relevant information was collected to inform the development of individualised care plans. Care plans were developed for each patient and reviewed regularly through multidisciplinary discussions, with updates made as required to reflect changes in patient needs, risks, or treatment goals. Staff provided a range of treatment and care based on national guidance and recognised best practice, ensuring interventions were evidence-based, safe, and responsive to the diverse needs of patients. The staff team included, or had access to, the full range of specialists required to meet patient needs, ensuring appropriate professional input was available to support complex physical and mental health requirements. Staff from multiple disciplines worked collaboratively, combining their expertise and coordinating effectively to ensure that care and treatment decisions were comprehensive, consistent, and promoted safe, positive, and person-centred outcomes for patients. However, there was often no clear record of formal capacity assessments being carried out or established consent arrangements within the electronic care records system.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs.

We reviewed 14 patient’s care records and found that in each case a comprehensive assessment of the patient’s physical and mental health had been carried out, in a timely manner at, or soon after, admission.

We saw evidence that patients received physical and mental health assessments on an ongoing basis throughout their time in treatment, and that care plans were regularly reviewed and updated accordingly to reflect patients’ current information and support needs.

We found that care record progress notes generally gave a thorough overview of patient's support. However, other documentation on the electronic care records system wasn’t always updated in line with the content of progress notes - For example: Whilst progress notes showed that patients’ expectations and wishes were often documented, this information was not captured in the care plan section relating to patient expectations and wishes.

The service planned and delivered people’s care in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence.

The service provided treatment for organic and functional illnesses. Doctors prescribed medicines in accordance with trust policies and national guidance. Prescribing decisions were based on the patient’s presentation, the type of dementia and the patient’s physical health history. Doctors considered all the cautions and contraindications associated with the medicine and weighed up the risks and advantages. They advised patients and their families to report any side effects. Follow-up appointments took place every 3 to 6 months. Psychologists provided cognitive behavioural therapy and therapy to address the effects of trauma. Occupational therapists conducted functional and practical assessments. They arranged for equipment to be provided to support patients with activities for daily living. Nurses administered slow-release intramuscular medication. Some patients received electro-convulsive therapy.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. For example, staff encouraged all patients receiving antipsychotic medicine to receive an annual physical health check. Staff supported patients to access dentists, chiropodists and hearing services.

Staff participated in clinical audit and quality improvement initiatives. The service conducted regular audits of physical health checks before prescribing, infection prevention and control, and care notes. Following an audit of case notes, the service introduced an action plan to improve the recording of demographic and equality information. Staff were participating in quality improvement initiatives. These projects sought to make improvements in the process for dementia screening blood tests, allocations, enhancing feedback from the friends and family forms and identifying unconscious bias in formulation.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Overall staff training compliance across the service was over 94%.

A member of staff who had recently completed induction within the service reported that the training was comprehensive and that they valued the protected time provided to complete it, including additional shadowing and practical experience in procedures such as phlebotomy and ECGs.

Staff received individual supervision every six weeks in accordance with the trust’s policy. Staff reported that supervision was useful, providing protected time to discuss caseloads. They described managers as receptive and responsive to ideas and requests.

The frequency of staff supervision was mostly in line with Trust policy; however, the Solihull hub was an outlier, with compliance at 62%. Appraisal compliance across the service was 98%.

Managers ensured that staff received the necessary specialist training for their roles. For example, some staff had attended conferences in trauma informed care and advocacy nursing. Staff had access to Tier 2 dementia training to enhance their ability to support the patient group effectively.

The service worked well across teams and services to support people. Staff worked collaboratively within multidisciplinary teams to review needs, share information and agree coordinated care plans. Teams maintained strong partnership working with external agencies to promote continuity of care and holistic support.

Staff held effective multidisciplinary meetings each week. Meetings were chaired by a consultant psychiatrist and attended by nurses, psychologists, occupational therapists, student nurses and trainee doctors. At these meetings, staff discussed around 15 patients and entered notes of the discussion directly onto the patient’s record. Within each patient discussion, staff provided details of recent visits, highlighting any changes to the patient’s circumstances and presentation. This included details of the views of the patient, their family and other professionals that were working with the patient. The team agreed a plan for patient that typically involved bringing forward planned visits, reviewing medication, arranging capacity assessments or liaising with other professionals.We heard that managers met for weekly touchpoint meetings to share updates and raise any queries or concerns. Managers also attended monthly HR and KPI surgeries in order to maintain oversight and provide input in these areas.

Each team held monthly business meetings, bringing together staff from all professional roles within the team to share and discuss key updates about the service. Actions from previous meetings were reviewed, and new actions were agreed at the end of each meeting. Staff said these meetings as beneficial, allowing them to stay informed and to share thoughts, concerns, or ideas.

Staff and departmental leads from across dementia and frailty services attended the monthly Dementia and Frailty Clinical Governance Committee meeting, which reviewed clinical governance, patient safety, service quality, and feedback to support improvements in dementia and frailty care.

The service held a monthly Community Services Team Managers Meeting, which brought together managers to oversee service delivery, monitor performance, and address operational challenges, alongside a monthly community forum that enabled staff to engage with service developments and receive updates on changes.

The service supported people to manage their health and wellbeing. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

We observed posters in waiting rooms promoting services from external organisations, such as singing sessions and memory cafés, which were aimed at supporting patient wellbeing. The waiting rooms also contained information about recommended physical activities and their associated health benefits.

Staff encouraged and supported patients in maintaining a healthy lifestyle. For example, a member of staff had attended a conference to increase checks for prostate cancer in minority ethnic communities.

We saw dedicated notice boards providing carers with information on available services, including support groups, dementia awareness sessions, financial support and respite options. This signposting was intended to promote carer wellbeing and support carers to sustain their caring role.

We saw evidence that staff provided psychoeducation to patients and carers. Care records demonstrated that staff discussed diagnoses, treatment options, medication, and coping strategies.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Patients did not always benefit from timely monitoring of outcomes due to prolonged waiting times, meaning assessments and interventions were delayed. Extended waiting times limited the ability of staff to consistently measure progress, review outcomes and adjust care in response to changes in need.

Staff used recognised rating scales to assess and record severity and outcomes. Some staff used the Rowland Universal Dementia Assessment Scale or the Addenbrooke’s Cognitive Examination tool, designed to detect dementia and cognitive impairment. The service had introduced Dialogue+, a system for patients to rate their satisfaction with key aspects of their lives and treatment. Staff established a patients’ baseline by conducting this questionnaire during the early stages of their care and treatment. The questionnaire was repeated at later stages of treatment to measure the patient’s progress. However, staff explained that patients’ cognitive impairment made it difficult for them to respond to questions or understand the purpose of the exercise. This meant the system was not a reliable measure of progress or outcomes.

The service gathered patient feedback via the national NHS Friends and Family Test (FFT). The sample reviewed comprised 36 completed tests collected during the first 10 weeks of 2026. The majority of comments were positive, highlighting staff as friendly, helpful, attentive, and informative. Negative feedback primarily related to waiting times and the need for clearer communication or updates.

Although we did see some evidence of capacity assessments having been carried out and consent being sought by the service, practical application of the Mental Capacity Act was generally inconsistent and arrangements around consent were often unclear.

For patients who might have impaired mental capacity, staff did not consistently assess and record capacity to consent appropriately. There was often no clear record of formal capacity assessments or established consent arrangements within the electronic care records system.

Although progress notes sometimes recorded that consent had been sought and obtained, this was inconsistent across care records, often making it unclear what consent arrangements were in place, including information sharing with family members. In several cases, notes indicated that patients lacked capacity but did not specify which decisions this related to. For these patients no formal capacity assessments were documented, and often no details were provided about when assessments occurred, how they were conducted, or by whom. Staff were generally aware of decision-making processes for patients who lacked capacity and of instances where family members held enduring powers of attorney for welfare or financial matters. However, documentation was often incomplete, particularly in sections relating to powers of attorney, reducing overall clarity about the arrangements in place.

However, we did see some examples of when patients lacked capacity, staff making decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff liaised with a patient’s family and their GP to arrange a best interests meeting. For example, staff arranged a best interests meeting to consider whether a patient lacking capacity should move to supported accommodation. They invited the patient, their husband, the physio therapist, occupational therapist and social worker to the meeting to ensure the discussion included different perspectives on the patient’s circumstances.

Staff took practical steps to enable patients to make their own decisions. They supported people to make decisions by providing information in different formats. In some cases, staff took steps to improve communication, such as checking whether the patient had a hearing impairment, required information in easy read format or in an alternative language.