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Provider: Greater Manchester Mental Health NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 9 January 2020

Our rating of the trust stayed the same. We rated it as good because:

  • We rated effective, caring and well-led as good, and safe as requires improvement. We rated seven of the trust’s ten core services as good, two as requires improvement and one as outstanding. In rating the trust, we considered the current ratings of the six services not inspected this time.
  • We rated well-led for the trust overall as good.
  • Patients received a range of care and treatment based on national guidance and best practice from staff who had the range of skills needed to provide high quality care. Teams included or had access to the full range of specialists to meet the needs of patients.
  • Staff understood their responsibilities under the Mental Health Act 1983 and Mental Health Act Code of Practice.
  • Staff treated patients with compassion and kindness. Staff respected the privacy and dignity of patients and in most services involved patients in their care planning.
  • Services did not have referral criteria which excluded patients who may benefit from care and met the needs of patients, including those with a protected characteristic.
  • The trust investigated incidents and treated complaints seriously. The trust learned from the outcome of investigations and complaints, sharing learning across the organisation to improve services.
  • The trust had an experienced and senior leadership team who provided leadership to create a culture which supported high quality care. The trust engaged with patients, staff and communities to develop services which met the needs of local people and sought feedback to allow services to be improved.
  • Senior leaders understood the current and future risks to the trust and acted to mitigate these. Strategies were in place which supported the vision of the trust and its role within the wider health and social care system within the Greater Manchester area.

However:

  • The trust did not have effective processes in place to monitor the provision and compliance with supervision across its services.
  • Dormitory accommodation was being provided for patients admitted to acute wards for people of working age.
  • Not all patients within community services for working age adults had current risk assessments in place.
  • Patients waited too long for to access treatment in specialist community mental health teams for children and young people and community mental health services for working age adults.
  • Processes were not in place to ensure emergency equipment was safe to use in specialist community mental health teams for children and young people.
Inspection areas

Safe

Requires improvement

Updated 9 January 2020

Our rating of safe stayed the same. We rated it as requires improvement because:

  • We rated four of the ten core services as requires improvement and six as good.
  • In forensic inpatient wards systems and processes to safely prescribe, administer and record medicines were not always followed.
  • In community based mental health services for adults of working age not all patients had a current risk assessment in place.
  • In specialist community mental health services for children and young people emergency equipment had not been serviced to ensure it was safe to use.
  • In two core services staff had not received the required level of training in safeguarding children.
  • In specialist community mental health services for children and young people staff had not made an incident report when safeguarding referrals had been made.

However:

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.
  • The service had a good track record on safety.

Effective

Good

Updated 9 January 2020

Our rating of effective stayed the same. We rated it as good because:

  • We rated one of the ten core services as requires improvement and nine as good.
  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery-oriented.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported them to live healthier lives.
  • The teams included or had access to the full range of specialists required to meet the needs of patients under their care. Managers made sure that staff had the range of skills needed to provide high quality care.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.

However:

  • In acute wards for adults of working age and community based mental health services for adults of working age records did not show that supervision of staff in the service was effective. This was identified as a breach of regulation in acute wards for adults of working age in the 2017 inspection.

Caring

Good

Updated 9 January 2020

Our rating of caring stayed the same. We rated it as good because:

  • We rated nine of the ten core services as good and one as outstanding.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • Staff informed and involved families and carers appropriately.

Responsive

Good

Updated 9 January 2020

Our rating of responsive stayed the same. We rated it as good because:

  • We rated seven of the ten core services as good, two as requires improvement and one as outstanding.
  • Services were easy to access. Referral criteria did not exclude patients who would have benefitted from care. Staff assessed and treated patients who required urgent care promptly.
  • Services met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.
  • The design, layout, and furnishings of most wards supported patients’ treatment, privacy and dignity.
  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with teams and across the wider service.

However:

  • In specialist community mental health services for children and young people and community mental health services for adults of working age, patients who did not require urgent care waited too long for treatment.
  • Dormitory accommodation was still being provided at Park House an acute ward for people of working age.

Well-led

Good

Updated 9 January 2020

Our rating of well-led went down. We rated it as good because:

  • The trust had an experienced and stable board with a range of experiences that brought effective challenge and collective leadership. Leaders understood the challenges for the trust and recognised the positive progress that the trust had made. Leaders were able to identify where further improvement was required and worked together to ensure delivery of services.
  • Leadership, governance and culture supported the delivery of high-quality care. Leaders were visible and approachable.
  • Strategies and plans in place were aligned to the wider health and social care system. Plans were monitored and consistently implemented and there was evidence of improvement in the quality of services. The trust had completed a two-year programme to improve mental health services in the City of Manchester and was now developing its strategy and priorities for the next five years.
  • The trust identified, monitored and responded to current and future risks. There were effective audit processes in place and actions were taken when issues were identified.
  • An open and transparent culture was promoted by the senior leadership team. Staff were encouraged to raise concerns and felt able to do so. When things went wrong the trust adhered to Duty of Candour, investigated what happened and acted to improve services.
  • The trust engaged constructively with staff and people who use services working proactively to gather people’s views and developed services with their full participation. The trust showed a commitment to act on feedback received regarding their services.
  • The trust continued to maintain strong financial management. The trusts financial position was closely monitored and understood by the board. Financial decisions were considered against their impact on the quality or service delivery and patient safety.
  • There were systems in place to support improvement and innovation. The trust played an active and lead role in supporting the development and delivery of mental health services across Greater Manchester. The trust worked collaboratively with others, including Greater Manchester Health and Social Care Partnership to share learning and develop innovative services to meet the needs of the population it serves.
  • The trust had a strong research strategy and high level of research activity taking place throughout the organisation. The trust aims for its services to be academically informed and that research and innovation are embedded in its services and policies.

However:

  • The trust did not have effective processes in place to monitor the provision and compliance with supervision across its services. This was identified as a breach of regulation in acute wards for adults of working age during the September 2017 inspection.
Checks on specific services

Child and adolescent mental health wards

Good

Updated 23 February 2018

Our rating of this service improved. We rated it as good because:

  • The service had made improvements in many of the areas which previously were highlighted as concerns.
  • There was a shared culture of embracing the organisational values.
  • There was a culture of reporting concerns and learning from incidents.
  • Use of restrictive practices was carefully monitored and used as a last resort.
  • Risk awareness was taken seriously and there was evidence of regular risk assessments being conducted.
  • The senior management team met routinely with staff and had a presence within clinical areas.
  • There were real attempts to engage patients with every aspect of the service and develop their skills through work and education opportunities.

However:

  • Although most equipment was checked so it was safe to be used, not all safety checks had been completed when due.
  • The service did not always ensure patients understood interventions including medication.
  • Although physical observations were usually carried out, in one case we could not find records to show they had been completed.

Community-based mental health services for adults of working age

Requires improvement

Updated 9 January 2020

Our rating of this service went down. We rated it as requires improvement because:

  • In four out of six care records reviewed at the Central Manchester community mental health team, patients allocated a care coordinator in April 2019 had not been risk assessed, a situation confirmed with team management at the time of the inspection
  • Data provided about referral to initial assessment and referral to treatment times indicated very long waiting times within the service
  • Mandatory training data for safeguarding children level three was well below the trust target.

However,

  • environmental risk assessments had been completed, including ligature assessments, and actions taken to remove or reduce risks. Staff monitored patients waiting for assessment, with a duty officer system that allowed patients to contact the service during and after assessment
  • patient notes were recorded electronically and were found to be comprehensive and entered onto the system in a timely manner
  • Assessments of patients were comprehensive and holistic, and physical health monitoring was taking place, where required
  • Staff provided a range of treatments and access to treatment across the service, and care was delivered in line with national guidance
  • Staff were taking part in clinical audits and using results to drive improvement. Staff employed in the service had the right skills and experience to ensure informed treatment for patients
  • Staff were seen to be responsive and respectful when dealing with patients. Patients were involved in decisions about the service, where appropriate
  • There was a strategy to maintain and renew engagement with patients in the service, ensuring patients had every opportunity to receive the treatment they were prescribed.
  • The service used key performance indicators to take the service forward.

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 9 January 2020

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well so that a bed was usually available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • The design, layout, and furnishings of the wards did not always support patients’ treatment, privacy and dignity. Each patient did not have their own bedroom, as five of the wards at Park House had dormitories.
  • The trust did not have a robust mechanism for assuring itself that all staff received appropriate supervision. This was identified as a breach of regulation at the last inspection in 2017 and has been addressed as a trustwide issue at this inspection.

Specialist community mental health services for children and young people

Requires improvement

Updated 9 January 2020

We have not previously inspected this service under the current provider. We rated it as requires improvement because:

  • Children who did not require urgent care waited too long to start treatment.
  • Emergency equipment kept on the premises had not been serviced, meaning that it was not safe to use. None of the partner trust’s staff had completed level 3 training in safeguarding children. Between April 2018 and February 2019, staff only reported two safeguarding referrals as incidents.
  • Governance structures were not always effective. Routine checks had not identified that emergency equipment was overdue for a service. Managers could not be assured that staff were discharging their responsibilities in relation to safeguarding.

However:

  • Clinical premises where patients were seen were safe and clean. Patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • Managers promoted a positive culture. They worked with partners to meet local needs.

Forensic inpatient or secure wards

Good

Updated 9 January 2020

  • Our rating of this service stayed the same. We rated it as good because:
  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

However:

  • Staff did not always make requests for cover through the on-call management system.
  • Staff did not always review the prescription of high dose antipsychotic medicine.
  • Medicines were not always administered safely.  Staff oversight of the administration of medicine was inconsistent and patients were at risk because drug interactions were not recognised, or medicine administration reviewed, so medicine was not administered appropriately.
  • Staff did not always record information about patients’ care and treatment in a way that was comprehensive and easy to find.
  • Not all care plans were person centred and did not reflect the patient voice. Care plans used a medical language rather than the patient’s own words.
  • Recording of physical healthcare following rapid tranquilisation was recorded in patients’ electronic records but not all in the same place. Staff were recording monitoring either in daily notes or on medical early warning scores.
  • Patients’ one to one sessions with their named nurse were taking place, but not as two to three times a week as per the trust policy. One to one sessions were recorded but did not reflect the details of what was discussed and if this related to patients’ care, treatment and recovery.
  • Patients were offered a copy of their care plan, but this was not consistently recorded as to whether the patient had accepted or declined the offer.

Substance misuse services

Outstanding

Updated 23 February 2018

We have not previously inspected substance misuse services. We rated it as outstanding because:

  • There was a very strong recovery emphasis throughout the service. Staff worked with clients to help identify their goals and to develop their recovery capital. Staff were knowledgeable about local recovery and support services and they were promoted within teams.
  • Services were tailored to meet the needs of individuals and were delivered in a way that offered flexibility and choice. There were different pathways within community teams to address individual need and an innovative rapid access to alcohol detoxification pathway within inpatient services.
  • Client and carer feedback on the service was overwhelmingly positive. Clients spoke highly of staff and their supportive nature. Clients and carers were active participants in care and in decisions about treatment. Carers were able to access carer assessments and relevant support.
  • There was excellent multi-agency working. Services worked collaboratively with partner agencies within the local treatment network as well as with physical health services. There were clear referral processes into support services and mutual aid groups. Staff were active in facilitating client engagement.
  • The service employed volunteers and peer navigators with lived experience of substance misuse and recovery. Clients we spoke with talked positively about staff members and the visual representation of recovery that they provided.
  • There was excellent engagement with the community. Clients were encouraged and supported to attend community groups and services. There were community leads within teams to develop effective links and ensure that recovery was embedded within the team. There was a building recovery in the community asset fund that clients and staff could access to support new projects such as community allotments or trainee kitchens.
  • Clients and carers were able to give feedback on the service they received in a variety of manners. The service responded to feedback and developed action plans to address concerns.
  • Buildings were clean and well maintained. There were regular checks of equipment and maintenance records were in place. There were appropriate health and safety checks.
  • Staff actively managed client risk. Staff worked collaboratively with clients to complete risk assessments and develop risk management plans. The service prescribed in line with risk assessments and utilised methods such as supervised consumption to manage the risk of overdose or diversion. There were strong processes and procedures to manage safeguarding concerns and effective links with local authorities.
  • Staff had been trained to deliver psychosocial interventions. Services offered a range of one to one and group sessions to meet client need. Clients we spoke with were positive about the psychosocial interventions they received
  • There was a good governance structure. Quality of service provision and performance was monitored. Service and team managers were well regarded by staff. The service engaged effectively with stakeholders when introducing change.

However:

  • Staff in community services did not use personal alarms in a consistent manner.
  • Staff in community services did not always record consideration of mental capacity.
  • We found three care records where there was no consent to treatment or confidentiality agreement in place.
  • Although information sent by the trust showed six mandatory training courses below 75% compliance, local figures and staff confirmed training rates were higher. We observed skilled staff, competent in their role.

Wards for older people with mental health problems

Good

Updated 23 February 2018

Our rating of this service improved. We rated it as good because:

  • The service had made improvements following our last inspection. Staff were now completing observations following rapid tranquilisation. The safety of the environment had been improved with better lines of sight and the use of parabolic mirrors and staff observations. The gender segregation on the two wards at Trafford was much improved. Documentation around patients capacity was clear and we saw good evidence of capacity being assessed when necessary and best interest decisions being made appropriately.
  • There was adequate staffing levels to ensure patients were well looked after and able to spend one to one time with staff on a regular basis.
  • There were good patient risk assessments on each ward. The service provided a safe environment and risks were managed well. Patients told us they felt safe on the wards.
  • Staff deescalated aggressive and potentially violent situations well. Staff knew patients well and were able to use distraction and diversion techniques when they saw a patient becoming agitated. For example, the use of activity equipment that focused on patients interests and hobbies.
  • There was effective multidisciplinary team working evident on all wards.
  • Patients and carers gave universally positive feedback about the care and treatment they received on the wards we visited. Staff involved patients in decisions about their care where possible. They engaged with and supported families and carers where appropriate. Staff contacted them with updates on patient progress, held regular carers meetings, and invited them to ward rounds.
  • Recent changes within the service had led to a positive change in staff morale. Staff focused on the needs of the people using their service, providing high quality patient centred care, which reflected the trust’s vision and values. Senior managers were committed to improving the environment at the Manchester wards and had identified that the dormitories on those wards needed to be changed as a priority.
  • Two wards at Woodands hospital were AIMS accredited. The two wards at Trafford were going through the AIMS accreditation process with draft reports available at the time of our inspection.

However:

  • Staff were not always using the trust approved form for physical health monitoring following rapid tranquilisation.
  • We found there were delays in requesting second opinion doctors when patients had been detained for three months and administered medication in order to complete a form T2 or T3 (dependent on whether the patient was able to consent to treatment). There were also delays in section 62 being completed (emergency treatment of a detained patient) with medication being administered without the correct legal framework across all of the Wards except Maple Ward. We also found examples of when a section 62 had been completed and medications were not on the list but being administered.
  • On Cavendish Ward we found examples where patients had not been read their rights at the correct times or when there was a change in their detention status.
  • There was a lack of privacy Bollin Ward where privacy screens on bedroom windows had been left open and there were no privacy curtains in the bathrooms on the main corridor.
  • At Trafford the wards were very small with no quiet space for patients to use if they wanted to. Activities had to be done in the main lounge which meant that patients who wanted to sit quietly would either have to go to their rooms or listen to the activities.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 23 February 2018

Our rating of this service stayed the same. We rated it as good because:

  • The locations inspected were clean and equipped appropriately.
  • Staffing levels showed that very few vacancies existed within the service, and that shifts were adequately covered.
  • Care plans and risk assessments were completed in a holistic and comprehensive manner, taking into account the opinions of patients in the service.
  • Staff mandatory training compliance averaged above 80% for the service.
  • Activities for patients were meaningful, designed with an aim to not only keep patients engaged but to give skills for use in the community, including access to a recovery academy for both patients and staff.
  • Patients were positive in their comments regarding care in the service, and we saw evidence of positive interaction between staff and patients at each location inspected.
  • The Mental Health Act and Mental Capacity Act were observed and noted to be applied correctly.
  • There were very few complaints across the service, and we saw evidence of shared learning from complaints that had been investigated.
  • Key performance indicators were used to guide and improve practice across the service.
  • The service was due for Accreditation for Inpatient Mental Health Services under the Royal College of Psychiatrists.

However:

  • Acacia ward was in need of refurbishment and consideration for a total environment change: the trust had plans in place for implementation of such a change.
  • We saw a table used to inform staff of mandatory training figures was not importing the correct data in relation to immediate life support training, giving an incorrect data set in regards to said training; this was dealt with immediately on identification of the problem.
  • The sickness rate for staff was at 9%, but was only at 5% for the year to date.

Mental health crisis services and health-based places of safety

Good

Updated 3 June 2016

We rated

mental health crisis services and health-based places of safety as good because:

  • Staffing levels within the crisis teams helped ensure people in crisis received safe, appropriate and timely care. Teams had safe working practices and staff held manageable caseloads. Patients' individual risks were assessed and reviewed. Staff acted on adult and children's safeguarding matters. The three health based places of safety provided safe environments to assess patients

    .

    S

    taff learnt lessons following incidents to try and prevent further incidents happening.

  • There was very effective multidisciplinary working in the crisis teams and good interagency working with acute hospital staff and the police. There were very good systems in place for ensuring the hospitals’ duties under section 136 were met and very good clinical leadership into the health based place of safety. There was an alcohol worker working at the Trafford RAID service to support intoxicated patients. Nurses worked in police stations to provide professional and intensive support people who regularly presented to the police.

  • Patients were treated with dignity and respect. Patients were involved in identifying their crisis support needs and in developing the assessment and intervention tools used in the home based treatment teams.

  • Patients were usually seen quickly. Patients’ individual needs were considered and met. There were good complaints processes.

  • There were effective local, inter agency and crisis concordat meetings to improve services and patients' crisis experience. Staff were committed to providing high quality care and treatment and teams were managed by experienced and competent clinical leaders. There was a commitment to quality improvement such as improved health based places of safety environments, and improved staffing levels in crisis services.

However

  • The rationale for changes in levels of support relating to patients under the Bolton home based treatment teams were not always explicitly recorded.

  • It was not always clearly recorded that patients were informed of their rights verbally and in writing whilst in the health based place of safety and patients did not have access to a printed copy of the MHA Code of Practice.

  • There were problems across the trust with getting ambulances to take patients to the health based place of safety and there were delays in assessing patients when subject to section 136 including the response of approved mental health professionals at night but where these occurred, delays were beyond the full control of the trust.

  • In the home treatment teams, it was not always clearly recorded whether patients were given copies of their crisis care plans.

  • There were differing crisis care pathways in each locality and information about each service did not fully inform patients and carers on the services available to them.

  • Information on CQC’s role in complaints literature was not up-to-date.

Community-based mental health services for older people

Good

Updated 3 June 2016

We rated community based mental health services for older adults as good because:

  • Safe

Teams had sufficient staff to meet patients’ needs. Staff vacancies were being recruited into quickly. Staff reported that complexity of caseloads were reviewed in supervision to ensure equity. Team caseloads were at a manageable level. There were good lone working practices in the team and trust policy was followed. Staff knew about duty of candour. Patients had a crisis contingency plan in place in their care plan and staff knew how to respond to deterioration in a patients’ physical or mental health. Staff had a good understanding of safeguarding processes and knew their responsibilities to protect patients from possible risk of abuse and harm. Staff showed a good understanding of incident reporting and there was good reporting of incidents.

  • Effective

Staff attended a multidisciplinary group to review and problem solve complex cases, provide plans and anticipate care needs for those using health and social care services. There was a psychology team who provided input to patients, carers and staff. Care plans were holistic and person-centred. There was a staff development group who had protected time to meet on a monthly basis to undertake internal training. There were developments around the emphasis on physical health with some staff receiving specific training to support this. There was evidence of good inter-agency and multidisciplinary working.

  • Caring

Staff treated patients who used the service with kindness, dignity and respect. Staff demonstrated warmth and compassion in their interactions with patients and their carers. Staff involved patients and their carers in decisions about their care.

  • Responsive

There were five clinical pathways which gave clear and consistent support to patients. Patients reported that staff were flexible in their approach and quick to return phone calls. The service opened at weekends with reduced staffing in order to ensure flexibility and continuity of care. There was a duty system in place that ensured any urgent issues were dealt with in a timely manner. There were low numbers of complaints.

  • Well-led

Staff were aware of trust values. Staff told us that managers listened and they felt valued and supported. Supervision and appraisal were comprehensive and up to date. Clinical audits were regularly undertaken. Staff morale had improved since managers had become established in their role.

However

  • Mandatory training in basic life support was significantly below the trust target of 85% and below 75% for infection control.
  • Compliance with mandatory training across all teams was lower than the trusts’ target of 85%.
  • Training levels in the Mental Capacity Act and Mental Health Act were both significantly low.
  • The rights of patients subject to community treatment orders were not always being met. Patients were not referred to an independent mental health advocate after being placed on a community treatment order and their capacity to consent was not always recorded.
  • Carers were not always offered a carers assessment to ensure their needs were being met.
  • Patients were not always offered a copy of their care plan or given the opportunity to develop advanced statements about their care with staff.