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Provider: Greater Manchester Mental Health NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 18th September 2017

During a routine inspection

Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.

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

  • We rated eight of the nine core services as good, with one service rated as requires improvement. This takes account of the ratings of the four core services that we did not inspect this time
  • We rated safe as requires improvement, effective, caring, responsive as good.
  • We rated well-led at trust level as outstanding. The leadership team had effective oversight of the risks and challenges for the trust. They had overseen a very quick acquisition of a failing trust and were managing to maintain a strong clinical and financial performance. The trust was working in partnership with other organisations, including the housing and voluntary sector to promote well-being and good mental health. The trust carried out thorough investigations into serious incidents and had well established systems for learning lessons. The trust apologised when things went wrong. There were established systems for involving carers and service users with the transformation plans in Manchester demonstrated true co-production.
  • Staff generally managed risks well, with risk assessments well completed and reviewed. Staff recognised and reported safeguarding concerns and incidents. Staff understood the duty of candour. Although there were vacancies and sickness, systems ensured there were sufficient staff. Although some training courses were below trust target, the trust had taken steps to ensure there were enough skilled staff to provide care. Medicines were managed safely. Risks related to the two electronic management systems were being managed.
  • In four of the five core services we visited, care plans were holisitic and patient centred. This was not always the case in acute wards for working age adults and psychiatric intensive care units where care plans were not always personalised. There was a comprehensive audit programme and effective systems to monitor action plans. Although people’s rights who were detained under the MHA act were protected, we found that in wards for older people, there were issues with forms of authorisation and requests for second opinion doctors.
  • Feedback from people using the service was positive, with patients and carers telling us that staff were supportive and kind. Patients and carers gave us examples where staff had gone the extra mile to support them. People were generally involved in planning their care although this was not always the case in acute wards for adults of working age and psychiatric intensive care units. Feedback from substance misuse services was universally positive during the inspection and received the highest proportion of compliments by the trust.
  • Services were responsive to the needs of the population they served. Following the acquisition of Manchester out of area placements were high; the trust had plans in place to address and effective systems to monitor this. The transformation plans in Manchester were reviewing care pathways to improve access to services. Staff, patients and carers were involved in developing services. Complaints were well handled locally and at trust level.


CQC inspections of services

Service reports published 23 February 2018
Inspection carried out on 18th September 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 432.28 KB (opens in a new tab)Download report PDF | 2.69 MB (opens in a new tab)
Inspection carried out on 18th September 2017 During an inspection of Child and adolescent mental health wards Download report PDF | 432.28 KB (opens in a new tab)Download report PDF | 2.69 MB (opens in a new tab)
Inspection carried out on 18th September 2017 During an inspection of Substance misuse services Download report PDF | 432.28 KB (opens in a new tab)Download report PDF | 2.69 MB (opens in a new tab)
Inspection carried out on 18th September 2017 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 432.28 KB (opens in a new tab)Download report PDF | 2.69 MB (opens in a new tab)
Inspection carried out on 18th September 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 432.28 KB (opens in a new tab)Download report PDF | 2.69 MB (opens in a new tab)
See more service reports published 23 February 2018
Service reports published 3 June 2016
Inspection carried out on 8 – 12 February 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 344.87 KB (opens in a new tab)
Inspection carried out on 08-12 February 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 329.15 KB (opens in a new tab)
Inspection carried out on 9, 10 and 23 February 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 366.98 KB (opens in a new tab)
Inspection carried out on 11th February 2016 During an inspection of Community-based mental health services for older people Download report PDF | 330.88 KB (opens in a new tab)
Inspection carried out on To Be Confirmed During an inspection of Wards for older people with mental health problems Download report PDF | 373.34 KB (opens in a new tab)
Inspection carried out on 8-12 February 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 326.36 KB (opens in a new tab)
Inspection carried out on 8-12 February 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 409.97 KB (opens in a new tab)
Inspection carried out on 8-12 February 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 359.48 KB (opens in a new tab)
See more service reports published 3 June 2016
Inspection carried out on 8 February 2016 – 12 February 2016 and 23 February 2016

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We have rated services provided by Greater Manchester West NHS Foundation Trust overall as

good.

This was because we rated six of the eight services as good. We rated two service as requires improvement. These services were; child and adolescent mental health ward and wards for older people.

The trust did many things well and we saw good practice across most services.

The main areas which were positive were as follows:

  • Staff were caring, professional and worked to support the patients using the services.
  • The trust was supporting patients with their physical health well. People had their health assessed in a comprehensive manner and were being supported to have any health care needs addressed.
  • Staff, patients and carers had access to a wide range of opportunities for learning and development, which was helping improve care.
  • Patients and carers had the opportunity to be involved in how services were provided and their input was leading to changes.
  • The trust was aware of best practice and was using guidance and research to inform their work. Access to psychological therapies was good in the child and adolescent mental health wards and acute wards.
  • Patients could access care in their local service when they needed it. Services were designed to be accessible for all patient groups and the trust worked hard to ensure that hard to reach groups were engaged.
  • The trust had excellent working relationships with external agencies and stakeholders. An example was the work of the community team for older people working to reduce admissions into the acute trust.
  • Patients were cared for in the least restrictive way in the forensic service with patients self-medicating and positive risk management.
  • There was strong, effective and visible leadership. Staff knew the trust values and vision and their importance in the work of the trust. There was an effective governance system in place at board level so that the trust knew where action was needed.

However;

The main areas for improvement were:

  • Patients were not always having physical observations recorded when they had received medicines for rapid tranquilisation.
  • Patients were sometimes being secluded without the checks and safeguards of the MHA code of practice being applied.
  • In wards for older people, accommodation was not always being provided in line with same sex guidance.
  • Staff were not always recording decisions, and how they had been made in patients’ best interests on older people’s wards.
  • Not all staff were able to use the new electronic record system confidently and staff struggled to find records at times.
  • Not all staff had completed mandatory training and there were low numbers of staff who were up to date with their basic life support, immediate life support training, MHA and MCA training.
  • Not all staff were receiving regular supervision.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.