Greater Manchester Mental Health NHS Foundation Trust

Ratings - Forensic inpatient or secure wards

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Requires improvement

Our view of the service

We carried out this assessment as we needed to review the concerns identified from the previous assessment, which took place in April 2024, to see if the necessary improvements had been made. Following the previous assessment, we rated the trust’s forensic inpatient or secure wards as inadequate overall and for the safe and well led key questions and requires improvement for the effective, caring and responsive key questions, and we issued a s29A warning notice, dated 18 June 2024.

This assessment covered 33 quality statements across the safe, effective, caring, responsive and well-led key questions. The on-site element of the assessment took place on 14 to 16 October 2025 on the trust’s main site in Prestwich. We visited 5 medium secure male wards and 2 women’s secure wards within the Riverside Centre and 2 male low secure wards within the Lowry Unit. The male medium secure wards included Rydal (15 bed admissions ward), Dovedale (15 bed admissions ward), Eskdale (16 bed assessment and treatment ward), Ferndale (16 bed assessment and treatment ward) and Keswick (19 bed pre-discharge ward). The male low secure wards included Delaney (15 bed admissions ward) and Isherwood (15 bed pre-discharge ward). The women’s secure wards included Hayeswater (6 bed admissions ward) and Borrowdale (12 bed treatment ward). Both these were part of the women’s blended service with a mixture of medium and low secure patients.

We found that the trust had made improvements in some areas including the mitigation of environmental risks, the management of medicines, ward security procedures and governance systems. This included the majority of the issues leading to the s29A warning notice issued following the last assessment. However, our assessment also found some continued areas of concern in relation to staffing, medicines management, the mitigation of individual patient risks and recordkeeping.

Mental Health Act and Mental Capacity Act Compliance Summary

We found that the trust was mostly compliant with the requirements of the Mental Health Act in relation to reminding patients of their rights under the Act, ensuring patients were granted leave from the hospital (section 17 leave) in appropriate cases and the safeguards in relation to medicines prescribed to people. However, we found some gaps in the records of people who were secluded so we could not be assured that the medical and multi-disciplinary team checks on secluded patients were always taking place at the intervals required by the Mental Health Act Code of Practice. We also found that staffing pressures were negatively impacting on patients’ ability to take all the section 17 leave they had been prescribed at times.

We found some gaps in the records in relation to the assessment of people’s capacity to consent to their care or to make other decisions, such as those relating to their finances or the plans for their future care following discharge from the ward. We also found that meetings held to make decisions in a patient’s best interests where they lacked the capacity to make this decision themselves were not always clearly documented in people’s records.

We rated the service as Requires Improvement. We found 3 breaches of the regulations in relation to safe care and treatment (Regulation 12), governance (Regulation 17) and staffing (Regulation 18).

Patient risks were not always well managed as there were gaps in the risk management plans and risk assessments were not always updated regularly. Some patients were not consistently receiving the physical health monitoring they needed and medicines were not always managed safely. There were staffing shortfalls on all the wards, which at times were negatively impacting on the quality of care and on patient and staff wellbeing. There were gaps in some of the ward management records including those relating to environmental risks, staff induction and the management of blanket restrictions. Care records did not always reflect full compliance with the Mental Health Act Code of Practice or the Mental Capacity Act.

However, the wards were safe and clean and we found that the management of fire and ligature risks had improved since our last visit. Effective systems were in place for managing and learning from incidents and complaints. Patients had person-centred and holistic care plans covering all aspects of their care and these usually showed evidence of involvement of the patient and those close to them. Patients received care from a multidisciplinary team (MDT) of professionals including psychiatrists, psychologists, occupational therapists and registered mental health nurses and their progress was regularly reviewed by the full MDT. Patients and their carers were able to feed back to the trust on their experience of the service and we saw evidence of action being taken in response to this feedback. Admissions to, and discharges from, the wards were managed well, with no evidence of any significant barriers to effective patient flow. Effective governance systems were in place to monitor the quality and safety of the care provided and to provide assurance of this to the trust’s board. This included systems for involving patients and those close to them and capturing their voices about their experience of the service.

We have asked the provider for an action plan in response to the concerns found at this assessment.

People's experience of this service

We spoke with 55 patients during our time on the wards. Patients told us that the wards were usually clean and that individual members of staff were mostly helpful and supportive. However, around half the patients we spoke with (22 out of 55) told us that staffing shortfalls negatively impacted their care at times. Examples of the impact of this included patients not being able to take all the leave they had been prescribed, not being able to access the secure garden on their ward for fresh air or not having frequent one-to-one sessions with their named nurse. Most patients said they were able to access food which met their needs, although some said the food was not good quality and others said they did not always get what they ordered. Patient feedback about access to varied activities was mixed, with some patients saying they were happy with the activities on offer and others saying they were bored at times as there was not much to do. Patients reported low levels of restrictive interventions such as physical restraint, and usually said staff treated them respectfully and that they felt safe on the wards. However, some patients said that staff did not always speak kindly to them, particularly if they were temporary staff who did not usually work on their ward. Patients said they felt involved in their care and confirmed they had access to regular community meetings where they could raise any concerns or questions they had.

We also spoke with 12 relatives and carers. Feedback from family carers was mixed, with some reporting a positive experience for their relative and others raising some concerns about the care their family member was receiving. Most of the carers who gave us feedback said the wards were clean and said that their relative felt safe in the hospital. Carers were also mostly positive about the activities available for their family member and the quality of care overall. The main theme of concern raised by family carers related to not getting sufficient information about their relative’s progress, with 5 out of the 12 relatives saying they did not get regular progress updates, 4 out of 12 saying they were either not involved at all in their relative’s care planning or only involved because they were so persistent, and 3 out of 12 saying they were not given any opportunity to give feedback about their experience as a carer. Also, some relatives (4 out of 12) said their relative had told them that the staff were not always respectful or polite to them and some raised concerns about their relative not having access to leave (2 out of 12), therapies (2 out of 12) or activities (3 out of 12) to meet their needs.