Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant patients were supported and treated with dignity and respect; and involved as partners in their care.

Staff mostly treated patients with compassion and kindness. They respected patients’ privacy and dignity. They usually understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff usually involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided.

This service scored 65 (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 2. The evidence showed some shortfalls. We heard from patients and relatives that staff did not always treat patients with kindness, empathy and compassion. However, we observed caring interactions between staff and patients and staff respected patients’ privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Feedback from patients about the way staff behaved towards them was mixed, with most patients saying they felt well supported by staff but some (9 out of 55), saying that a staff member had spoken to them or treated them inappropriately at times. An additional 2 patients said that staff on their ward were always in the office rather than interacting with patients. Also, 4 out of 12 relatives we spoke with told us that their relative had complained about some staff not being kind and compassionate towards them.

Staff supported patients to understand and manage their care, treatment or condition. All patients had a named nurse and usually had access to one-to-one sessions with them and other familiar staff members. However, we found that staffing pressures negatively impacted on staff’s accessibility to patients for one-to-one support, with 22 out of 55 patients describing some kind of negative impact on the quality of their care caused by staff shortages.

Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We observed positive, warm and supportive interactions between staff and patients during our time on the wards.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Some of the patients we spoke with mentioned specific staff members who understood their individual needs well and none of the 55 patients we interviewed raised concerns about staff not being aware of their needs. However, we saw that some people’s care plans did not include any information about their protected characteristics, for example having Black or minority ethnic origin, how their care should be tailored to ensure any individual needs arising from these aspects of their identity were met or how they would be safeguarded from discrimination during their admission to the ward.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. There was a Freedom to Speak Up process in place for staff to raise concerns confidentially and most of the staff we spoke with said they were aware of how to raise concerns and that they would feel safe and comfortable doing this if needed. None of the staff we spoke with said they had witnessed any inappropriate behaviour towards patients from their colleagues.

Staff maintained the confidentiality of information about patients. Paper and electronic records were stored securely and we did not observe any staff speaking about confidential matters inappropriately during our site visit, for example staff made sure that discussions about patients’ care took place in private rooms and not in front of other patients on the ward.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The information provided was not always in a form accessible to the patient group. Of the 22 sets of records we reviewed, 4 did not include care plans written in accessible language to support patients’ understanding of their care. Some patients with protected characteristics, for example relating to race or disability, did not have care plans or additional assessments on their records relating to these needs or aspects of their identity. Some of the patients we spoke with (4 out of 55) said they were not able to access food which met their individual needs. A patient also told us that had not been able to access spiritual support as the chaplain had stopped visiting their ward, although all the ward managers we spoke with said there were systems in place for all patients to access the trust’s multi-faith chaplaincy service and information about this was displayed on the wards and included in the welcome packs for patients.

However, the service made adjustments for disabled patients – for example, by ensuring disabled people’s access to premises and by meeting patients’ specific communication needs. Written information could be made available in languages other than English and accessible formats on request. Ward managers described the system in place for accessing interpreters if patients had a need for this, this included British Sign Language interpreters for deaf patients. We saw evidence in the records of this taking place, for example a patient whose first language was not English had weekly one-to-one sessions with their named nurse and an interpreter, and their interpreter also attended their ward rounds. Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. This was displayed on noticeboards on all the wards we visited and included in the welcome packs patients received when they were admitted to the ward. The menus we reviewed showed that patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies, intolerances and preferences (for example vegetarian and vegan options). However, some patients told us they could not always access food which met their needs and preferences.

The trust was a pilot site for the implementation of NHS England’s Patient and Carer Race Equality Framework (PCREF) and was submitting quarterly reports to NHS England setting out the actions taken to implement the framework across all its services. The most recent report (for quarter 4 2024/25) included monitoring data which showed an overrepresentation of patients from a Black or minority ethnic background in overall detentions under the Mental Health Act and in patients who have been subjected to restrictive interventions. The trust had an action plan in place to work towards greater equality and an improved patient experience for Black patients and those from other racialised ethnic backgrounds.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff usually responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

The individual needs of each patient and the risks relating to their care were assessed at the point of admission and were kept under regular review. All the records we reviewed included a completed assessment of risks and needs. Care plans were in place on all the records we reviewed which set out how staff should provide care in order to meet people’s needs and mitigate risks. For example, on some records where the patient presented a risk of violence and aggression towards others, there was information in their care plan about triggers, signs of escalation and measures which could help de-escalate situations.

Staff identified and responded to changing risks to, or posed by, patients. Risk assessments were usually reviewed and updated following incidents involving the patient (although this had not happened on 6 out of 22 of the records we reviewed). Managers and staff told us that they used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened and this was supported by the fact that the rates of physical restraint and other restrictive interventions were low across the forensic service. During our time on the wards staff were usually available and responsive to patients, however during our structured observation on Ferndale ward we did observe a patient requesting support and a delay in this being provided by staff. Staff on this ward, and others, told us that staffing pressures sometimes made it challenging to meet people’s needs in a timely way.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff mostly felt respected, supported and valued. The majority of staff we spoke with (32 out of 35) told us that they felt well supported by immediate and senior managers and were positive overall about working for the provider and their team. However, some staff told us they did not always feel supported by duty managers out of working hours if there were staffing challenges impacting their ward. We also observed staff struggling to access timely support during our evening visit to Isherwood ward. Also, some staff described being frequently moved between wards due to staffing issues which they said was destabilising for staff and patients.

Staff had access to support for their own physical and emotional health needs through an occupational health service. There was also a staff wellbeing lead in post, although some of the staff we spoke with told us that the availability of staff wellbeing support services had decreased since the time of our last assessment. The wellbeing lead produced monthly bulletins to report on the wellbeing interventions provided to staff.

The service’s staff sickness and absence were variable, ranging from an average of 7% to an average of 18% across the 9 wards in the 6 months preceding our assessment. We spoke to some staff who had recently returned from sickness absence and they told us they had felt well supported on their return to work. Rates of formal staff grievances were low (7 across all 9 wards in the 12 months preceding our assessment).

The provider recognised staff success within the service. Team meetings included an appreciation and celebration section as a standard agenda item and the trust had an online employee recognition platform linked to the trust’s values. Most of staff we spoke with told us they felt valued and respected at work.

Staff appraisals included conversations about career development and how this could be supported. The staff we spoke with told they were happy with their access to training and development opportunities. Staff feedback about flexible working arrangements and maintaining work life balance was mixed, with some staff feeling well supported with their personal circumstances and others feeling the trust could do more to meet their needs.