Greater Manchester Mental Health NHS Foundation Trust

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• 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

This means 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 requires improvement. At this assessment the rating has changed to good. This meant patients’ outcomes were consistently good, and patients’ feedback confirmed this.

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. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward teams mostly included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and usually discharged these well, although the records did not always demonstrate full compliance with the recordkeeping requirements of either Act.

This service scored 71 (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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 22 sets of care records during the assessment. All the records we saw showed that staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. These usually covered all relevant aspects of the individual’s health and social care needs, however 1 set of records did not include any evidence that the individual’s nutritional needs had been assessed and another patient, who had a diagnosis of autism, had no documented assessment of sensory and communication needs on their records. This was fed back to staff on the relevant wards at the time of our assessment.

Managers told us, and records confirmed, that all patients had a physical examination by a doctor and their physical health needs were also assessed at the point of admission to the ward. Patients were receiving checks of their vital signs at least weekly on all the wards and we saw evidence on the records that the National Early Warning Score (NEWS2) system was used to ensure any concerns in relation to people’s physical health were identified and escalated without any undue delay.

The records we saw included detailed, person-centred, recovery-oriented care plans which covered each person’s individual assessed needs. We saw evidence on the records that staff reviewed and updated care plans regularly, including when people’s needs changed. Most of the patients we spoke with told us that they had been involved in the development of their care plans and said they were involved in the review of their plans through the ward round meetings which took place fortnightly. Most of the care plans (18 out of 22) were written in language which was likely to make them accessible to the patient. However, of the 12 family carers we spoke with, 4 said they were not as involved in the planning of their relative’s care as they would have liked.

Managers and staff described how information relevant to each individual’s care was shared at handover meetings to make sure that all staff on each shift were aware of any changes to each patient’s needs. Records were kept of handover meetings which usually showed these discussions taking place, and these records were usually complete and up to date (on 8 out of 9 wards).

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and usually discharged these well. However, records did not always demonstrate full compliance with either Act.

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 (NICE). These included medication, psychological and occupational therapies and activities, and training and work opportunities intended to help patients improve their range of skills and enhance their independence. An annual NICE guidance position report was presented to the trust’s patient safety and effectiveness committee, most recently in September 2025.

All patients were receiving care from a multi-disciplinary team including a consultant psychiatrist, registered mental health nurses, forensic and/or clinical psychologists, occupational therapists and social workers. The medium secure, low secure and women’s blended wards all had an evidence-based model of care which was kept under review by the relevant trust board sub-committees. Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Where patients had a specific physical health care need requiring referral, for example to a dietician or speech and language therapist, we saw evidence that timely referrals were made. We saw records which confirmed that a range of staff participated in clinical audit, benchmarking and quality improvement initiatives.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new substantive staff with appropriate induction. However, we did not always see evidence that bank staff received an induction when they first started working on the ward. Managers told us, and staff confirmed, that both managerial and clinical supervision meetings (to discuss case management, to reflect on and learn from practice, and for personal support and professional development) were provided regularly. The records confirmed that these were taking place, although on some wards the percentage of staff up to date with their supervision was below 80% due to staffing pressures. Managers and staff also told us, and the records confirmed, that regular staff team meetings took place on the wards and minutes of the meetings were circulated to ensure relevant information was shared with those who were unable to attend, for example staff who worked regular night shifts. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. There was a programme of mandatory training available for staff and managers monitored their team’s compliance with this. Managers also ensured that staff received the necessary specialist training for their roles. This included training on meeting the needs of people with a learning disability and/or autism, which is a national requirement for all health and social care workers. As of the date of our assessment over 90% of staff on all the wards we visited were up to date with this training.

Mental Health Act

The trust had written policies setting out the requirements for staff to comply with all aspects of the Mental Health Act in relation to the care of patients and staff were able to access these via the trust’s intranet. Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff received training on the Mental Health Act as part of their mandatory training and over 80% of staff were up to date with this on all wards except for Ferndale (77%) and Rydal (78%). The staff we spoke with were aware of their responsibilities under the Mental Health Act and knew how to seek support and advice from the trust’s Mental Health Act administrators, who were based elsewhere on the Prestwich site.

An independent advocacy service sent advocates to all the wards and provided a quarterly report summarising themes from patient concerns and reporting on patient engagement with the advocacy service. Patients confirmed they were able to access an independent advocate including during their ward round meetings. Information about how to access the advocacy service was displayed on all the wards. Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. This was apparent on all the records we reviewed and the trust carried out regular audits to make sure people were reminded of their rights at the intervals required by the Mental Health Act.

Staff usually ensured that patients were able to take section 17 leave (permission for patients to leave hospital) when this has been granted. However, not all patients were receiving all the section 17 leave they had been prescribed, especially on the assessment and treatment wards where people were more likely to be prescribed escorted leave. Patients told us this and records and staff feedback confirmed it. We were told this was mainly due to staffing pressures on the wards meaning there were not always staff members available to facilitate all the escorted leave some people had been prescribed. However, all patients who were able to take section 17 leave from the hospital were getting at least some leave from the ward.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of patients' detention papers and associated records (for example, section 17 leave forms) correctly and so that they were available to all staff that needed access to them. We did not identify any concerns with the Mental Health Act paperwork we reviewed during the assessment. The trust had systems in place for monitoring compliance with the Mental Health Act including data monitoring systems and audits.

Staff on several wards reported challenges in recording seclusion reviews due to these records being paper based and needing to be manually added to the main electronic records system at a later date, which could lead to delays and gaps in the electronic records. Some of the seclusion records we reviewed had gaps in the records of medical and multi-disciplinary reviews, so we could not be fully assured these were always taking place at the intervals required by the Mental Health Act.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multi-disciplinary meetings. All patients had fortnightly multi-disciplinary ward round meetings at which their care was reviewed in detail and these were documented in each patient’s care records. External stakeholders such as probation workers and community care coordinators were able to attend ward rounds where appropriate, for example when a patient was approaching the point of discharge from the ward. Staff shared information about patients at effective handover meetings within the team at the point of each shift change. Handover records were usually complete and up to date. Since our last assessment, the trust had also introduced daily multi-disciplinary ‘Plan Your Day’ meetings on all wards, which staff and managers told us were helpful for information sharing and planning for the day ahead. However, some staff (5 out of 35) said that the ward teams of nurses and healthcare assistants and the other clinical staff did not always work well together.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). The commissioners for the service reported positive working relationships with the leadership team and said these had improved in recent years, with increased openness and transparency.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. Patients and staff told us that they had access to the Recovery Academy based within the Riverside Centre, which offered a range of groups and courses for patients which supported their recovery and promoted mental and physical wellbeing. The trust had made positive progress in implementing its smoke free policy since our last assessment, with incidents of patients smoking on the ward or in the secure garden areas significantly reduced.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, sports activities and cooking healthy meals. We saw evidence in records of activities of this nature taking place on all the wards and some of the patients we spoke with told us about cooking and exercise activities they took part in on the ward and at the Patterdale Centre, where more extensive facilities to support patient activities were available.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used nationally recognised rating scales to assess and record severity and outcomes (for example, the Health of the Nation Outcome Scales (HoNOS) and the Forensic Inpatient Quality of Life Questionnaire (FQL-SV)). These were completed on or shortly following admission and were reviewed around every 6 months by the multi-disciplinary teams. We saw completed and up to date HoNOS and FQL-SV records on the care records we reviewed. There were also opportunities for patients to give verbal feedback on their experience of their care and treatment at one-to-one meetings with their named nurse and at weekly community meetings on all wards.

A range of audits were also carried out across the forensic service to monitor a wide range of aspects of patients’ care including the safety and cleanliness of the care environment, the safe management of medicines and the accurate and timely completion of care records. The outcomes from audits were monitored through sub-committees of the trust board and lessons learned were shared with the ward teams through team meetings and email bulletins. The staff we spoke with confirmed that they received these updates.

We scored the service as 2. The evidence showed some shortfalls. The records we reviewed did not always demonstrate compliance with the Mental Capacity Act when people lacked the capacity to make decisions about their care and treatment. However, the service did tell people about their rights around consent and respected their rights when delivering care and treatment.

Staff took all practical steps to enable patients to make their own decisions. The patients we spoke with who had the capacity to consent to their care told us that they felt involved in their care and had the opportunity to attend their ward rounds and express their views. Patients were regularly reminded of their detention status under the Mental Health Act and their rights as a detained patient, including any restrictions on their right to refuse treatment for their mental illness. We reviewed prescription charts and Mental Health Act paperwork for 69 patients and we did not identify any concerns with these records.

Mental Capacity Act

Staff received training in the Mental Capacity Act as part of their mandatory training and over 80% of staff on all wards except Ferndale (77%) were up to date with this training. The staff we spoke with had a good understanding of the Mental Capacity Act, and were aware of where to seek support and guidance on the assessment of capacity and support for patients lacking decision making capacity if needed. Due to the nature of the service all patients were detained at the hospital under the Mental Health Act and therefore there were no deprivation of liberty safeguards applications made in the 12 months prior to our assessment. Staff took all practical steps to enable patients to make their own decisions and people’s capacity to consent to all aspects of their care and support was reviewed as part of the ward round process. For patients who might have impaired mental capacity, staff assessed capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. However, we found some gaps in the records in relation to capacity assessments and best interests decisions – staff assured us that these processes had taken place to support patients but this was not always clearly documented in people’s care records. Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it. The most recent audit of Mental Capacity Act compliance took place in October 2025. This also identified multiple instances of capacity assessments and/or best interests decision making not being correctly documented in people’s records.