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.

This is the first assessment for this service. This key question has been rated Good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 10 care records during the assessment.

Staff did not always complete a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Perinatal assessments including current presentation, historical mental health needs, mental state and risk to baby were not completed in full and current for 9 of the 10 women on the ward. Five were blank or not opened on the system. Two were partially completed. Two were completed in 2023 and 2024 and were not current for the current admission. One was completed and in date. This meant considerations specific to this service were not always considered for the women who were accessing the service at the time of the assessment.

Staff assessed patients’ physical health needs in a timely manner after admission.

Patients told us that staff developed care plans with them, however these were not easily accessible on the electronic care records, and staff struggled to locate them.

We accessed the care plans following the on site assessment and reviewed 9 records. The care plans were based on areas of need, goal and intervention required. All care plans were completed, however some had gaps in the formulation section, background history and patients views of the care plan and whether they had received a copy of the care plan.

The service had developed a baby admission and care plan document to include how best to support the baby, their likes and preferences and progress against milestones. We reviewed these and they were personalised and completed promptly following admission.

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 discharged these well.

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. These included medicines and psychological therapies and parenting skills. The staff team included a psychologist who delivered psychological therapies including providing self help resources which patients told us were helpful.

There were nursery nurses and a health visitor in the staff team who focused on the care of the babies and assisting mothers with developing these skills, they also offered a creche at key times to enable patients to complete self care skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Records showed liaison with midwives, obstetricians and other external health professionals.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. There were details of babies food requirements, including a white board in the milk kitchen with individual requirements to enable staff to support mother with feeding. An input and output record had been introduced to monitor babies food and fluid intake.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Improvements were implemented as a result of these, for example the introduction of a mother and baby milk kitchen policy and the introduction of nursery nurse development meetings, led by the health visitor.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. The team included doctors, nurses, nursing assistants, psychologist, social worker, occupational therapy staff, nursery nurses and a health visitor. The team also had external organisations providing input into the ward, including Action On Postpartum Psychosis who delivered activities on the ward and supported patients from a peer perspective and Dads Matter who facilitated a support group for dads.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Service specific training was provided to staff including: perinatal training yearly, baby safe sleep and physical health in infants, and infant feeding training.

Managers provided new permanent staff with an appropriate induction. However, we reviewed the induction process for bank staff and found for 3 staff that we reviewed, only one of them had a completed induction record and observations check completed.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The health visitor supervised the nursery nurses and the ward manager supervised senior nurses and the nurses supervised the nursing assistants.

Managers ensured that staff had access to regular team meetings. These were taking place approximately monthly for the 5 months prior to the assessment.

The percentage of staff that had had an appraisal in the last 12 months was 67%.

The percentage of staff that received regular supervision was 77%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. This included specialist training for the service.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

100% of staff had received training in the Mental Health Act.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy. Information was displayed on the ward and it was also a standard agenda item on the community meeting agenda.

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.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. The majority of patients were informal, with 7 informal patients and 3 patients detained under the Mental Health Act, the multidisciplinary team worked in a least restrictive approach.

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 reviewed these and they were in order.

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 multidisciplinary meetings. We observed a ward round and found the whole team were involved, provided updates and agreed areas to focus on. External professionals were involved including children’s services and community mental health teams. The patient and partner were fully involved in the meeting too.

Staff did not share all necessary information about patients at handover meetings within the team. In the handover we observed, the nurse handed over the observation level of all patients and babies and if they were on leave or on the ward and potential discharge dates, however, did not include risk.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation; managers attended inpatient huddles and perinatal huddles daily Monday to Friday. We observed the perinatal huddle and found that updates were shared between community clusters, outreach team and the inpatient team. This included women in the community who may require an inpatient admission and possible discharges from the inpatient ward.

The team had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). Records showed communication with the teams, including updates on the patient’s progress and we saw external teams were involved in the ward rounds.

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 pregnancy and post natal risks. Records showed liaison with obstetricians regarding delivery options.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups took place and cooking sessions. Also the promotion of sleep hygiene for both baby and mothers.

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 recognised rating scales to assess and record severity and outcomes. Monitoring of babies progress and development took place. Assessment of mothers parenting skills, including bonding with baby took place by nursery nurses, overseen by the health visitor.

Staff used technology to support patients effectively. Blood tests and other physical health monitoring took place as required. The ward round used links for external people to join the meeting remotely.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Interpreters were used for patients whose first language was not English.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. We saw a capacity assessment in relation to labour and how the patient was going to deliver the baby.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Minutes showed that best interest discussions took place with appropriate professionals, we saw minutes of a best interest discussion with colleagues in midwifery and obstetrician roles.