Greater Manchester Mental Health NHS Foundation Trust

On this page

• 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 Good. At this assessment the rating has remained Good.

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

This service scored 67 (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 17 care records. Of these, 13 were either not completed in full or personalised. At the Children and Young People’s Eating Disorder Service, 1 out of 4 care records reviewed did not have a care plan in place. At the Junction 17 day service there were gaps in the care plans, and the care plans did not include any goals for young people. At Wigan CAMHS, of the 5 care records reviewed, 3 did not have a care plan in place. Of the 2 records which had care plans, they did not include goals. In Bolton CAMHS, of the 4 care records reviewed, 3 had care plans however they were not very personalised and included lots of blank sections.

We observed that staff completed a comprehensive mental health assessment of the young person. The assessment included family too.

Staff assessed young peoples’ physical health needs during the comprehensive assessment. In the Children and Young People’s Eating Disorder Service, this included height, weight and their physical health and physical functioning.

Care plans were current and recently reviewed at Junction 17 day service. However, at Bolton CAMHS 1 out of 4 records reviewed included a current and recently reviewed care plan. At Children and Young People’s Eating Disorder Service, 2 out of 4 care plans reviewed were recently updated. None of the 5 care plans we reviewed at Wigan CAMHS were up-to-date.

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 young people accessing the service. 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 including dialectal behavioural therapy, cognitive behavioural therapy and Eye Movement Desensitization and Reprocessing (EMDR)

Staff participated in clinical audit, including care plan audit, supervision audit, handwashing audit. From these action plans were created to address any areas for improvement.

The team included the full range of specialists required to meet the needs of young people in the service. This included dietitian, doctors, health visitor, mental health practitioners, nurses, occupational therapists, psychologists, social workers, support time and recovery worker and support workers.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the young people accessing the service. Several staff had worked in the service for a long time. Staff with the relevant roles were employed into the teams, for example at the intensive support team who supported young people with a learning disability, speech and language therapists and learning disability nurses worked in the team.

Managers provided new staff with appropriate induction. Records showed that staff received fire inductions and local inductions in addition to the corporate induction.

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. Staff received managerial and clinical supervision, however teams where the compliance of this was below 75% was Bolton CAMHS with 37% for clinical supervision and 44% for managerial supervision. Junction 17 day service was 67% compliant for managerial supervision. Children and Young People’s Eating Disorder Service was 58% compliant for clinical supervision and 70% for management supervision and Wigan CAMHS was 46% for management supervision. All other teams were over 75%. Managers ensured that staff had access to regular team meetings. These usually took place monthly.

Staff had received an appraisal in the last 12 months. The teams where compliance was less than 75% was Bolton CAMHS with 61%, Bolton intensive support team with 71%, the Children and Young People Eating Disorder service with 36%. All other teams were over 75%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. A young person had delivered a presentation to the Children and Young People Eating Disorder service about their experiences and how the service could improve with meeting the needs of autistic young people.

Managers dealt with poor staff performance promptly and effectively. Records showed there had been 11 grievances and disciplinary action in the service in the last 12 months.

Mental Health Act

This service had limited involvement with the Mental Health Act. However, staff from the teams providing in reach support to the inpatient services may be involved in the care of children and young people who were detained under the Mental Health Act.

Staff had completed training in the Mental Health Act with 100% compliance in 6 teams. Teams with less than 75% compliance were Bolton CAMHS with 73%, Children and Young People’s Eating Disorder Service with 71% and Building Attachment and Bonds service with 67%.

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.

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. Monthly team meetings took place.

Staff shared information about young people at effective handover meetings within the team. Daily huddle meetings took place. These included the opportunity to discuss young people that clinicians were concerned about and any staffing challenges. These issues were then escalated at daily tactical meetings with senior leaders.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation including other community teams and inpatient services.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). This included Wigan CAMHS working alongside social care staff in their Hub to assist with mental health assessments with the aim of timely assessments and shared decision making. Social care staff spoke positively about this arrangement.

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 young people to live healthier lives. In the Children and Young People Eating Disorder service, the dietitian worked with young people regarding healthy eating and developed individualised meal plans for young people.

Activities at Junction 17 day service included exercise and relaxation activities to promote positive wellbeing.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes (for example, Health of the Nation Outcome Scales). Staff explored if young people had experienced adverse childhood events as part of the assessment for the service.

The service used goal-based outcomes, and the template was in the electronic care records. Review of 17 care records showed that 12 of the care records had care plans, however 6 of them did not include goals. This meant staff were not routinely completing goal-based outcomes with young people.

Staff used technology to support young people effectively (for example, for prompt access to blood test results and online access to self-help tools).

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 young people to make their own decisions. Staff had a variety of resources they could use, for example visual resources.

For young people 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 in the Children and Young People’s Eating Disorder Service, capacity assessments completed regarding physical health needs.

When young people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. This included liaising with inpatient services to ensure their wishes and preferences were shared and advocated for.