Greater Manchester Mental Health NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement.

Requires improvement: This meant people’s needs were not always met.

The service was in breach of Regulation 9 Person Centred Care for the care plans which did not always reflect people’s individual needs and for the waiting times to access Bolton and Wigan CAMHS.

This service scored 61 (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 1. The evidence showed significant shortfalls. The service did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

At the last inspection there was a breach for Regulation 9 Person centred care, relating to waiting times and a requirement that people must not be waiting for longer than 18 weeks from the point of referral to start of treatment. Most referrals had contact with the service for their first appointment either face to face or by phone within 18 weeks. There were 10 young people at Bolton CAMHS waiting for more than 18 weeks for their first appointment.

We reviewed the waiting times and lists for the services we visited and found at Bolton CAMHS for the single point of access second appointment, the longest a young person was waiting was from 2 June 2025, which was over 39 weeks. There were 320 waiting for their second appointment.

At Bolton CAMHS, for their core escalation list for those young people with prioritised complex needs, there were 30 young people waiting and the longest wait was from 17 December 2024. This was over 63 weeks.

There were 74 young people waiting on the non-escalation core waiting list with the longest wait was from 18 August 2023. This was over 132 weeks.

The waiting list for an ADHD assessment was 893 young people. The longest a young person had been waiting was from 5 June 2023. This was over 143 weeks.

The waiting list for an Autism assessment was 324 young people waiting. The longest a young person was waiting was from 7 May 2024. This was over 95 weeks.

There were 38 young people waiting for cognitive behavioural therapy with the longest young person waiting since 12 September 2024. This was over 76 weeks.

There were 5 young people waiting to access the dialectical behavioural therapy skills-based group. The longest a young person had been waiting was since 10 March 2025. This was over 51 weeks.

There were 24 young people waiting to see a doctor for a psychiatry review. The longest a young person had been waiting was from 19 October 2025. This was over 20 weeks.

At the last inspection in 2019, there were 334 young people waiting for a case manager, at our onsite assessment there were 104. This is a reduction from last time.

At Wigan CAMHS, of the young people waiting longer than 18 weeks, there was 1 person waiting for exposure and response prevention for 63 weeks. There was 1 person waiting for a neuropsychological assessment for 60 weeks. There were 6 young people waiting for psychotherapy and the longest had been waiting for 59 weeks. There were 14 young people waiting for post diagnosis tic feedback and the longest a young person had been waiting was for 53 weeks.

This meant Bolton and Wigan CAMHS were not meeting the NHS constitution of starting consultant led treatment within a maximum of 18 weeks from referral. There were discussions taking place with commissioners regarding a Greater Manchester-wide approach to assessments for Autism and ADHD, however this was still in the development stage.

At the Children and Young People Eating Disorder Service there were no waiting lists. There were no young people waiting longer than 4 weeks at the crisis team and Junction 17 day service. There were no young people waiting longer than 8 weeks at Bolton MHST. There were no young people waiting longer than 12 weeks at Wigan school link, Wigan MHST and the Wigan and Bolton cared for team. There were no young people waiting longer than 16 weeks at Wigan Building Attachments and Bonds Support team. This meant these services were meeting the mental health access and waiting time standards.

We reviewed 17 care records. Of these, 13 were either not completed in full or not 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. This meant the service were not ensuring young people were at the centre of their care and treatment choices.

Parents and young people told us that the service does not always make reasonable adjustments for young people, for example 1 young person preferred to communicate by writing, but the worker did not support this. Another young person preferred information about the service and what to expect in a visual format, and this was not available. This meant the service were not responding to the individual needs of all young people accessing the service.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff ensured that young people had access to education and work opportunities. At Junction 17 day service there was an education department that young people attended.

Services were provided in young people’s local communities, including in schools.

Young people were involved in the participation group which followed the Lundy model of participation focusing on space, voice, audience and influence. The group were involved in interviewing staff, developing resources and creating the newsletter.

Families were involved in the assessment process; however young people were consulted on whether there were parts of the assessment that they wanted to do individually. We saw practitioners respected their wishes and facilitated this.

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was no information available for young people and their families about each of the teams. Some teams had a brief overview of the service, others had leaflets however they were all words and not very accessible.

Families told us that they were not provided with very much information about the service.

Information was aimed at referrers rather than the young people and their families.

Leaflets said that people needed to contact the service if they required the information in another language or format.

When young people had been referred to a service where there was a waiting list, there was not a consistent letter that was sent to young people and their families about what to expect, next steps and numbers to contact if things change. Some teams had letters however the guidance regarding what to do if a young persons risk or mental state changed was not consistent.

When visiting the service, we found that information was on display regarding treatments, local services, and how to complain. This was displayed on notice boards.

Families and commissioners told us that the service kept them updated on the young person’s progress, however they were not always invited to reviews.

Newsletters co-produced by the young people had been created and included how schools can help to deal with exam stress and how to ask for help with this

Feedback from young people included that more visual resources would be helpful to explain what was happening next. Young people said information in advance would be helpful about what to expect at the assessment appointment.

Staff made notifications to external bodies as needed. This included liaison with local authorities.

Information governance systems included confidentiality of care records. All staff had a log in to access the secure electronic care records.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had received 81 concerns and complaints in the last 12 months. 39 of these were complaints. Themes included lack of communication, staff attitudes, cancelled appointments, calls not being returned, and waiting times.

Of the 39 complaints received in the last 12 months, 24 complaints were upheld.

Young people and families mostly knew how to complain. QR codes to access links were included in leaflets and also displayed in waiting areas. Of the parents we spoke with, 3 out of 21 did not know how to complain.

Community meetings took place at Junction 17 day service approximately every 2 weeks. Minutes showed that complaints and compliments were discussed in these meetings.

The service had received 9 compliments about the service over the last 12 months. These related to the individual therapy young people had received and also the Junction 17 day service.

There was an allocated practitioner based in Wigan CAMHS who was leading on complaints and the investigation of these from a systemic and just culture approach.

Staff knew how to handle complaints appropriately. The Patient advice and liaison service (PALS) led on the investigation of complaints and involved an appropriate staff member to investigate the complaint.

Some teams had an agenda item of feedback and complaints in their team meetings to receive feedback on the outcome of investigation of complaints and they acted on the findings. However, Bolton CAMHS, Wigan CAMHS, School link service, Intensive support team, Children and Young People Eating Disorder Service and Wigan MHST did not have this as a standard agenda item, therefore we were not assured how staff in those teams received feedback from complaints.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of young people with mobility needs were met. The majority of the services were on the ground floor. For those on upper floors, treatment rooms could be accessed via a lift.

Staff did not always make reasonable adjustments for young people. For example, 1 young person preferred to communicate by writing, the worker did not support this. Another young person preferred information about the service and what to expect in a visual format and this was not available. This meant the service were not responding to the individual needs of all young people accessing the service.

There were waiting lists to access Bolton and Wigan CAMHS, which meant young people had to wait to access treatment and therapy. The longest a young person was waiting was over 143 weeks in Bolton for an ADHD assessment. However, Wigan had reduced their waiting list and time and had reviewed young people and discharged those young people where possible. The longest a young person was waiting at Wigan CAMHS was 63 weeks for exposure and response prevention.

Discharge planning meetings took place, and families were involved in these.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. The participation worker promoted this, and young people were involved in the participation group.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff were trained in equality, diversity, inclusion and human rights with all teams having over 85% compliance.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff supported young people to make decisions about their care and treatment and their future, which included crisis plans to refer to when they were struggling.

Families were involved in the young person’s discharge planning from the service.

Support for young people included focusing on developing strategies to deal with school transition and exams within the school-based teams.

Reasons for young people being referred to the service included impact of loss of a family member, and staff supported young people to work though emotionally difficult experiences. We saw the social anxiety model in use where this related to exams. We saw relapse prevention being explored with young people, including what they have implemented and what they will continue to implement. This was preparing young people for the future when they are discharged from the service.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. We observed a multidisciplinary review for a young person which included the staff from the service, family, school and the local authority, all working together with the aim of recovery for the young person.