Greater Manchester Mental Health NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The Trust had introduced a new strategy, vision and priorities in 2025. These were:

“Our purpose: Working in partnership to improve the quality of life for all we serve

Our vision: Great places for care and great places to work

Our Strategic Priorities for the next three years are: Delivering Care that Matters, Working Together and Being Fit for the Future.”

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. This included wanting the best outcome for young people and their family members. Staff told us they felt part of a team, no matter what band they were.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. We saw information displayed on notice boards about the provider’s vision and values.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Minutes showed that at Wigan CAMHS, staff were discussing the clinical pathways the service offered and the progress in reducing waiting times. Away days took place to enable staff to contribute to discussions about the service, including what went well and areas for improvement whilst having the opportunity to spend time with colleagues in a team building setting.

Staff could explain how they were working to deliver high quality care within the budgets available. This included performance, reviewing progress with young people with the aim of discharge to enable them to take on more young people.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There were several leaders in interim positions or new to their role. Leaders were developing their skills, knowledge and experience to understand and perform their roles. Newer leaders told us how more experienced staff were supportive of them and assisted in their induction process, sharing knowledge of the team, processes and systems.

Some leaders had a good understanding of the services they managed. Others were new to their role and were developing their understanding of the services they were responsible for. Leaders could explain how the teams were working to provide high quality care. This included ongoing work at Bolton and Wigan CAMHS to reduce the number and length of time young people were waiting to access the service.

Senior leaders were mostly visible in the service and approachable for young people and staff. However, some senior leaders were responsible for several teams and had to split their time between the teams.

Leadership development opportunities were available, including opportunities for staff. Staff told us of compassionate leadership training that they were booked on to attend.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Young people and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Young people and families were invited to complete experience questionnaires. There were QR codes with links to the questionnaires on notice boards in waiting rooms and also within service leaflets.

Managers and staff had access to the feedback from young people, carers and staff and used it to make improvements. Feedback from young people and families was discussed at most team meetings. Feedback was collated and showed positive feedback about the service provided.

Young people and carers were involved in decision-making about changes to the service. Coffee mornings, parents support groups and psychoeducation sessions took place. There was a young people’s participation group where young people could become involved with job adverts, interviews, and the décor of the buildings.

There was a participation worker who had recently been employed at the service, they were supporting young people to be involved in interviewing new staff and developing training to deliver in schools.

Staff were provided with information about how to speak up during their induction. This included contact details for the Freedom to Speak Up Guardian. In the last 12 months, 11 staff had raised grievances within the service. The majority of the staff we spoke to, said they felt able to raise concerns with their managers. Staff told us about the Freedom to Speak Up Champions and that improvements were being made in the culture of the service.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The Trust had a BAME staff network, disability staff network and LGBT+ staff network to promote equality and diversity within the service.

Staff were able to apply to work flexibly, for example having flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the young people the service were supporting.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.There was a clear framework of what must be discussed at a team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. The agenda included team wellbeing, incident feedback, safeguarding and complex cases. However, incident feedback was not a standard agenda item at Bolton and Wigan MHST and the intensive support team.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. For example, at the Junction 17 day service learning from an incident included the assessment and care planning process prior to a young person attending the service, and we saw that this had been fully embedded.

Weekly patient safety meetings took place. These included leaders and members of the multidisciplinary team. Items discussed were rapid reviews of care, incidents and safeguarding, complaints, compliments and escalation of clinical matters. Actions were agreed at the meetings and reviewed at the following meeting.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Audits included hand washing audits, care record audits, supervision audits and did-not-attend audits.

Staff understood the arrangements for working with other teams, both within the provider and externally, to meet the needs of the young people. Examples of joint work included In Wigan CAMHS, staff worked on rotation in the partnership hub, with colleagues from children’s social care services to offer advice on cases that were being referred to the hub and if appropriate to offer a mental health assessment for possible CAMHS involvement. This venture provided a timely response to young people and their families and shared knowledge and expertise from colleagues from different organisations with the aim of supporting the young people.

Staff maintained and had access to the risk register at team or directorate level. Staff at team level could escalate concerns when required.

Staff concerns matched those on the risk register. For example, waiting and access times for Bolton CAMHS were on the risk register. An improvement plan was in place for Bolton CAMHS with a weekly review of this and clear actions identified.

Where cost improvements were taking place, they did not compromise young people’s care. Service story boards included the budget, where there had been an overspend in an area, and how this had been reduced in another area.

The service used systems to collect data from teams and directorates that were not over-burdensome for frontline staff. Monthly story boards were created for each service. These included performance, training, staffing, incidents, finance and innovation. Data for these reports were collated from other systems including training systems and incident reporting systems.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. Staff had laptop devices and mobile phones so that they could work from a variety of bases.

Information governance systems included confidentiality of care records. Care records were electronic and staff had individual log in details to access the care records. Staff offices were not in parts of the building where young people accessed.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and care delivery. Team managers showed us the systems they used, including staff record systems, care record systems, Power BI reports for waiting times and performance and this was collated into the monthly story boards.

Information was in an accessible format, and was timely, accurate and identified areas for improvement. Meeting minutes included actions and had action trackers embedded within the minutes. Monthly story boards included risks within the service and areas to focus on.

We scored the service as 2. The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Stakeholders told us that there was positive partnership working in place. However, areas that stakeholders said the service could improve was the decision that children needed to be in a stable environment before being able to access therapy, which delayed access for children to receive the required interventions.

We were told there could be delays or a lack of response to consultation requests and some children were discharged from the service quickly without clear communication.

We were also told that communication from the service to external stakeholders, and willingness to meet to discuss service improvements and joint working, were areas stakeholders would like to see improvements in. For shared referral processes, transparency around risk and safeguarding concerns for people being referred was an area for further development from a stakeholder perspective.

Stakeholders told us that improved communication and updates on actions that CAMHS services were leading on would be helpful. Also, clarity on the offer from CAMHS and waiting times for the services.

Young people and staff could meet with members of the provider’s senior leadership team to give feedback. Senior leaders visited the services and welcomed feedback from staff and young people accessing the service.

Other opportunities for feedback included via the participation group for young people and coffee mornings and psychoeducation events for parents and families.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff were not given the time and support for improvements and innovation in the service.

Staff did not have opportunities to participate in research.

Staff did not participate in national audits relevant to the service.

However, staff were involved in quality improvement methods. Quality improvement projects included review of care documentation for Bolton single point of access and review of the Lester tool for adolescents and how this could be incorporated into the care records.

Some innovations were taking place in the service. At the intensive support team, they based the service on the Ealing model which includes evidence-based principles and incorporates neuro-affirmative, intersectional, and creative communication practice to ensure the child’s voice guides decision making.