Chief Inspector of Hospitals finds that Manchester Mental Health and Social Care Trust requires improvement

England's Chief Inspector of Hospitals has told Manchester Mental Health and Social Care Trust that it must make improvements to its services following an inspection by the Care Quality Commission.

Overall the trust has been rated as Requiring Improvement. The trust provided services that were rated as Good for caring, and requires improvement for providing services that were safe, effective, responsive and well led.

During the inspection in March a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited the trust’s mental health hospital wards and community mental health services.

Manchester Mental Health and Social Care Trust provides NHS mental health, substance misuse, perinatal and prison healthcare services across Manchester, as well as a number of community mental health services.

Full reports on all core services are available at: www.cqc.org.uk/provider/TAE.

Inspectors found community mental health services for older people were Good.

Every service was found to be caring, with staff at all levels committed to providing good patient care. Staff treated people with kindness, dignity and compassion and the feedback received from patients was generally positive.

There were enough staff on duty to keep people safe and patients’ needs were assessed and care planned appropriately. People receiving inpatient treatment had access to advocacy services and staff showed an awareness of patients’ emotional needs by seeking specialist support where necessary.

Systems were in place to maintain staff safety. The trust had good lone working policies and arrangements for its community services.

However, inspectors were concerned about the safety on the trust’s assessment unit for people receiving crisis care, as risk assessments did not include some fixtures and fittings that could be used as ligature points by patients who were at risk of suicide.

One of the trust’s rehabilitation wards at Park House did not ensure patient’s dignity because long-term patients were being cared for in dormitory style bedrooms.

Although there were systems in place to investigate serious incidents and safeguarding concerns, there were some delays in processing incident reports internally led to delays in investigating incidents and sharing learning among staff to prevent reoccurrence.

Due to several serious untoward incidents, the trust had adopted an overly restrictive approach to managing risks. These restrictions were not being reviewed to ensure they were appropriate to patients’ current needs.

Inspectors found that the quality of care plans varied. In some areas care plans were not detailed or specific to patients' needs and often did not demonstrate how people were involved in their care, particularly on acute inpatient wards.

Patients’ medication for treatment for mental disorder was not always properly authorised. Appropriate checks were not always taking place to ensure that patients’ detention under the Mental Health Act was legally supported by the appropriate documentation.

Inspectors also found that the trust wasn’t managing patients effectively through the mental health system as people did not always receive care and treatment from the most appropriate team.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals, said:

“We have found considerable variation in the quality of the services provided by Manchester Mental Health and Social Care Trust.”

“While staff were working hard across the trust to provide compassionate care and support to patients, the use of overly restrictive practices on the trust’s acute wards and the psychiatric intensive care unit was a concern.“

“At the time of the inspection, the trust was in a period of uncertainty following its withdrawal from the foundation trust process. This was continuing to cause difficulties for many front line staff and morale was particularly low.”

“The senior team must continue its efforts to better engage with staff across all grades improve channels of communication and strengthen the trust’s quality assurance processes.”

"People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. We will return in due course to check that the improvements needed have been made.”

The inspection team identified a number of areas where the trust must make improvements including:

• The trust must ensure that incidents are investigated in line with trust policy and there are robust systems in place to make sure learning or good practice is shared.
• The trust must ensure that environmental risk assessments for ligature points of SAFIRE unit are updated.
• The trust must ensure that patient’s privacy and dignity is promoted and that it that it provides care in line with the same sex accommodation guidance at all times.
• The trust must ensure that Mental Health Act documentation is completed correctly for patients especially on the older people’s wards to ensure people are being supported to understand their rights, their medication is authorized, their leave is approved and their detention is legally supported by the appropriate documentation being in place.
• The trust must ensure that there are effective recovery focussed care plans and discharge planning in place for adults receiving community-based mental health so that patients do not remain in services longer than is clinically appropriate. 

Overall, inspectors identified the following areas of good practice:

• The perinatal ward had a self-contained flat that could be used to support a graded discharge if appropriate.
• The perinatal ward maintained contact with patients seven days after discharge to ensure continuity of care into the community.
• All of the trust’s core services were rated as Good for caring.

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

Earlier this week the Care Quality Commission presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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