Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Staff did not always treat patients with kindness and compassion. Patients and their loved ones told us some staff were respectful, caring, and patient. We observed positive interactions between staff and patients including staff sitting and chatting with patients and engaging in activities. Some staff had a good rapport with patients. However other patients told us staff ignored them and were uncaring. We observed staff ignoring patients when they needed something or were distressed and staff not always intervene when patients behaved aggressively or in a way that made others feel uncomfortable. Patients sometimes felt unsafe due to staff not responding to their needs. Staff did not always consider patients privacy and dignity. We observed staff talking about patients in front of them and patients told us staff did not always let them know before entering their bedspace. Staff gave patients welcome packs to help them settle into the wards, however these varied in quality between wards. Patients had access to advocacy including culturally appropriate advocacy. A significant number of patients had not had their Mental Health Act rights read within the required timescales. During our assessment of this key question, we found following concerns which led to breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014: the management of person-centered care which resulted in a breach of regulation 9; You can find more details of our concerns in the evidence category findings below.

This service scored 40 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us that staff did not always respond when others behaved aggressively on the ward. This made them feel unsafe. Patients said that some staff were respectful and caring, however patients also told us that some staff were not caring, did not always listen and said that staff sometimes ignored them when they asked for support. Patients said that staff did not always maintain their dignity, as they did not always knock before entering a person’s bedspace. This was particularly concerning because some patients were in dormitories which increased challenges to maintain their privacy and dignity.

Staff told us bank staff did not always carry out detailed observations or engage with patients. Some staff felt there was not enough staff and that this impacted on patient care, for example they told us there was a lack of female staff to carry out observations. Staff told us they engaged in activities with patients and made adjustments for those who had cultural and religious needs. Managers on some wards told us they carried out reflective practice with staff. Managers monitored culture on the wards and said they had made changes to staff teams where there had been concerns about culture on the ward.

Partners of the service told us there were sometimes challenges with communication, particularly in relation to safeguarding activity. They also shared concerns about evidencing a trauma informed approach and concerns around risk management. Partners of the service also told us that communication with families was not always effective and that, staff were not always following care plans, or carrying out observations effectively.

We completed 17 Short Observational Framework for Inspection Observations and observed that staff did not always intervene when patients were acting in ways that caused distress to others. Staff were not always present in communal areas and we saw several instances of staff ignoring patients and talking amongst themselves. However, we also observed some warm and positive interactions with patients including staff sitting and chatting with patients and engaging in activities and saw staff who had a good rapport with patients. Several of the wards had dormitory accommodation for patients. Patients found these noisy and lacking in privacy and dignity. However, the service was in the process of building new accommodation to provide patients with individual rooms and an improved environment.

Staff had not always considered patient’s individual cultural needs, for example patients did not always have information accessible in their own language and could not always access groups appropriately because they did not have an interpreter. Staff had not always considered patient’s personal cultural and social needs, for example there was not always a care plan to support the needs of transgender patients. We found that staff had not always considered individual interventions for autistic people and people with learning disabilities and several patients told us they struggled with the levels of noise on the wards.

Staff told us how they supported patients with protected characteristics. Meals were available to meet dietary and cultural requirements such as vegetarian and halal food. Staff made adjustments for patients who were fasting for Ramadan, and there was a multi faith room available. Staff gave examples of how they sourced information in patient’s own language; however, they told us this was sometimes difficult and we observed this did not happen consistently. Staff told us they tried to accommodate autistic people in single rooms where possible but said this was not always possible. Staff told us it was sometimes difficult to meet the needs of autistic patients, for example a patient struggled with bright lights and staff were unable to dim the lights for them. However, staff also gave examples of how they used personalised approaches used to help patients de-escalate. Staff on one ward had sourced a calming box with sensory items.

During our inspection, we observed staff talking amongst themselves and not interacting with or supporting patients. However, we also observed positive interactions. We observed staff not intervening when patients were becoming aggressive or causing others on the ward to feel uncomfortable. The lift was broken on one of the wards which meant that a patient with mobility issues was placed on an inappropriate ward due to their mobility needs. Patients were not always able to freely access all areas of the ward, for example patients on 1 ward were unable to access the patient kitchen. We noted the seclusion room on one ward had mood lighting and interactive games to support patients whilst they were secluded.

Care records showed a lack of involvement in care plans and risk assessments. Staff had not always explored patient's cultural needs in their care plans such as language barriers. There was evidence of patient meetings occurring on some of the wards, however meetings did not always take place regularly. Staff received equality diversity and human rights training and some staff had received training to become equality, diversity and human rights champions, which included anti-racism and neurodiversity training. Equality, diversity and human rights was considered within some governance meetings and patients had access to advocacy including culturally appropriate advocacy.

Patients were able to have regular contact with their loved one but carers told us that it was sometimes difficult to contact the wards. Carers were invited to attend multi-disciplinary team meetings and most patients told us they had access to advocacy. They told us there were not always enough staff to do preferred activities such as going to the gym or cooking. Some patients did not have access to interpreters and struggled with communication.

Staff told us that there was sometimes a lack of activities for patients. Evening activities were not always available and activities did not always meet the needs of the different patient groups. Advocates visited the wards weekly. Staff told us they kept patient’s loved ones informed about their care before and after ward rounds. Staff told us they read and summarised patient’s rights for them, however audits showed this was not consistent across all wards.

Blanket restrictions were in place on some wards, for example patients were unable to access the ward kitchen on one ward and patients could only access one of the ward gardens under supervision. We also observed the lift was broken on one ward which affected those with limited mobility. We observed staff talking amongst themselves and not interacting with or supporting patients, although we also observed positive interactions including staff involving patients in ward activities and a staff member leading a discussion on equality and diversity.

Patients had not always had their rights read. Patient’s Mental Health Act rights audits showed 60% of patients had not had their rights read in the first 2 weeks of admission. Welcome packs varied significantly from ward to ward, for example the leaflet on Elm ward consisted of 4 pages and the patient pack on Oak ward was 38 pages. Some packs were more accessible than others and some were very text heavy and not user friendly. Records showed a lack of patient involvement in care plans and risk assessments. Some wards had useful information for patients, for example mapping packs were used on Blake wards to provide support to patients to tell staff about themselves, however this was not consistent across all wards. Evidence for patients’ meetings suggest they did not always occur regularly.

Patients told us that staff were not always responsive to their needs, particularly bank and agency staff at night who did not always know them well. Some patients said they were ignored by staff and told us staff did not always have the time to meet their needs. Some patients told us that staff did not always respond to their sensory needs.

Staff gave us examples of how they supported patients including examples of adjustments made to support patients with spiritual needs, dietary requirements and communication needs. However, during our inspection we found this support was inconsistent. Staff said it was sometimes difficult to facilitate section 17 leave.

During the inspection we observed staff talking amongst themselves and not interacting with or supporting patients. Staff did not always intervene when patients were acting in ways that caused distress for other patients. However, we also observed positive interactions. Staff did not always notice or intervene when patients needed support or when patients acted in a way that could have caused harm to other patients. We observed that staff did not always respond when patients were smoking in the garden or vaping on the ward. The environment on several wards was poorly maintained and not always clean which effected patient’s comfort on the ward. We also observed an incident where staff did not respond to a patient who was physically unwell and had not met the person’s physical health needs and dietary requirements.

Managers were available both in the day and at night to support staff and there was an on-call system in place. Staff had regular handovers to share patient information. These varied in quality, some handovers were thorough and detailed and some did not reflect relevant information about all patients or the risks on the wards. Patient observations were meant to occur at random intervals but we found they were occurring at predictable times which increased the risk for patients who were at risk of self-harm. The patient survey suggested that patient’s needs were not always met. Patient meeting minutes showed that issues raised were not always acted upon and a number of issues were raised repeatedly without action.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.