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

Staff assessed the mental health needs of patients on admission but did not always assess patient’s physical health needs which meant staff had not identified key physical health needs for some patients. Wards did not always have access to a full range of treatment for patients. Not all locations had a psychologist and patients did not always have access to therapy groups. Patients mostly had up to date care plans in place, however these varied in quality, were not always personalised and patients were not always involved in the development of their care plans. Patient’s care did not always meet their needs or reflect their protected characteristics. For example, support for patients with communication needs was sporadic and staff did not always consider the needs of transgender patients. Staff had not always supported patients to lead healthier lives. Conditions such as diabetes and epilepsy were not always well managed and physical health monitoring was inconsistent. Staff offered activities and advice to support patients with healthy eating and to take more exercise, and to reduce tobacco use, however the management of smoking on the wards was largely ineffective.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients were not always involved in developing their care plans and risk assessments. Not all care plans were up to date and did not always include all of the patient’s needs. For example, we found records where patient’s cultural and identify needs had not been considered. We also found care plans that did not consider patient’s communication needs including those whose first language was not English and those whose communication had been affected due to medical conditions. Care plans were not always personalised and patients were not always aware they had a care plan.

Staff told us that risk assessments and care plans were in place for patients, however they said they did not always have time to read them and relied on information shared in handovers to understand patient’s needs. Staff told us how they supported patient’s needs, for example they told us about having patient’s rights translated into another language, and another ward had created an accessible care plan for a person with a learning disability. However, staff said they sometimes struggled to meet the needs of autistic patients.

Assessments were completed inconsistently between wards. Some patients had comprehensive assessments which included health passports for autistic people and occupational therapy assessments. There were some detailed and holistic care plans and risk assessments, which provided clear direction to staff in supporting patients with a range of needs. However, some assessments were incomplete and staff had not always considered patient’s physical health, their wellbeing, and preferred methods of communication with them. Staff had not always updated risk assessments weekly and care plans for individual concerns were not always in place. Staff had not always completed a Physical Health Intervention and Treatment assessment and physical health problems were not always monitored, for example, some care plans for diabetes and epilepsy did not provide clear guidance to enable staff to support patients appropriately. Staff had not always completed catheter care plans and monitoring for skin integrity was not always in place for patients who required this. Matrons monitored care plans and risk assessments and the issues reflected in these audits mirrored the concerns we found whilst on inspection. Audit findings had not always resulted in improvements to practice.

Staff did not always plan and deliver patient’s care and treatment with them. Some patients told us they were not clear on what treatment was available to them. Not all patients who wanted to, had seen a psychologist, although patients who had seen a psychologist said they found it helpful. Some patients felt there was not a broad enough range of treatment options available to them. Patients told us there were activities available such as art and music groups and they shared mostly positive feedback about the groups they had been involved in. Patients told us they were not always involved in the development of their care plans. Some patients told us their care plans were difficult to understand and felt they did not always reflect their needs. Most patients told us staff had supported them to understand their prescribed medicines.

Wards did not always have a full range of staff. Staff told us patients did not always have access to psychological input, for example there was no psychologist at Park House. There were 3 clinical psychologists across the hospital and sessions were delivered at the therapy hub. There were activity workers on most wards but patients sometimes lacked access to therapy groups. There were occupational therapists working across wards but staff told us patients did not always have access to occupational therapists when needed. Staff told us they made referrals to other services where needed, including podiatry, dieticians and chiropodists. Staff told us patients received information about their treatment at multi-disciplinary team meetings and said they supported patients to understand their medicines if they were unsure about what they were taking or any side effects. Some staff spoke about following national institute for health and care excellence guidance for different diagnoses.

Staff met weekly for multi- disciplinary meetings to discuss patients care and treatment. Patients and their relatives were invited to these meetings. Multi-disciplinary teams included consultants, junior doctors and nurses but did not always include psychology, social work input or occupational therapist as wards did not always have a full complement of staff. Matrons were carrying out audits on a range of quality and treatment issues. These audits showed that patients were not always receiving one to ones from their named nurse although levels of compliance varied between wards. Formulation assessments, which support staff and patients to develop a clearer picture of patients experiences and challenges had not always been completed. Rapid tranquilisation had not been audited for the past 6 months, which was concerning because the trust had previously identified this as an issue, and we found that staff were not always carrying out post tranquilisation checks. Patient’s nutrition and hydration needs were not always being met. Staff were not always completing patient’s food and fluid charts and documentation of attempts to encourage people to eat and drink were not always completed.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Not all patients using the service felt their physical health needs were met. Patients told us vaping was occurring on the wards and patients were smoking in the ward gardens and sometimes on the wards. Staff had not always completed care plans relating to physical health concerns and care plans did not always provide clear guidance to staff about how to manage health conditions such as diabetes and epilepsy. Patients told us there was not always enough staff to take them to the gym. However, patients told us staff encouraged healthy eating on the wards and we observed a mindfulness and relaxation group occurring on Oak ward which patients enjoyed.

Some of the wards held healthy lifestyle groups including a walking group, a healthy breakfast club, and a smoothie making group. Staff told us they encouraged patients to make healthy food choices, have less takeaways and take more exercise. Staff told us that activity staff took patients to the gym. Staff were trying to introduce vapes and nicotine patches to reduce smoking and there was a smoking lead who could advise them how to support patients to reduce their tobacco use. However, most staff told us this was a challenge and this reflected our observations on the wards. Staff told us the physical health team attended the wards and we saw that staff made referrals to specialist services such as diabetes nurses and chiropodists.

Plans were in place on each ward to address smoking, however these were ineffective as we observed patients smoking on most wards. Physical health monitoring was inconsistent. For example, patients had not always had their National Early Warning scores (NEWS2) completed as frequently as required and staff had not always recorded patient’s blood test results. Audits also showed significant gaps in the health monitoring on some wards, including medication changes not being updated, and health conditions not being recorded. We found that care plans for physical health issues were inconsistent, some lacked detail and did not provide appropriate guidance to support staff caring for patients.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.