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

Patients were not always at the centre of how their care was planned and delivered. Patient and carer involvement in their care plans was poor and some patients and their loved ones were not aware of whether they had a care plan. Most patients and their carers did not know how to complain and felt the information relating to ward processes was poor. However, they felt that they could make a complaint if they needed to and that staff would take their complaint seriously. Most staff understood how to support patients to make a complaint and managers investigated and responded to complaints in line with the trust’s policy. Patients could not always access the care and support they needed. Support for patient’s individual needs varied and some patients lacked support with communication needs, individual health needs and consideration of protected characteristics. Reasonable adjustments and support were not always in place for autistic people and people with a learning disability.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients had care plans but these varied in quality and did not always fully reflect their needs. Not all patients were aware they had a care plan and not all patients felt involved in the development of their care plan. Carers mostly told us they were invited to meetings, however not all carers had been involved in developing their loved one's care plan and several carers were unaware of whether their loved one had a care plan. Patients understood their prescribed medicines. Patients told us that staff were not always responsive to their needs and did not always intervene when there was conflict on the wards.

Staff gave us examples of how they supported patients in a person-centred way for example one staff member told us they supported a patient who had difficulty communicating by using a photobook and flashcards. Staff supported people to attend places of worship and with dietary requirements. Staff told us that there were sometimes leaflets and information available in the patient’s own language, although this was not consistent for all patients. Staff told us patients could express their likes and dislikes through care plans and in the ward round.

Staff did not always ensure patient's individual needs were met. We observed several occasions where staff were talking amongst themselves and not interacting with or supporting patients. We observed occasions where staff were not present in communal areas and occasions where they did not intervene when patients were acting in ways that caused distress for other patients. However, we also observed positive interactions between staff and patients and observed that some staff had a good rapport with patients. Staff did not always notice or intervene when patients needed support and did not intervene 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. There were issues with patients using illicit drugs on some wards. 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 including a lack of assessments for skin integrity, mobility and nutrition and hydration needs.

We reviewed 61 care records. These varied in quality, most covered a range of issues, but some lacked detail. Care plans did not always include the patients views and input and were not always interpreted into the patient’s first language. The monthly inpatient matron highlight report identified a high level of concerns with person centred care. It contained a section on ward challenges including inconsistencies in responses to deliberate self-harm incidents, issues with care planning and managing leave, and 1-1 named nurse sessions not always occurring. Nursing audits were carried out and these also showed a range of concerns including patients not being read their rights, issues with care plans, medication and managing risk. Audits had not been acted upon to improve the quality of care and safety of the service. Patients were not always involved in care planning and risk assessments and were not always at the centre of their care.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Patients did not always know how to complain and some felt that their complaints were not dealt with. Carers felt they could provide feedback and said they would speak to staff if they had any concerns, however they told us they had not been given official information about how to do this and most carers told us they had not been asked for feedback about the service. There was evidence of patient engagement meetings taking place, however this was not consistent.

Most staff knew how to support patients to make complaints. Staff told us there were posters and cards providing patients with information on how to complain. Some staff spoke about encouraging patients to complain if they had concerns. Staff fed back to patients about the results of their concerns and complaints.

Patients were not always able to provide feedback and share concerns. We observed staff speaking about patients in front of them. Staff talked among themselves when patients were trying to give feedback. Some patients could not communicate well with staff due to language barriers or physical health needs and this was not always supported effectively.

There was a complaints policy which was in date and provided relevant guidance to staff to manage complaints. We reviewed a range of complaints and complaint responses over the past 12 months. Complaints were responded to appropriately including apologies to those who had complained. Complaint themes included poor staff attitudes and issues with care received.

Patients could not always easily access the care and treatment they needed. Support for patients who spoke a different language was not always consistent and this meant that some patients were unable to participate fully in groups. Patients with autism did not always have their needs met, which impacted on their experience of care and support.

Not all staff had received an induction or appropriate training which affected care being provided in a timely way. Staff could not always support the needs of autistic patients, for example, some patients had sensory needs that could not be met. Staff had not had formal epilepsy training, which was concerning because some patients on the ward had epilepsy and care plans did not always clearly explain how to support people. Wards were mostly accessible, although the lift was broken on one of the wards.

We gathered feedback from partners and they did not have any concerns about this evidence category.

Some of the wards had low training compliance for vulnerable adults, and people with learning disability, and autism training. Staff received mandatory training in equality, diversity and human rights, and all wards had compliance rates of over 80% for this course. The trust had moved from mixed gender wards to single gender wards. Leaflets were produced informing patients about the move to single gender wards and how staff would maintain and support people with their sexual safety. However, these did not refer to transgender or non-binary patients and how the transition to single sex wards could affect these patients. Overall, there was limited information within governance documents that focused on equity in access.  

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.