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

We assessed 1 quality statement from this key question, independence, choice, and control. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question is requires improvement. We identified one breach in person centred care, of the legal regulations. We found on some wards there was minimal therapeutic activities taking place. Care plans were not always clear as to how the patient was involved with their care planning and kept informed and up to date. Care plans did not always reflect identified needs for patients and how staff should support them with these. However, friends and family tests showed positives responses for patients being involved in their care and treatment as well as being treated with respect and dignity. Patients had access to friends and family. Patients and carers could be involved in service and carer forums as well as involving people in co production of service design.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Kindness, compassion and dignity during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

Patients and their carers shared mixed views about independence, choice, and control. Patients we spoke with generally felt informed about their care and treatment. Patients described that they had received information about their medication and that they were involved in reviews about their care and treatment. Patients reported that, where appropriate, their family, carers or loved ones were involved in meetings about their care. The wards held community meetings for patients and patients reported that they could raise issues during these meetings. Patients could access advocacy services. Patients we spoke with were generally positive about the staff and felt they were treated kindly and caringly by staff. We observed mostly positive interactions between staff and patients. Carers and family members reported activities took place both on and off wards. They understood the challenge to motivate people to take part and generally staff were described as encouraging and facilitating interests and activities. A few family members stated there was not enough variety or activity options. Family members and carers felt welcome on wards and knew there were visitor rooms that could be used. However, for most visits, leave was arranged for family members to go out with their relatives. Visits included to local cafes, parks, or shops. Some carers expressed the need for a private space off the ward to speak with staff about aspects of their relative’s care and treatment. Two patients mentioned in interviews that staff did not always knock on their bedroom doors when entering. We observed some instances of staff not always knocking on bedroom doors when entering patient rooms, including during our tours of some of the wards.

Staff and managers described how patients would be supported in being involved in decisions about their care and treatment. Staff stated that patients would be involved in their ward rounds and on some wards were given preparation sheets to assist them in preparing for the ward round. Staff stated that patients could access advocacy services whilst on the ward and described how patients could access these services. Staff and managers noted that patients would be asked about what activities they would like to be delivered on the wards. Staff also stated that community meetings took place on a regular basis and that all patients had the opportunity to attend, although did note that the meetings were not always well attended by patients. Staff and managers described how information was shared with patients on admission and how this would continue to be shared throughout their stays on the ward. Managers could give examples of how patients with communication issues had been supported to understand information in ways that would best suit them. Staff and managers described how family and carers would be involved and kept informed about their loved one's care and treatment in line with the wishes of the patient. Managers did note that there could be challenges in supporting patients to access community or voluntary opportunities outside of the ward environment and noted that there were not many patients participating in these at the time of the inspection. Managers stated that the patient voice should be captured within care records, even if the patient declined to be involved. Some managers explained that this was an area where they could improve on this as a ward team.

The levels of therapeutic activities and interactions taking place on the wards differed across the wards and we did not see evidence of ward teams taking approaches to think creatively about trying to engage with those patients who were reluctant or unwilling to engage. There were some wards where little activity and therapeutic engagement was taking place. There was also a lack of systems and recording methods in place to assist staff teams in having an oversight as to patient engagement, or lack of, in activities. There was a lack of opportunity for patients to involve themselves in community activities outside the ward and very few patients were engaged in any activities or opportunities off the ward.

Care plans were not always clear as to how the patient was involved with their care planning and kept informed and up to date with this. Record keeping did not assist this process; for example, in some records it was only recorded in progress notes as to whether a care plan was offered to a patient, but this was not reflected in the care plan tab itself. Care plans did not consistently demonstrate the required quality and did not always reflect identified needs for patients and how staff should support them with these. We observed 10 patient records for patients that had substance use or smoking issues and the care plans lacked evidence of meaningful interventions and person-centred support that could be offered to the patient. There were activities timetables provided for each ward. However, this was not what we observed whilst on the ward. These indicated a wide range of activities on and off the wards. There were patient meetings on the wards. These allowed patients to be involved. Welcome booklets highlighted to respect each other’s choices, decisions, and lifestyles. The trust collated data weekly (best care every day) this highlighted 1-1-time patients received and if patients had declined or received a copy of their care plans. There was limited data recorded to indicate that patients had leave off the wards for the week of data submitted. Friends and family tests showed positives responses in patients being involved in their care and treatment as well as being treated with respect and dignity. There was a service user's voice forum, patient and carers had fed back to the trust board about their experiences within the rehab services. Patients had also been involved in producing the clinical pathways across the service as well as being involved in co production work. There were carers and patient forums that patients could attend.

We did not look at Responding to people’s immediate needs during this assessment. The score for this quality statement is based on the previous rating for Caring.

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.