Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 1 quality statement from this key question. 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. There were ineffective governance systems and processes in place to ensure that long stay or rehabilitation services had appropriate oversight and monitoring of the care and treatment being provided to patients. The systems and processes in place did not assist staff in assessing, monitoring, and improving the quality and safety of the services provided. We found ineffective systems to address ligature risks, patient risks and fire safety checks were not always actioned or recorded. The delivery of high-quality care was not assured by the leadership and governance. There were failures in performance management and audit systems and processes. Risks identified within action plans were not always reviewed or actioned.

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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Managers acknowledged that the wards had been through some quite significant periods of change in terms of new processes and systems. They recognised the impact that these changes coming at once could have on staff and most managers were trying to be supportive of these changes whilst also making sure staff were not overwhelmed. There was, however, a feeling that a lot of the changes were being enacted on the back of feedback from the other inpatient services and were not completely suited towards the goals and ethos of rehabilitation - although all recognised the importance of implementing the changes and giving feedback to senior managers. Managers had access to the division teams' channel, where managers could review data submitted. Managers told us they or their deputies could attend weekly senior managers meetings. Monthly managers network meetings were in place. Staff told us they visited other wards to look at what they could improve on and gave feedback to each other.

The service did not have effective and embedded governance processes in place with clear responsibilities, roles, systems of accountability and good governance. This had an impact on the delivery of safe, high-quality care. There were a number of audit processes in place, but these had not been effective in making improvements to risk assessments and care plans, and in managing environmental risks relating to infection prevention and control, environmental and fire safety as well as ligature risk assessments. There were service level meetings taking place. Capital, estates, facilities, nursing, and governance had collaboratively established a group known as the quality circle group. This group is to provide a forum to share information and escalate gaps in service delivery, by ensuring effective communication and joint responsibility. However, we still found gaps in managing the environments and fire safety and ligature risks. The trust had a governance structure in place. This fed information from patient and carer feedback, complements concerns and complaints feedback from others as well as service user and governor feedback up to senior leadership teams. As well as feeding up to the board of directors attended by the chairs of patient/service user councils. The wards had various meetings that varied in frequency across the wards. They had staff meetings, morning meetings, safeguarding meetings, and daily huddles as well as clinical team meetings and service level meetings. There was a trust wide risk register in place.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.