24 November 2022
Our rating of the trust stayed the same. We rated it as good because:
- We rated effective, caring and well-led as good, and safe as requires improvement. We rated seven of the trust’s ten core services as good, two as requires improvement and one as outstanding. In rating the trust, we considered the current ratings of the six services not inspected this time.
- Patients received a range of care and treatment based on national guidance and best practice from staff who had the range of skills needed to provide high quality care. Teams included or had access to the full range of specialists to meet the needs of patients.
- Staff understood their responsibilities under the Mental Health Act 1983 and Mental Health Act Code of Practice.
- Staff treated patients with compassion and kindness. Staff respected the privacy and dignity of patients and in most services involved patients in their care planning.
- Services did not have referral criteria which excluded patients who may benefit from care and met the needs of patients, including those with a protected characteristic.
- The trust investigated incidents and treated complaints seriously. The trust learned from the outcome of investigations and complaints, sharing learning across the organisation to improve services.
- The trust had an experienced and senior leadership team who provided leadership to create a culture which supported high quality care. The trust engaged with patients, staff and communities to develop services which met the needs of local people and sought feedback to allow services to be improved.
- Senior leaders understood the current and future risks to the trust and acted to mitigate these. Strategies were in place which supported the vision of the trust and its role within the wider health and social care system within the Greater Manchester area.
- The trust did not have effective processes in place to monitor the provision and compliance with supervision across its services.
- Dormitory accommodation was being provided for patients admitted to acute wards for people of working age.
- Not all patients within community services for working age adults had current risk assessments in place.
- Patients waited too long for to access treatment in specialist community mental health teams for children and young people and community mental health services for working age adults.
- Processes were not in place to ensure emergency equipment was safe to use in specialist community mental health teams for children and young people.
21 April 2022
We last inspected child and adolescent mental health wards at the trust in 2018. At this inspection we rated the service as good overall, with requires improvement in safe.
We visited Junction 17 and Gardener Unit.
The inspection was unannounced (the service did not know we were coming).
During the inspection the inspection team:
- Toured the wards
- Interviewed the ward managers and the senior leaders within the service
- Spoke with Children and Young People who were using the service
- Spoke with carers of Children and Young People using the service
- Spoke with other staff members including, nurses, doctors, junior doctors, psychologists, family therapist, art therapist, music therapist, domestic staff, support workers, occupational therapy staff, the headteacher of the school and the wellbeing lead
- Attended and observed a multidisciplinary meeting
- Looked at the care and treatment records of Children and Young People on the wards
- Carried out a check of medication management
- Reviewed prescription charts
- Looked at a range of policies, procedures and other documents relating to the running of the service.
- Attended and observed ward based activities.
Our rating of this service stayed the same. We rated it as good because:
- Patient feedback about the staff was universally positive. Children and Young People told us that the staff had changed their lives and that the level of support they received had gone above and beyond what was expected of them. Children and Young People felt that staff genuinely cared about their wellbeing, and took the extra time needed to get to know them individually. Children and Young People and their families/carers were involved in all decisions about their care and treatment, and the multi-disciplinary team spent time explaining different options available to Children and Young People.
- The service provided safe care. The environment was clean, safe, well maintained and fit for purpose. The environment was in keeping with the needs of young people and was decorated and furnished to suit their needs. Risks were well managed, and staff had a good understanding of the risks the patient group posed. Risk assessments were thorough and individualised. The wards had enough staff to safely manage the patient group and staff were well trained. Medicines were managed safely, and staff had a good understanding of safeguarding procedures.
- Comprehensive assessments were made for each patient, most started prior to the patient’s arrival. There was a range of treatments available for Children and Young People which were in line with best practice guidance. There was a vast multi-disciplinary team available to young people in the service. This included a full therapy team with access to a family therapist immediately. Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
- Staff planned discharge well and involved outside agencies that were relevant to the Children and Young People care. This meant that discharge was only ever delayed if there was a clinical need, or due to the time some more specialised placements took to secure. The involvement of Children and Young People in the local community was important. Children and Young People were involved in local groups, attended local attractions with staff and even attended local colleges on public transport. Children and Young People were actively encouraged to be part of the local community and staff supported them to do this.
- The service was well led. All staff and even Children and Young People told us that the senior team were visible and frequently spent time on the wards, not only for meetings but to meet Children and Young People and get to know them and support the staff team. The senior team were experienced in CAMHS and had worked in them for some time. The systems in place to support staff enabled them to do their work much more easily. The team had a clear vision about the future for the service and were working hard to ensure this materialised. The passion for the service shown by the senior leaders within the service was clear for all to see and staff remarked on how this leadership and support had impacted positively on the morale of the team. All staff we spoke to were extremely proud to work within CAMHS services and wanted to ensure that they did their best for the Children and Young People who were in their care. Both wards were accredited with the quality network for inpatient child and adolescent mental health services and were involved in research to improve the service.
9 January 2020
We have not previously inspected this service under the current provider. We rated it as requires improvement because:
- Children who did not require urgent care waited too long to start treatment.
- Emergency equipment kept on the premises had not been serviced, meaning that it was not safe to use. None of the partner trust’s staff had completed level 3 training in safeguarding children. Between April 2018 and February 2019, staff only reported two safeguarding referrals as incidents.
- Governance structures were not always effective. Routine checks had not identified that emergency equipment was overdue for a service. Managers could not be assured that staff were discharging their responsibilities in relation to safeguarding.
- Clinical premises where patients were seen were safe and clean. Patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
- Staff developed care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The teams included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
- Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
- The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
- Managers promoted a positive culture. They worked with partners to meet local needs.
3 June 2016
We rated community based mental health services for older adults as good because:
Teams had sufficient staff to meet patients’ needs. Staff vacancies were being recruited into quickly. Staff reported that complexity of caseloads were reviewed in supervision to ensure equity. Team caseloads were at a manageable level. There were good lone working practices in the team and trust policy was followed. Staff knew about duty of candour. Patients had a crisis contingency plan in place in their care plan and staff knew how to respond to deterioration in a patients’ physical or mental health. Staff had a good understanding of safeguarding processes and knew their responsibilities to protect patients from possible risk of abuse and harm. Staff showed a good understanding of incident reporting and there was good reporting of incidents.
Staff attended a multidisciplinary group to review and problem solve complex cases, provide plans and anticipate care needs for those using health and social care services. There was a psychology team who provided input to patients, carers and staff. Care plans were holistic and person-centred. There was a staff development group who had protected time to meet on a monthly basis to undertake internal training. There were developments around the emphasis on physical health with some staff receiving specific training to support this. There was evidence of good inter-agency and multidisciplinary working.
Staff treated patients who used the service with kindness, dignity and respect. Staff demonstrated warmth and compassion in their interactions with patients and their carers. Staff involved patients and their carers in decisions about their care.
There were five clinical pathways which gave clear and consistent support to patients. Patients reported that staff were flexible in their approach and quick to return phone calls. The service opened at weekends with reduced staffing in order to ensure flexibility and continuity of care. There was a duty system in place that ensured any urgent issues were dealt with in a timely manner. There were low numbers of complaints.
Staff were aware of trust values. Staff told us that managers listened and they felt valued and supported. Supervision and appraisal were comprehensive and up to date. Clinical audits were regularly undertaken. Staff morale had improved since managers had become established in their role.
- Mandatory training in basic life support was significantly below the trust target of 85% and below 75% for infection control.
- Compliance with mandatory training across all teams was lower than the trusts’ target of 85%.
- Training levels in the Mental Capacity Act and Mental Health Act were both significantly low.
- The rights of patients subject to community treatment orders were not always being met. Patients were not referred to an independent mental health advocate after being placed on a community treatment order and their capacity to consent was not always recorded.
- Carers were not always offered a carers assessment to ensure their needs were being met.
- Patients were not always offered a copy of their care plan or given the opportunity to develop advanced statements about their care with staff.
23 February 2018
Our rating of this service stayed the same. We rated it as good because:
- The locations inspected were clean and equipped appropriately.
- Staffing levels showed that very few vacancies existed within the service, and that shifts were adequately covered.
- Care plans and risk assessments were completed in a holistic and comprehensive manner, taking into account the opinions of patients in the service.
- Staff mandatory training compliance averaged above 80% for the service.
- Activities for patients were meaningful, designed with an aim to not only keep patients engaged but to give skills for use in the community, including access to a recovery academy for both patients and staff.
- Patients were positive in their comments regarding care in the service, and we saw evidence of positive interaction between staff and patients at each location inspected.
- The Mental Health Act and Mental Capacity Act were observed and noted to be applied correctly.
- There were very few complaints across the service, and we saw evidence of shared learning from complaints that had been investigated.
- Key performance indicators were used to guide and improve practice across the service.
- The service was due for Accreditation for Inpatient Mental Health Services under the Royal College of Psychiatrists.
- Acacia ward was in need of refurbishment and consideration for a total environment change: the trust had plans in place for implementation of such a change.
- We saw a table used to inform staff of mandatory training figures was not importing the correct data in relation to immediate life support training, giving an incorrect data set in regards to said training; this was dealt with immediately on identification of the problem.
- The sickness rate for staff was at 9%, but was only at 5% for the year to date.
23 February 2018
Our rating of this service improved. We rated it as good because:
- The service had made improvements following our last inspection. Staff were now completing observations following rapid tranquilisation. The safety of the environment had been improved with better lines of sight and the use of parabolic mirrors and staff observations. The gender segregation on the two wards at Trafford was much improved. Documentation around patients capacity was clear and we saw good evidence of capacity being assessed when necessary and best interest decisions being made appropriately.
- There was adequate staffing levels to ensure patients were well looked after and able to spend one to one time with staff on a regular basis.
- There were good patient risk assessments on each ward. The service provided a safe environment and risks were managed well. Patients told us they felt safe on the wards.
- Staff deescalated aggressive and potentially violent situations well. Staff knew patients well and were able to use distraction and diversion techniques when they saw a patient becoming agitated. For example, the use of activity equipment that focused on patients interests and hobbies.
- There was effective multidisciplinary team working evident on all wards.
- Patients and carers gave universally positive feedback about the care and treatment they received on the wards we visited. Staff involved patients in decisions about their care where possible. They engaged with and supported families and carers where appropriate. Staff contacted them with updates on patient progress, held regular carers meetings, and invited them to ward rounds.
- Recent changes within the service had led to a positive change in staff morale. Staff focused on the needs of the people using their service, providing high quality patient centred care, which reflected the trust’s vision and values. Senior managers were committed to improving the environment at the Manchester wards and had identified that the dormitories on those wards needed to be changed as a priority.
- Two wards at Woodands hospital were AIMS accredited. The two wards at Trafford were going through the AIMS accreditation process with draft reports available at the time of our inspection.
- Staff were not always using the trust approved form for physical health monitoring following rapid tranquilisation.
- We found there were delays in requesting second opinion doctors when patients had been detained for three months and administered medication in order to complete a form T2 or T3 (dependent on whether the patient was able to consent to treatment). There were also delays in section 62 being completed (emergency treatment of a detained patient) with medication being administered without the correct legal framework across all of the Wards except Maple Ward. We also found examples of when a section 62 had been completed and medications were not on the list but being administered.
- On Cavendish Ward we found examples where patients had not been read their rights at the correct times or when there was a change in their detention status.
- There was a lack of privacy Bollin Ward where privacy screens on bedroom windows had been left open and there were no privacy curtains in the bathrooms on the main corridor.
- At Trafford the wards were very small with no quiet space for patients to use if they wanted to. Activities had to be done in the main lounge which meant that patients who wanted to sit quietly would either have to go to their rooms or listen to the activities.
23 February 2018
We have not previously inspected substance misuse services. We rated it as outstanding because:
- There was a very strong recovery emphasis throughout the service. Staff worked with clients to help identify their goals and to develop their recovery capital. Staff were knowledgeable about local recovery and support services and they were promoted within teams.
- Services were tailored to meet the needs of individuals and were delivered in a way that offered flexibility and choice. There were different pathways within community teams to address individual need and an innovative rapid access to alcohol detoxification pathway within inpatient services.
- Client and carer feedback on the service was overwhelmingly positive. Clients spoke highly of staff and their supportive nature. Clients and carers were active participants in care and in decisions about treatment. Carers were able to access carer assessments and relevant support.
- There was excellent multi-agency working. Services worked collaboratively with partner agencies within the local treatment network as well as with physical health services. There were clear referral processes into support services and mutual aid groups. Staff were active in facilitating client engagement.
- The service employed volunteers and peer navigators with lived experience of substance misuse and recovery. Clients we spoke with talked positively about staff members and the visual representation of recovery that they provided.
- There was excellent engagement with the community. Clients were encouraged and supported to attend community groups and services. There were community leads within teams to develop effective links and ensure that recovery was embedded within the team. There was a building recovery in the community asset fund that clients and staff could access to support new projects such as community allotments or trainee kitchens.
- Clients and carers were able to give feedback on the service they received in a variety of manners. The service responded to feedback and developed action plans to address concerns.
- Buildings were clean and well maintained. There were regular checks of equipment and maintenance records were in place. There were appropriate health and safety checks.
- Staff actively managed client risk. Staff worked collaboratively with clients to complete risk assessments and develop risk management plans. The service prescribed in line with risk assessments and utilised methods such as supervised consumption to manage the risk of overdose or diversion. There were strong processes and procedures to manage safeguarding concerns and effective links with local authorities.
- Staff had been trained to deliver psychosocial interventions. Services offered a range of one to one and group sessions to meet client need. Clients we spoke with were positive about the psychosocial interventions they received
- There was a good governance structure. Quality of service provision and performance was monitored. Service and team managers were well regarded by staff. The service engaged effectively with stakeholders when introducing change.
- Staff in community services did not use personal alarms in a consistent manner.
- Staff in community services did not always record consideration of mental capacity.
- We found three care records where there was no consent to treatment or confidentiality agreement in place.
- Although information sent by the trust showed six mandatory training courses below 75% compliance, local figures and staff confirmed training rates were higher. We observed skilled staff, competent in their role.
9 January 2020
Our rating of this service went down. We rated it as requires improvement because:
- In four out of six care records reviewed at the Central Manchester community mental health team, patients allocated a care coordinator in April 2019 had not been risk assessed, a situation confirmed with team management at the time of the inspection
- Data provided about referral to initial assessment and referral to treatment times indicated very long waiting times within the service
- Mandatory training data for safeguarding children level three was well below the trust target.
- environmental risk assessments had been completed, including ligature assessments, and actions taken to remove or reduce risks. Staff monitored patients waiting for assessment, with a duty officer system that allowed patients to contact the service during and after assessment
- patient notes were recorded electronically and were found to be comprehensive and entered onto the system in a timely manner
- Assessments of patients were comprehensive and holistic, and physical health monitoring was taking place, where required
- Staff provided a range of treatments and access to treatment across the service, and care was delivered in line with national guidance
- Staff were taking part in clinical audits and using results to drive improvement. Staff employed in the service had the right skills and experience to ensure informed treatment for patients
- Staff were seen to be responsive and respectful when dealing with patients. Patients were involved in decisions about the service, where appropriate
- There was a strategy to maintain and renew engagement with patients in the service, ensuring patients had every opportunity to receive the treatment they were prescribed.
- The service used key performance indicators to take the service forward.