Greater Manchester Mental Health NHS Foundation Trust

On this page

• 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

Governance varied across locations. Governance meetings had different structures, formats and content in different locations Some appeared comprehensive and others were brief and lacked actions to address issues raised. Policies were in place and most of these were in date and relevant to staff need. However, governance processes were not always effective at ward level. For example, processes in place for inducting staff prior to working on the ward were ineffective and we found agency staff on many of the wards had not received an induction. Managers did not manage health and safety well. Health and safety documentation was mainly out of date and mitigations and actions identified to address areas of concern had not been completed. Fire safety and smoking on wards were not effectively managed and wards were not always well maintained. Oversight of risk was ineffective. The risk register was not accessible to relevant staff across all location and many of the risks did not have actions, mitigations or closed dates. Management of training and supervision levels lacked a cohesive approach. Training compliance varied significantly between wards and supervision compliance was very low on some wards. Staff did not always feel listened to and some staff raised concerns about racism and felt this was not being addressed. Staff experienced burnout and felt there was not enough time to carry out their roles. However, most staff felt supported by their immediate line manager and felt the culture on the wards had improved. Senior staff were generally visible on the wards. During our assessment of this key question, we found following concerns which led to breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014: the management of governance which resulted in a breach of regulation 17; You can find more details of our concerns in the evidence category findings below.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most staff supported each other well and said their immediate managers were supportive. Staff mostly felt that staff morale had improved, however not all staff felt valued and some told us there had been incidents of bullying and harassment in some of the teams. Some staff also felt that racism was not always being effectively addressed. Staff told us they received communications about service development and provided examples of initiatives they found helpful including coaching sessions, a legacy mentor who provided support for preceptorship nurses and reflective practice sessions. Matrons provided support by carrying out monthly matron audits and visiting the wards.

Governance meeting minutes did not show any consistent themes addressing shared direction and culture. The content of governance meetings varied significantly across locations. Individual governance minutes reflected some elements of shared direction and culture, for example one set of minutes discussed some work that was carried out around equality and diversity, however, these themes were not replicated across all locations. The trust had 5 core values which were: we are caring and compassionate; we inspire hope; we are open and honest; we work together; and we value and respect. They also had a 5-year strategy in place. The trust’s values were incorporated in their some of the trust’s policies, for example the induction policy includes training on the trust values and objectives for new starters and the supervision policy set out expectations to incorporate the trust’s values within supervision. However, not all staff had received regular supervision as per their policies and the culture on some of the wards did not always reflect the trust's values, for example, staff did not always interact with patients, respond to their needs or intervene when patients felt unsafe.

Staff told us the executive team visited the ward occasionally and that some senior leaders, such as the head of operations and the associate director, visited the wards regularly. Some managers felt the Senior Leadership Team were supportive and approachable, however other staff felt less supported by the organisation. Most but not all staff felt they were listened to by leaders. Some staff felt that senior leaders only attended the wards when there was a problem and some staff said that leaders did not always show empathy when there were challenges on the wards.

Staff were not always effectively managed and supported by managers. Supervision levels varied significantly between wards with 27% of staff receiving supervision on Mulberry ward and 100% at Maple House. Training compliance also varied between wards and training compliance on some wards and for some courses was low. Managers did not always follow policies and procedures at ward level, for example managers did not always ensure that staff were inducted prior to working on the ward and leaders had different approaches to maintaining a smoke free environment which were inconsistent and ineffective. Leaders did not ensure that the ward environments were safe and this meant some of the patients did not feel safe on the wards. However, the staff survey suggested that most staff felt supported by their managers. This corroborated with what we were told by staff members. Managers told us they could access training specific to their roles and that there was induction training in place for new managers.

There was a varied response from staff regarding the culture on the wards, some staff said the culture was positive whilst other staff raised concerns about there being a poor culture on some of the wards. Managers could give examples of how they dealt with these concerns. Managers told us the multidisciplinary team worked well together. Staff told us the freedom to speak up guardian visited the wards, however there were mixed views as to how effective the freedom to speak up guardian was. Staff mostly felt they could raise concerns, but some managers and staff did not always feel listened to.

The service had 2 freedom to speak up guardians for 6690 staff and 43 freedom to speak up champions. There were plans in place for improving the role and value of the freedom to speak up guardian. The freedom to speak up guardian had identified key themes and produced reports for the board. The team recognised there was some fear of retribution for speaking up and plans were in place to increase staff confidence to raise concerns and this was reflected in our conversations with staff. The team had introduced an anonymous form for staff to complete and the service also had a whistleblowing policy in place.

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.

The staff survey showed that staff generally felt trusted to do their job and most staff felt supported by their managers. However, on some wards staff did not feel there were enough staff to do their jobs properly, time pressures were unrealistic, staff felt burnout because of work and were emotionally exhausted. Staff did not regularly meet to discuss the team’s effectiveness and some staff felt their appraisals did not help them to do their job. Not all staff had received an induction prior to working on the ward and wards did not have enough staff who had received Prevention and Management of Violence and Aggression training and Immediate Life Support training to support the effective functioning of the ward and staff felt this impacted on the safety of the wards. Staff told us they struggled to manage smoking and were unsure about fire procedures. Quality matrons had been introduced to improve the quality of care on the wards and managers felt this role had been helpful.

Governance meetings did not always occur regularly for all locations, governance meetings lacked consistency across locations, the quality, format and agenda of the meetings varied significantly. Some were comprehensive and documented a range of key areas and included actions, whilst others were brief, lacked detail and actions taken. Most governance policies were in date and provided relatively comprehensive guidance for staff and there were a range of meetings in place to support the running of the wards including safety huddles, board rounds and patient flow meetings. The team meeting minutes we received were sporadic and suggested that team meetings were not occurring regularly. Effective systems were not in place to ensure there was a safe environment for patients. Staff did not monitor and manage fire risks effectively. Health and safety documentation was incomplete and out of date, staff were not always aware of emergency procedures, and emergency equipment including fire alarms, had not always been checked. Systems for ensuring that wards were smoke free environments were inconsistent and ineffective. Staffing reports showed that there were high numbers of bank and agency staff and that staff did not always have the required training or supervision. Managers did not always ensure that staff were inducted prior to working on the ward. There was a risk register in place for the trust which identified some of the key risks. However, some risks had been on the register for a long with no indication of mitigating actions or dates for actions taken. Some locations could not access the risk register. Audits were taking place, although we requested audits for all 23 wards and received audits for 7 wards which suggested they were not taking place consistently. These identified a range of issues which reflected some of the issues we identified on inspection including issues with care planning, risk assessments and physical health monitoring.

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.