Greater Manchester Mental Health NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

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. Advocacy, psychology, and occupational therapy was offered to patients. Recognised tools and evidence-based care and treatment were used to measure patient outcomes. However, we found care plans did not always reflect identified needs for patients. Records we looked at identified some health issues for patients such as weight gain and this was not reflected in their care plans.

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 Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their carers generally told us that people did not always receive holistic care, treatment and support that is evidence-based and in line with good practice standards. Patients were supported in managing their medication independently as appropriate. Patients described being involved in reviews about their care and that they could ask questions if they had any. Some patients stated that they felt they did not always have easy access to doctors as much as they wished to. Patients felt supported with their physical health and that staff would support them with any issues. Several carers and family members noted weight problems due to medication. One relative said they did not feel staff were interested in trying to do something about this. Most carers and family members reported that their relatives smoked, however the majority had stopped smoking tobacco and had transferred to using vapes with the support of smoking cessation practices. The use of substances was a concern to several carers and family members, but they were not aware if their relatives had been referred to addiction services support. The clinical team had supported relatives to explore treatment options and the opportunity to participate in clinical trials.

Managers and staff stated that patients could access psychological therapies although noted that not all patients chose to engage with this. Staff described that activities were available for patients, but some patients refused to engage with these. Managers and staff could not always describe how any patients that were refusing to engage were encouraged to participate or how they would monitor the levels of engagement. Staff and managers described how they supported patients with managing their physical health and could give specific examples of where patients had accessed specialist services when required. Staff stated that work took place with patients around being supported to and giving education about healthier living. Honeysuckle Lodge had a smoking audit completed with patients being offered nicotine replacement and e cigarettes. However, this was not provided as evidence for other wards we visited. There was a clinical pathway in place addressing National Institute for Health and Care Excellence (NICE) offering rehabilitation to adults with complex psychosis. There is a NICE policy in place. There was a draft mental health and housing plan in place with integrated care boards (ICBs) and another trust in response to the Getting It Right First Time (GIRFT) mental health rehabilitation programme.

There were a variety of evidence-based treatment pathways available to patients, however the service did not always actively engage patients in treatment to support their rehabilitation. We reviewed 31 patient records. Care plans were of varying quality and did not always reflect identified needs for patients and how staff should support them with these. We saw patient records outlining substance use concerns which lacked evidence of meaningful interventions and support that could be offered the patient. The trust had a physical health in mental health policy to ensure best practice in promoting patients' physical health. It was available on the trust intranet. It provided staff with specific tools to assess patients' physical health and reduce healthcare inequalities. The trust monitored use of a physical health intervention tool across the rehab services, documenting if the patient had refused support. The trust informed us that they currently do not measure Health of the Nation Outcome scores. This is because this is part of the ongoing work being completed with GIRFT leads and the Greater Manchester Complex Care and Rehabilitation forum. They have started a scoping tool as part of the GMMH rehab development project and identified what tools are utilised and what data will be used. Occupational therapy and psychology were offered to all patients. Recognised tools and evidence-based care and treatment were used to measure patient functioning. Evidence-based psycho-social interventions were used to support the achievement of individual patient goals. The rehabilitation clinical pathway included the need to address neurodiversity, sensory needs, a patients intelligence quotient (IQ), cognitive impairment and acquired brain injury model of care.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.