CQC takes action at Greater Manchester Mental Health NHS Foundation Trust to keep people safe

CQC inspected the trust’s acute wards for adults of working age and psychiatric intensive care units (PICU) and services for long stay or rehabilitation mental health wards for working age adults.

CQC carried out an unannounced inspection of 23 wards across their services for adults of working age and PICU in March 2024, due to concerns received about the safety and quality of care being provided.

Following this inspection, CQC imposed conditions on the service requiring them to make improvements in specific areas and send updates to CQC each month confirming the work they have done. These relate to the effective management of the service, ensuring there was a clean smoke free environment with suitable cleaning rotas, and ensuring staff on the wards have access to an up to date ligature risk assessment.

The service has been re-rated inadequate overall, as well as for being safe and well-led. Effective, caring and responsive were all re-rated as requires improvement.

Also, as part of CQC’s routine checks on the safety and quality of healthcare services, CQC carried out an unannounced inspection of long stay or rehabilitation mental health wards for working age adults in June 2024. 10 wards were visited as part of this inspection.

Following this inspection, the service’s overall rating has dropped from good to requires improvement overall, as well as for being safe and well-led. Effective and caring were re-rated as requires improvement. Responsive is rated as good.

The overall rating for the trust is unchanged and remains inadequate.

Alison Chilton, CQC deputy director of operations in the north said: 

“The trust hadn’t ensured all staff received an induction detailing what to do in the event of a fire and it was clear from our inspection, fire drills hadn’t taken place regularly.  During the acute and PICU wards inspection, there was a fire alarm drill and staff didn’t know how to respond and no-one took the lead in managing the situation.

“Staff told us they found it difficult to stop people from smoking on the acute and PICU wards and we were concerned that people were smoking in areas where there had already been fire incidents. We found fire hazards, such as oxygen cylinders not safely attached to walls, and on one ward a paper towel had been pushed into a smoke detector which could put people at risk of harm if didn’t work during a real fire.

“Across both services there were up-to date ligature risk assessments, but they weren’t always available on the wards for staff and didn’t always include how risks could be managed. When it did include how risks could be managed, action to address those risks wasn’t always taken quickly enough. It was also concerning that we had to point out a shower curtain with a fixed ligature point which staff were unaware of, and ligature cutters weren’t always regularly checked on some wards.

“Staff also didn’t always carry out observations when required on the long stay or rehabilitation wards. There were gaps in some observation records. We also saw that some staff were carrying out observations at predictable times. This increased the likelihood of those people who were at risk of self-harming, hurting themselves.

“However, on the long stay or rehabilitation wards people gave positive feedback about their care and told us that they were treated with dignity and respect. The service also has development programmes in progress to make improvements.

“We’ve told the trust where we expect to see rapid and significant improvements and will continue to monitor closely while these improvements are made. We will return to carry out another inspection and will not hesitate to take further action if necessary to keep people safe.”

In the acute wards for adults of working age and PICU inspectors found: 

• People told inspectors they didn’t feel safe on the wards, because staff didn’t always intervene when other people were acting aggressively or in a way that made them feel uncomfortable.
• The overall environment was poorly maintained, with a boarded-up window on one ward, unpainted plaster on parts of the walls of another, and cracked paint and chipped frames on another.
• Medicines administration was not always recorded accurately, and one person was taking an incorrect dose of medication, which had not been identified by staff.
• There were daily meetings to identify barriers to discharge. However, some of the actions required to facilitate safe discharge did not always take place in a timely way and key referrals sometimes took place after people were discharged.
• People were not always involved in the development of their care plan and risk assessment and several people were unaware they had a care plan.
• Some staff had a good rapport with people on the wards. However other people using the service said staff ignored them and were uncaring.

Inspectors also found: 

• There were enough staff to keep people safe, however staff did not always have the required skills and training to care for people’s individual needs.
• There was evidence staff raised safeguarding concerns in people’s medical files and safeguarding concerns were shared in handover meetings.
• Staff generally felt supported by their managers and felt they could raise concerns.

In the long stay or rehabilitation mental health wards for working age adults inspectors found: 

• Care plans did not always reflect people’s needs and how staff should support them with these.
• There were fire safety policies in place however there were gaps in fire safety checks.
• There was a cultural approach of sharing things verbally rather than recording notes in records. For example, there was a requirement of two staff to be on observations for one person but there was no reference of this in their care records or handover notes.
• Risk assessments weren’t always updated with recent incidents such as when people were found smoking on the wards and illicit drug use. The potential risks from these incidents weren’t present and there was no clear guidance for staff.

Inspectors also found:

• There were effective systems and processes to protect people from abuse and neglect.
• People told inspectors the felt safe on the wards and that they could raise any concerns with staff or managers.
• Staff reported low usage of physical restraint across the wards. Managers were confident that staff would only use restraint where necessary and that staff could de-escalate incidents before requiring the use of restraint.
• Carers and family members reported activities took place both on and off wards.

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