Birmingham and Solihull Mental Health NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There were systems in place to ensure that staff learned from incidents which affected people who used the service. Staff were encouraged to raise any concerns and managers used these to implement learning and make changes where needed. People had mixed experiences of continuity of care. Some people experienced good support as they moved between services and teams however some people found it difficult to access services when they were in crisis. Staff showed us how they were working to improve this and ensure people had the support they needed. Staff worked well as multidisciplinary teams and liaised with people’s GPs and others involved in their care. Staff understood safeguarding and knew how to make referrals to safeguarding teams for adults and children. Improvements had been made to people’s risk assessments since our previous inspection. People were involved in their risk assessments. Staff understood people’s risks and how to support them. Staffing had improved since our previous inspection and where there were vacancies these were being recruited to. The Trust trained staff and staff had access to supervision and reflective practice. However, as at previous inspection not all staff had access to the system to record supervision. Since our previous inspection, the systems to record and store medicines had improved. This meant that people received their medicines safely and in a timely way.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they knew how to raise concerns about the service. They were confident that they would be treated with compassion and understanding and not be treated negatively if they did so.

Staff told us that lessons learned were shared at their business meetings every 6 weeks and discussed with all staff present. Staff said that ways forward and how to learn from incidents were discussed in a positive way based on openness and transparency. They said if there was an immediate risk this would be discussed in the daily morning meeting. Staff said they also discussed learning from incidents in their clinical and management supervision. Staff said within the teams there was a team and collective approach to discussion for learning points and any risks associated. Managers attended monthly clinical governance meetings with other team managers where learning from incidents were also shared. Managers discussed ways to implement any changes to make improvements to the quality of care. Staff said they were encouraged to raise concerns and the process was about what they could all learn from it, and they would not feel blamed or treated negatively if they did so.

The Trust had reviewed their Clinical Governance Committees structures and streamlined them to ensure consistency. Agenda items included quality and safety and lessons learned. Minutes reviewed of these meetings showed there was discussion about incidents and actions identified to learn lessons. These actions were followed up at the next meeting to ensure they were progressed.

People had mixed views about the continuity of their care. Most people we spoke with said that teams worked well together and shared information when needed about their care needs. However, some people told us that when they were in crisis it was difficult to access services sometimes out of hours and doctors were not always available to speak with out of hours. One person said that when they were in hospital, they were still getting appointments to see the community team even though they knew they were in hospital. They said it felt like the teams did not work together. One person said they were moving to another area and their community psychiatric nurse had ensured they had their medicines, had arranged a change of their community mental health team, and ensured their physical health needs would be met. They said the nurse was amazing!

Staff liaised with people’s GPs, social workers and community urgent care teams to ensure continuity of care for people. Staff worked together as a multidisciplinary team from the time a person is referred to the team. Staff told us that the transformation project of community mental health services had given people better access to teams and support. The neighbourhood teams worked between the GPs and the community mental health teams to enable a joined-up approach, so people moved safely between services. Staff were confident that the new ways of triage and assessments will bring down waiting times for assessment, but this was still new and not fully evaluated. One team manager said there were issues with people accessing crisis support. The teams had a duty nurse who tried to manage support for people in crisis daily. They said the home treatment teams (HTT) do not support a person until a medical assessment has been completed which cannot always be done quickly. However, the transformation project was looking at consultant psychiatrists doing less follow up work and focusing more time on urgent assessments. However, other managers told us there was a weekly meeting between the clinical leads for the community mental health teams (CMHT) and HTT’s. They reviewed people’s needs and agreed who could be moved back to the CMHT’s and vice versa. This enabled a safe transition between teams to ensure continuity of care. There was also an additional meeting every 8 weeks to discuss how the services worked together. Depending on a person’s needs the teams worked together jointly. The HTT’s also supported people over weekends if the CMHT had concerns about the person’s safety. Staff told us the waiting times were high for people to access Art Psychotherapy but people waiting for this remain under the care of the CMHT Medic to allow effective oversight and monitoring.

Care records reviewed showed that information was shared with the person’s GP, the multidisciplinary team supporting the person and other services involved with the person’s care. Multidisciplinary team meetings we attended about people’s care were detailed and all team members had a joined-up approach to safety that involved the person. Records showed that people’s views and staff were listened to, and these were included in people’s care plans.

People told us they felt safe using the service. They said that if they told staff they felt unsafe that staff would take this seriously and make any safeguarding referrals needed.

Staff understood safeguarding and when and how they needed to take appropriate action to keep people safe. Staff said they had good support from the Trust safeguarding lead who were available by phone or email to discuss any safeguarding concerns they had about people. Staff told us they had opportunities to discuss people’s risks and safeguarding concerns in their daily meetings. Staff said they visited people in pairs if there was a risk to them or potentially a risk to the person.

The Trust trained staff in safeguarding adults and children from abuse. Records showed that where appropriate staff had made safeguarding referrals to partners to ensure people were safe from abuse and neglect. Staff had also discussed any safeguarding concerns they had about people or their children with partners where appropriate.

People told us they were involved in their care plans and risk assessments and staff empowered them to make decisions about their care. People said that staff gave them time to talk through how they felt and supported them to manage their distress. People said they were involved in looking at their risks and developed care plans with staff to manage those risks. People’s carers told us they were involved if the person agreed to this, and they felt staff listened to them.

Staff told us when they were on duty calls that they completed a mini risk assessment for any person who required immediate support and then referred the person for ongoing support if needed. Staff told us people’s risks were discussed in their daily morning meetings. However, we observed, and staff told us at Ladywood, Aston and Handsworth CMHT’s morning meeting there was limited time for discussion about people’s risks and no staff raised any items or risks. Staff said that this meeting was not well attended by staff usually and there was not time for discussion. However, we observed the manager discussed the risk of the high weather temperatures and the need for staff to check on people’s health and welfare. Staff told us at other teams that they focused on people’s risk at their morning meeting. We observed staff at Longbridge discussing a person’s risk, two staff agreed to visit the person that day. Another staff member had good knowledge of the person’s needs and supported them with obtaining medicines and sharing their understanding of the person’s risks. Staff at Aston and Ladywood/Handsworth hub showed they understood the diverse needs of people in their area and ensured that risk assessments were person centred and reflected the person’s culture and language. Staff had knowledge of managing people’s complex risk. Staff were discussing with the local Police via telephone about a person’s risks who had recently returned to the area. Staff had good knowledge of the person and their risks and discussed this with the team. They discussed the next steps in alerting colleagues and external teams where relevant. All staff said they managed lone working well and there were systems in place to support staff and people who used the service.

Since our previous inspection in August 2023, we found risk assessments had improved and the Trust had met the warning notice we served. The Trust used a system called DIALOG+ which actively involved people in their care. However, not all people’s records had been transferred over to this system, but staff were in the process of doing this. The Trust told us that this system was being rolled out to all teams with a changeover date of 4 November 2024. Records reviewed showed a detailed assessment of the person’s risk. Risk assessments were updated every year or if there had been incidents or a change to the person’s risk. Most records evidenced involvement of the person and their carer where appropriate in their risk assessments. Staff at multidisciplinary team meetings reviewed people’s risk history, current risks, the person’s wishes, and respect of their choices.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us that staff were helpful and had the skills to empower them to make decisions about their care. People said that staff were good, kind and listened to what they said. Carers told us that staff used observation skills well and noticed things about the person they cared for, so they got the support they needed. People said that staff supported them to go to activities which reduced their anxiety.

Staff said staffing levels were safe. They said that staffing levels had improved since our previous inspection and the Trust was continuing to fill further vacancies. Staff told us they had access to regular training which included e-learning as well as opportunities to do additional training. There continued to be vacancies for psychology staff although these vacancies were being recruited to. They said this impacted on people waiting a long time for psychology support. At Longbridge CMHT some nurses were leaving but recruitment was in progress. Managers said it was difficult to recruit to band 6 nurse posts which impacted on staff caseloads and the availability of sufficient care coordinators. The Trust told us this was in line with difficulties nationally to recruit to band 6 posts. In some services Clinical leads had a caseload to reduce the risks to people using the service until further posts were recruited to. Staff at Longbridge said the turnover of doctors during their rotations could have a negative impact on people using the service due to a lack of continuity. However, people using the service could access a doctor when needed. Staff at Newbridge CMHT said they needed more permanent doctors as there were currently 6 locum doctors in the team. They said that whilst the doctors were good, they needed a permanent doctor who is committed to the service. The Trust told us they have seen an overall reduction in locum and agency posts. Managers at Aston, Handsworth and Ladywood told us there was ‘burn out’ and sickness in the team. Staff said the impact on them was they regularly covered each other and worked long hours to complete their work. Staff said as they were not fully staffed caseloads were not manageable.

We observed on home visits to people who used the service that staff were kind and caring. Staff took time to listen to people and we saw that staff were passionate about their job and ensuring the best outcomes for people who used the service.

The Trust told us that there were staff vacancies in all the teams. However, these were being recruited to. Where needed they used bank and agency staff to cover vacancies, staff sickness and staff on maternity leave. They encouraged agency staff to work for the Trust permanently to fill vacancies. We saw evidence that interviews were being held to recruit to vacant posts and some new staff were starting in the month following our site visit. Staff told us they had regular clinical and management supervision, peer support, reflective practice and appraisals. However, there continued to be, as identified at previous inspections, difficulty with team managers not being able to input supervision data for staff. Staff need to do this themselves which may affect the data as not all staff could access the system. The Trust told us that they were working to improve the access and recording of clinical supervision.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff completed mandatory medicines management training and annual assessments were completed to ensure they remained competent. Staff followed national practice to check patients had the correct medicines when they were admitted into the service. There were processes in place to investigate when incidents occurred, and lessons learnt were cascaded to staff. Staff told us they explained people’s medicines to them and the potential side effects. They told us if changes needed to be made this would be discussed with the person and their medical team. Staff demonstrated how they had improved medicine processes to make them more robust since our previous inspection. Staff said they worked with the Mental Health neighbourhood teams to ensure medicine requirements were transferred over safely when people using the service were discharged from the community mental health team.

People received their medicines safely and in a timely manner. Decision making processes were in place to ensure people’s behaviour was not controlled by excessive and inappropriate use of medicines. We saw evidence that staff interacted with people using the service in the clozapine clinic. We spoke to one person in the clinic who told that that they felt listened to and staff made every effort to accommodate their preference for appointments. Staff ensured that side effects and therapeutic drug level monitoring of medicines was carried out in line with national guidance, to ensure people using the service were safe and experience good health outcomes. Staff provided specific advice to people using the service and their carers about their medicines. Pharmacy staff provided specific counselling to people when they were discharged with new medicines to ensure that they understood how to take them. We observed that medicines were given to people in a person-centred and caring way. We observed multidisciplinary team meetings that were focused on reviewing peoples’ care plans and decisions made about their treatment where appropriate.

The service used electronic prescribing and medicines administration record chart. We reviewed eleven prescription records and found that all had allergies documented, appropriate prescribing and assessments had been completed. Staff ensured that medicines were prescribed and administered according to the appropriate mental health act certificates, and consent to treatment was sought and documented in line with national guidance. Medicines were stored securely and safely; the service did not store controlled drug medicines. People received their medicines as prescribed, and staff ensured that take home medicines were given to discharged people in a timely manner. The service managed controlled medicines stationery such as FP10 (prescriptions) in line with the national guidance.