Greater Manchester Mental Health NHS Foundation Trust - HQ

We spoke with NHS England who commissioned the service provided by Greater Manchester West Mental Health NHS Foundation Trust. They told us they did not have any concerns about the service provided at HMP & YOI Styal at the time of our inspection.

Greater Manchester West Mental Health NHS Foundation Trust were commissioned to provide an integrated mental health service within the prison.

The integrated service was well promoted across the prison and women had good access to a range of services that included a twice weekly drop in centre.

Women we spoke to were very positive about the support received

Care pathways required development. This would assist nursing staff in identifying and targeting resources to those areas of high demand on the service.

Care planning records needed further development to fully illustrate the joint care planning arrangements that were in place women with complex mental health needs.

There were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The substance misuse service at HMP Wymott was delivered under the name of 'Discover', and included both clinical and psychosocial services. This report specifically relates to the clinical treatment of prisoners at the prison.

We found that there were measures in place that ensured prisoners received their methadone and other prescribed drugs in a dignified and respectful way.

We found that prisoners transferring to HMP Wymott that required on going treatment and support with substance misuse were guaranteed continuity of care and support.

We saw that staff from the team had good working relationships with other partner agencies across the prison including prison staff. This meant that prisoners were assured good joint working arrangements were in place around their care and treatment.

The team had three vacant posts and agency staff along with a member of staff who was on secondment to the team were covering the vacancies. Despite these vacancies we saw that the Trust had ensured that there was a sufficient number of staff on duty to meet the needs of people who used the service. We were told that all vacancies had been advertised and interviews were scheduled for July 2014.

We found that the strength of the service was its commitment to supporting and empowering prisoners to become drug free and there were a number of monitoring systems in place that ensured prisoners received a consistent service.

We were satisfied that staff had access to an appropriate training programme to develop signing skills.

Staff were supported by competent and well established signers to utilise the skills in order to develop and gain confidence in communicating with deaf patients.

Although we acknowledged the actions the trust had taken there were still shortfalls in appropriate numbers of qualified staff, with the specialised skills required to meet people's needs.

We found the unit had suitable arrangements in place to ensure that patients were able to give feedback about the care and services they received.

We were able to speak with a relative who was visiting at the time and we were told: "I think the service is excellent; they respected X's cultural needs and they (the staff) listened to me when I discussed Ramadan".

Via interpreters we spoke with five patients. Comments included " I am consulted about my care and I do feel that I am involved", "I am happy, the staff treat me fine", "I see X (the advocate) regularly, this helps me to understand what's going on and also for me to make any complaints" and "I go the meetings and group sessions, I enjoy those, I think the staff take notice".

We found patients had appropriate information and were aware how to make a complaint about the service. This was provided in a format that met their needs.

We spent time speaking with as many young people as possible to gain an understanding and feedback about their care and welfare. Comments included: "Staff are helpful, friendly and are always approachable" and 'I do feel respected". Another person said: 'They (the staff) are all very fair and not unkind in anyway'. Young people told us staff were helpful and supportive but they were very busy.

The trust had well established and robust safeguarding systems in place. There was an effective structure in place to protect patients and support staff.

There were sufficient qualified, skilled and experienced staff to meet people's needs. Senior managers and senior ward staff acknowledged there had been issues earlier in the year, however the trust had taken action to rectify this issue.

When we spoke with staff we were told they were very satisfied with the amount of training that was offered within the trust. Comments included: "One thing I like about working here, there is always opportunities for training",

The trust had effective and robust systems in place to assess and monitor the quality of the services provided. People who used the service were asked for views about their care and treatment.

We spoke to two prisoners who had experience of using the service. They told us they felt involved and included in their care and support plan.

One prisoner said, 'I came off my medication with support from the psychiatrist and the team,' and,'they suggested I did it gradually so I wouldn't be ill. They were great'.

The Inreach team provided individual case work support to prisoner's engaged with the service. Prisoners' we spoke with confirmed that they had met with a named nurse for weekly one to one sessions. Prisoners told us they found the sessions helpful and as their mental health improved the weekly sessions were reduced. One prisoner told us, 'If I'm feeling low I know can get to see them.' They told us they never had to wait more than 24 hours to see a nurse if they were feeling anxious.

One person said of the service, 'It's friendly, it's a good service.'

Another person told us, 'Their good'the team helped me in many ways.' and 'I have a hundred percent trust in them.'