High Court Application For Judicial Review Over Failure To Involve Service Users In Plans To Change Community Mental Health Services Across Greater Manchester

Source: Press Release, Irwin and Mitchell Solicitors, 31 May 3023

Public Law And Human Rights Lawyers Instructed By Service User To Issue Legal Challenge Into NHS Trust’s “Ongoing Failure” To Involve Public In Planning Process

A man has launched a High Court legal challenge against plans to redesign community mental health services across Greater Manchester area.

The Greater Manchester Mental Health NHS Foundation Trust is in the process of changing its services across Bolton, Wigan, Salford, Trafford and Manchester, which it has dubbed the ‘Greater Manchester Community Mental Health Transformation.’

It’s understood that there were three phases, with the final one – implementation planning – to take place throughout March and April.

However, service users expressed their concerns saying the Trust failed to involve, or consult them, in the decision making, and were not invited to take part in, or made aware of, the co-design process which took place at events in January and February.

Craig Hamilton, 47, of Hulme, has been using mental health services for 25 years and says he is likely to require support from the services subject to redesign for the rest of his life. 

With the support of the community campaign group CHARM (Communities for Holistic Accessible Rights based Mental Health), he has instructed expert public law and human rights lawyers at Irwin Mitchell to investigate the lawfulness of the decision to proceed with the changes.

Craig’s legal team wrote to the Trust in February to ask it to review its process.  At the time, the Trust asserted that ‘user engagement’ is a key consideration for the service design and future decision making.  It also stated it was in the process of “making arrangements for future involvement and engagement of service users… to ensure they have appropriate opportunity to be involved in the service redesign.”

However, three months on, the position remains the same, with no or no meaningful involvement of service users to date.  As a result, the lawyers have now launched an application for a judicial review in respect of the Trust’s ongoing failure to comply with its duty to involve the public in the planning process.

Expert Opinion

“Mental health services across Greater Manchester provide vital support to thousands of people, many of whom have been left deeply disappointed by these proposals and how they believe the Trust failed to involve them in such an important process. 

“Changes to the services are always an emotive issue. The first-hand account we’ve heard from Craig is deeply worrying. He believes they’ll have a significant impact on him and many others. 

“We wrote to the Trust earlier this year but they’ve failed to do what we’ve asked of them. We’ve now applied for a judicial review, as we strongly believe the Trust is in clear breach of its statutory duty by not ensuring there is adequate public involvement in the changes. 

“People with mental health issues are some of the most vulnerable in society and we should be doing our best to provide them with the support they need.”  

Gerard Devaney-Khodja, Public Law and Human Rights Trainee Lawyer

The changes are understood to have already resulted in many employees leaving and posts being left unallocated.

Meanwhile, service users fear that the proposed changes will also lead to removal of services for Craig and people with severe mental illness through the shift in funding from secondary mental health care services into primary care.

This would mean that Craig would be less able to access care or therapy when he needed it.

Craig said: “I’ve struggled with my mental health for a long time and the community mental health services were a huge help for me but over the last few years the provision has gradually become worse.

When I heard the Trust was planning a redesign, I was really worried, as were many other people who attempt to access mental health services in the area, particularly as there has been a lack of inclusion of service users in the process.

“It’s been a very distressing time, as we feel like we’re being totally disregarded.  I’ve experienced difficulties with being able to access appropriate treatment and I want to ensure those same difficulties aren’t recreated in the new service.

“If the plans go ahead without the involvement of users, it could have a negative effect on a lot of vulnerable people, not just me.  It’s morally and ethically disappointing.  We really hoped we wouldn’t have to take it to court, but we’ve been left with no option.  All we’re asking for is to be a part of the decision.”

A spokesperson for CHARM said:

“Throughout this process there was a failure to involve service users prior to the Greater Manchester model being decided, with money being allocated and posts recruited before any consultation with the wider public. Most recently, the consultation that has been taking place has been a tick box exercise with crucial decisions regarding the allocation of funds having already been made and partially implemented. Meetings that did take place were presentations not consultations.”


Edenfield and the Mental Health Crisis in the City of Manchester  – How it is connected and can we sort it out?

This is the Briefing paper we prepared for the Manchester City Council Health Scrutiny Committee held on 24 May 2023

Thank you for the opportunity to join your discussions. We are writing this briefing document as an expression of our great concern about the state of mental health care in the City of Manchester. 

CHARM is an independent community organisation that has been scrutinising services from a grassroots perspective for the last three years. We are people with lived experience, trade unions, family groups and citizens who scrutinise the commissioning and provision of mental health services in the City of Manchester. 

We are calling for changes in the way psychiatric services are provided in Manchester.

The Edenfield scandal has thrown a national light on the lack of compassion and humanity toward the most vulnerable people in our society. However, what occurred at Edenfield is not exceptional, indeed the problems are widespread and systemic.

Further, the services in Manchester are not fit for purpose and are being overwhelmed. This is having the greatest impact on the people and families who use Greater Manchester Mental Health NHS Trust services the most and over the longest periods of time.

CHARM has been pointing this out for three years, publicly drawing attention to the growing crisis in an article in the Manchester Evening News in January 2021. In response a GMMH spokesperson responded:

 “… our services have remained safe, service users well-cared for and we have maintained safe staffing levels”.

This was also the messaging constantly received by the Health Scrutiny Committee.

Now we know this was not the case and as a consequence GMMH Trust is subject to an independent NHS review, into the safety of in-patient and is under further investigation because of failing community care provision. 

What can we do about this crisis?

Firstly we need to understand why the funding is so low when the need is so high? Why has funding not been increased to meet the high level of need in our City?

Manchester average spend for mental health for 21/22 was £162.70 (per capita) national average was £209.78 inspire of being in the gives level of need (see breakdown below)

However it is not only funding, it is also the future shape and role of services and how we could develop a service that meets the aspirations of a global city.

Our presentation today offers evidence from lived experience of the inadequacies of GMMH services – at Edenfield, in inpatient units and community services.

However, CHARM is also solution-focused. 

We invite all Councillors to become partners in finding new ways of supporting people and that can assist the Integrated Social Health Care Board, the GMMH Trust, the Local Authorities in Greater Manchester and other stakeholders to devise an action plan to modernise and humanise mental health services. We believe we need a root and branch review of how the mental health needs of the people of Manchester and the City Region can be met in the future. 

We have our own proposals that we would like to discuss with you.

We look forward to helping to deliver this new approach by contributing our knowledge and international contacts that will open up a new direction for Manchester’s mental health support system founded on human rights, social justice and community.

We would be happy to meet with any of you to take these concerns forward.

If you would like to know more about the specific concerns see our website here

Data and Evidence of the challenges we face

Below we list some key data that is needed to help make important decisions as to the future direction of mental health support, especially for those people in crisis and with long term needs.

1. This crisis has caused large numbers of staff to leave – 800 in one year, the highest of any Mental Health Trust in England.  Further, morale of staff at Greater Manchester Mental Health Trust is at an all time low (Source: NHS England March 2023).

2. As councillors, you will be aware from surgeries that people with serious mental health issues find services very difficult to access. Most emergency referrals outside of office hours are being dealt with by the police (20-40% of police time is spent dealing with mental health related calls and incidents, with figures in Manchester peaking during 2021, with more than 38,000 concerns submitted by officers). 

3. People seeking help via A&E can wait for long periods of time and are often turned away for not meeting the threshold for requiring a service.

4. By many measures are services are struggling, including for psychological support (see below)

5. Further, In Manchester there are currently over 1000 (of the most vulnerable people who have been assessed as needing a care coordinator) placed on a waiting list. Our Community Mental Health Teams are struggling with unmanageable case loads. These figures are far higher than the other boroughs served by GMMH even when adjusted for population size.

6. It has also come to our attention that the funding for mental health care for Greater Manchester is in the lowest quartile for England. Yet it has some of the greatest level of need. The following graphs show how bad the situation is:

CHARM Manchester, Communities for Holistic, Accessible Rights-based Mental Health

Contact: charm.mentalhealth@gmail.com


‘I was forcibly restrained and injected with medication I didn’t want for months’ – They were at their lowest and this is how they were treated

Helena Vesty reports the latest in the Greater Manchester Mental Health Trust saga – as those needing help most speak of feeling abandoned by those supposed to be looking after them and being ‘shipped’ to distant parts of the country in their most distressing days

Helena Vesty

GMMH users told horrifying stories of their treatment (Image: MEN/UGC)

‘I said I didn’t want medication, I was forcibly restrained and injected for months’.

They were in their most vulnerable moments, begging for help – and were instead left with harrowing experiences at the hands of those who were supposed to be caring for them.

Greater Manchester Mental Health Trust (GMMH) is at the centre of swirling turmoil. The Manchester Evening News has spent years reporting deaths of patients which have shown GMMH wrongdoing in coroners’ courts. 

Ryanair Says 9.99 Air Fares ‘Are Possibly Behind Us’

Last year, an explosive Panorama investigation captured apparent humiliation, verbal abuse, mocking and assault of patients – plus alleged falsification of medical paperwork. The documentary focused on the inpatient facility, the Edenfield Centre, on the site of the former Prestwich Hospital. 

Numerous investigations – police, independent and internal – sprang up, uncovering sweeping concerns about the trust’s culture and the fundamental safety of its users.

In April, GMMH’s chief executive officer announced his resignation as he claimed the trust is on the road to recovery, amid national intervention from the NHS which plunged the huge mental health provider into the equivalent of special measures.

But the public condemnation comes after years of internal praise and glowing reports from distant regulators, all of which fostered a leadership which ‘believed their own propaganda’, according to one independent review. Those being treated by GMMH say they know all too well about the problems they say have been endemic for years in mental health care in Greater Manchester.

On Wednesday, May 24, GMMH users gathered to give evidence of their experiences to Manchester Council’s health scrutiny committee. Councillors held an urgent session to assess the progress made by GMMH since the shocking Edenfield revelations – which they say has fallen woefully short so far.

But along with fury from councillors, GMMH leaders were also faced with patients, all members of mental health activism group Charm, who were invited to bravely tell their moving stories publicly.

They spoke of being forcibly restrained, feeling abandoned by those supposed to be looking after them and being ‘shipped’ to distant parts of the country, away from their families, for treatment in their most distressing days. They all demand better.

Claims were made in a Panorama programme that patients at the Edenfield Centre were abused(Image: BBC)

‘I used to be a Chinese language tutor – when I went to Edenfield, I was forcibly restrained and given injections for months’

“Prior to being sectioned, I was a Chinese language tutor, now I’m a service user. I lived at the Edenfield Centre for three-and-a-half years,” shared one woman, who wishes not to be identified.

“My experience is that restraint is used as a first resort, rather than a last resort. When I first arrived at Edenfield, I said I did not want to take medication. I had heard psychiatric medication could have bad side effects.

“As a result of declining medication, I was forcibly restrained by four members of staff and injected. This is a distressing process.

“This process went on for a couple of months, then I asked during a ward round why I was being restrained when I had never resisted. This process then stopped.”

The site is the subject of a police investigation after the abuse allegations

The former Edenfield resident said the injections continued over the course of about six months, but have left lasting impacts. “My kidney function dropped from around 84 points to 54 points. I now have stage three kidney disease,” she told the council meeting.

“Due to feeling unwell, I asked to be prescribed oral medication. I was shown the descriptors for three types of medication.

“I opted for the one which I considered to have the least dramatic side effects. I knew that weight gain was one possible outcome of taking medication.

“While at Edenfield, I put on over five stone in weight, despite taking regular exercise. I now have diabetes and an essential tremor in my hands. 

“People who knew me before Edenfield say they hardly recognise me.”

Scenes from the programme

The woman also spoke of feeling ignored and misunderstood by mental health professionals, leaving her questioning her care.

“I have cause to wonder whether some of the mental health professionals I have met understand LGBTI experiences in socially deprived areas,” she said. “Prior to being sectioned, I experienced neighbour nuisance on and off for about 15 years.

“Some of the verbal abuse I received was homophobic. Approximately a dozen of my house windows were smashed, there was arson and graffiti.

“My car door was pulled off, the ignition ripped out and the car windows smashed. One of the first psychiatrists I met ruled that I believed that my neighbours were trying to harm me. 

“His suggestion was that I was delusional.

“Later I showed evidence of anti-social behaviour around my home to another psychiatrist. The evidence seemed to be ignored. 

“LGBTI+ people seem to be overrepresented in mental health services. Perhaps it is time that we begin looking at what happens to service users, rather than what is considered an innate problem.”

The programme showed staff ‘sleeping’ on shift

GMMH has been slammed for allowing the proliferation of a ‘combative management’ style, andt ‘believing its own propaganda’, which ultimately failed to see the shocking conditions it was cultivating. 

“My experience of mental health services is that they are accepting of praise but not of criticism,” agrees the woman.

“While I was at the Edenfield Centre, changes were implemented in the women’s services. All women were to be housed behind the Edenfield fence. These changes did not apply to the men’s service. 

“I’d heard that the rationale for the change was that women seem more isolated. I failed to understand how locking old women behind a high fence would make them feel less isolated. 

“I spoke about the changes at two meetings, I later found out that at this time my behaviour was seen as symptomatic of a mental illness. These types of comments stifle descent. 

“I would recommend that GMMH implement robust mechanisms for hearing the views of service users.”

‘There were no medics available so I had to be taken to A&E by three police officers – before I got sent hours across the country while seriously unwell’

Mum-of-two Rachel Tully is another GMMH user, testifying in devastating detail about how she was hauled across the country during immense suffering because of lacking beds in Greater Manchester

“I have been a service user for my whole adult life, which is approximately 40 years. My diagnosis is anorexia, bulimia and bipolar affective disorder,” she told the committee. 

“I am a human. I have two children, and I was a special needs teacher for 14 years.

“I spent a lot of time on mental health sections, and have never been without a community psychiatric nurse or social worker. I’ve noticed a real difference over the last few years in the community mental health team. I have had five community psychiatric nurses over the last two years – which has had a huge impact on my mental health.”

Rachel sharing her story (Image: Manchester Council)

During her last admission to hospital, she said, there were no medics available so she had to be escorted to A&E by three police officers who sat with her for hours while she waited for help.

“On my main last admission, I was under the home-based treatment team and apparently very unwell. My friends were extremely worried and tried to contact the team but were not able to get a doctor or a nurse – so they sent the police. 

“Two police came and spent three hours in my home, and still no doctors or nurses came. So they got me out of the house and were able to arrest me.

“I was put in a van and three police took me to the A&E department at North Manchester General. There were no available cubicles so we were put in a kitchenette on hard chairs, this was extremely distressing to me.

“After another three hours, midnight came and the police were supposed to clock off their shift, but there was no backup and they had to stay on, on overtime. This is three police [officers] on overtime, I never was at any point resistant or aggressive.

“Six hours per police [officer], per overtime – all night, three of them. You can imagine how much money that is going to cost.”

GMMH is now embroiled in turmoil (Image: MEN MEDIA)

After this hours-long ordeal, all Rachel could do was weep as she was told she had to be taken to Norfolk to get a bed at an inpatient facility.

“I was then … [taken by] private ambulance at 6am [which] shipped me to Norfolk,” explained Rachel. “All I did was cry and in less than two days in bed, a bed came available at Park House [an inpatient ward at North Manchester General Hospital]. 

“Again a private ambulance came and they said I needed to go in the cage at the back. I begged them not to put me in and they did.

“I spent three hours on a wooden seat with no seatbelt, while the ambulance man sat on a comfy seat smoking on the other side of the grill. [It was a] horrendous experience and I have never, ever in any way been aggressive or out of control.”

During the committee, GMMH leaders spoke of the ‘daily challenges’ being faced by the trust, including a recruitment and retention crisis, as demand for mental health services continues to soar following the pandemic. Rachel says understaffing is one of her biggest concerns as her nurse has been on long term sick leave and she has instead been left with staff she does not feel comfortable with.

“Another concern is how many inexperienced agency staff are working on the wards and in the community,” shared Rachel. “Recently, my community psychiatric nurse was on long term sick leave so last month, a male nurse came to my house to give me a depo injection and I was all alone – [and I] still had to pull my trousers down and it’s in my notes that I have real difficulties with males.

“I want to see adequate support for the staff and better care for patients.”

‘I was fighting for my life and went weeks without contact from GMMH – until I protested in a car park to insist I got desperately needed help’

Craig Hamilton was the third GMMH user to share their story in front of the trust’s chiefs. He admitted he struggled over the Covid-19 pandemic and went to his GP for help.

But even his doctor was hamstrung as the pair became caught up in long waits for assistance from mental health services, said Craig: “I’ve been a service user for 26 years, all in Manchester and I’m very grateful to have had a lot of good care over that time. It has, however, been a bit different in recent years. 

“In 2020, I had been working for a couple of years for myself in a business. I realised I was struggling, my early warning signs were coming back. 

“My friends were noticing it, but I knew it. Expert patient programmes in the past have helped me recognise that. 

“I went to my GP and he referred me. I had a lot of suicidal ideation and he was very worried about seeing me like this. 

Craig praised some of his treatment over the years – but now says major changes must be made(Image: Manchester Council)

“He wanted to try and get me to see someone in the community mental health team. I had multiple assessments, didn’t go anywhere, they didn’t see my needs as great enough for that added help.

“I was really, really struggling. My GP was having difficulties, he really wanted to look at medication but couldn’t because of the [rules governing him]. 

“The wait to see a psychiatrist, somebody who could change those meds, was over nine months. I don’t think that’s good enough, I’d like to see a quicker route.

“I don’t think nine months is timely care for us and our families.”

Craig Hamilton (Image: UGC)

Craig spoke of a frustrating revolving door – until he reached breaking point. 

“I tried medication for three months, gave it time, went back to my GP and it wasn’t working. What happens then? The same process,” he said.

“I have to go back to the start of the queue and wait another nine months from that three months. How long is timely [care]?

“In this process I was really struggling with self-employment, I was getting it done. I worked for a good two years without getting the right medication. 

“The home-treatment team eventually got me an outpatient appointment after nearly two years. They came and visited my home and I thought I was being seen to – but then they just disappeared. 

“I phoned up about a diagnosis and didn’t get a reply. I phoned the next week and didn’t get a reply. 

“The next week I phoned up every day for a week, no one got back to me. They just didn’t do it. 

“Eventually, because I was desperate and fighting for my life, I drove down to the medical centre and parked it across the car park – I had tried to use appropriate channels and tried to speak to them and it just wasn’t there.

“I want to see easier routes to see a psychiatrist and I want to know what [timely care] is.”

‘We’re sorry’

Chief executive Neil Thwaite, who is serving his notice, did not attend the session and was instead on annual leave – prompting councillors to insist that he is held accountable before leaving the trust. Instead, the deputy CEO and the director of GMMH’s improvement plan, Andrew Maloney, led the delegation.

Mr Maloney responded to the stories of the Charm group, saying: “We are sorry to anyone who has experienced care and treatment which falls below the high standards we strive for.

“We are committed to hearing the experiences of service users and carers, and working with them to improve our services together. This will be embedded in every pillar of our improvement plan.”

From left: Greater Manchester Mental Health Trust deputy chief executive Andrew Maloney and chief executive Neil Thwaite (Image: GMMH/MEN)

Manchester Council’s health and care executive, Tom Robinson, said the town hall will push for and support change within GMMH, but warned: “By the time we get to that anniversary, we need to be able to demonstrate quantifiable results. At the moment, I can’t see how that’s achieved.

“We have to go further, faster, and there has to be an urgency between now and the end of the year to get to where we need to get to.”

Source: Manchester Evening News, 26/05/2023


GMMH publish Draft Improvement Plan to address Edenfield scandal and other service failings

This improvement journey will only succeed if the views of our service users, their families and carers, alongside those of our staff and stakeholders, are central to the development and implementation of our detailed plans.

GMMH Trust 23rd February 2023

Go the Summary Report page on the GMMH website here

Read their statement below:

“In September, the BBC’s Panorama revealed appalling behaviours by some of our staff at the Edenfield Centre. In doing so the documentary shocked us all and shamed the vast majority of our hard-working colleagues, for whom patient care and safety is fundamental and absolute.

In November, the Care Quality Commission (CQC) published a lengthy report, based on their inspections of some services across our Trust earlier in the year, which identified a series of failings. Soon after, the Trust was placed into Segment 4 of NHS England’s Oversight Framework and enrolled into the national Recovery Support Programme. We welcome this support.

Early on, the Trust Board accepted responsibility for, and sought to understand the root causes of, these multiple and serious failures. We have commissioned a number of clinical reviews and other investigations, conducted by independent and expert bodies. Some of these are still underway and will report their findings in the coming months.

The pressing need for immediate – and long-term – change within our organisation is clear. The Board has recognised the scale of the challenge ahead and understands it will not be a simple or straightforward task. But we are firmly committed to remedying the problems that have so clearly emerged over the past year and improving outcomes and experiences for our service users, their families and our staff. We are also committed to doing so in a spirit of openness and collaboration.

On this page, you will read more about our Improvement Plan. This has been in development since last autumn and includes a number of immediate actions to tackle the most urgent quality and safety issues, alongside a comprehensive set of long-term ambitions to improve everything we do at the Trust, grouped into five themes:

Patient Safety

An Empowered and Thriving Workforce

Clinical Strategy

A Well governed Trust

An Open and Listening Organisation

This improvement journey will only succeed if the views of our service users, their families and carers, alongside those of our staff and stakeholders, are central to the development and implementation of our detailed plans.

We need your help to ensure we have identified the right areas for initial action and the ways in which these should be prioritised. Then, going forward, your continued engagement throughout our journey will also guide this shared vision into meaningful action, as we start to deliver these bold, long-term ambitions and measure the impact of the changes we make.

Our overall mission is to create the best possible place to work and the best possible place to be cared for – a high quality therapeutic environment which also produces the best possible outcomes for our service users. On behalf of the Board, thank you for your input and feedback – both now and into the future.”

Statement by GMMH Trust


Our Manifesto for Change: calling for an evolution in the way that mental health is understood and treated

Calling for an evolution in the way that mental health is understood and treated. The statement below is the introduction to the new Manifesto for Change that has been produced by Plattform, a mental health organisation (like Mind) in Wales. We need something similar for Manchester and the City Region.

You can read the full manifesto here

“To improve our mental health as a society, we need to look at the wider determinants of our physical and mental health and tackle the root causes of mental health difficulties at a community and population level. This will be good for all of us.

People in the poorest parts of the UK are living in a constant state of crisis, struggling on incomes that don’t cover the bills, living in damp and dilap- idated homes, having to raise children in poor cir- cumstances, and dying younger. This constant worry puts a strain on mental and physical health and the result is that people in more adversely affected communities experience a level of trauma and distress far higher than the rest of the population.

Our public systems, intended to help people when they are facing the toughest times, are no longer fit for purpose. They need redesigning so they work better for everyone. Often, we are told that our mental health is the result of our biology or a chemical imbalance, or it is downplayed as “something we all struggle with at times”. But we don’t all face the same struggles, and we don’t all have the same experiences of trauma.

For us to think differently about our public systems, we need a new conversation about mental health. We need to look at the root causes of distress and how we can create the sys- tems and communities where we can all thrive.

In this manifesto, we explore what this means in practice. Wales already has strong foundations, but we need to think about systems, and how we can build on those foundations further to support our vision of a healthy and trauma-informed society.

This manifesto is much more than just policy asks, although there are some of those too. It’s about all of us. It’s about how we act as citizens, friends, and neighbours. For those of us working in ‘helping’ systems, it’s about how we think about and act in those systems, both as colleagues and as people offering support. This impacts the multiple systems we are all part of, not just those related to mental health. It involves education, health, policing, social care, environment, community, leisure, arts, sport, and beyond.”

Talking with Voices

Talking with Voices: A novel dialogical therapy for adults with auditory hallucinations awarded £1.4 Million. A project GMMH can be proud of.


Following a successful feasibility trial, GMMH was awarded £1.4 million to host a randomised control trial investigating whether Talking with Voices, a new form of therapy, is an effective treatment for people who hear persistent and distressing voices. Talking with Voices is based on the idea that what voices say may reflect real-life conflicts and difficulties in the life of the voice hearer. The treatment involves a therapist ‘talking to your voice by asking it questions. The voice hearer then listens to the responses and repeats them out loud.

See more about the project here

Although hearing voices that other people can’t (‘auditory hallucinations’) is a common human experience, it can sometimes cause a lot of distress and be difficult to cope with. Research has shown that this may often happen when voices are related to negative emotions and/or to stressful events in the voice hearer’s life. As such, health services are recognising that it can be helpful to provide psychological therapy to people who struggle with hearing voices. Such treatment may reduce feelings of distress and help people find new ways of coping.  

Talking With Voices (TwV) is a new form of therapy for voice hearers that comes from the work of the International Hearing Voices Movement. It involves a combination of psychosocial education, psychological formulation, and dialogical engagement whereby a therapist directly interacts with the voice(s) by asking them questions which the voice hearer repeats back out loud.   

Over time, the therapist learns more about the voice(s) in order to support the voice(s) and voice hearer to develop a more peaceful, positive relationship. In addition, the therapist and voice hearer work together to try and understand how the voice(s) may relate to particular problems in the person’s life.  

Source: Greater Manchester Mental Health Trust, May 2023

Neil Thwaite, CEO of GMMH NHS Trust which runs Edenfield Centre to resign

Neil Thwaite, the CEO of GMMH NHS Trust in charge of the mental health unit in Prestwich at the centre of an undercover Panorama probe is set to step down from his role.

Shocking footage in the BBC programme showed staff at the Edenfield Centre mocking, slapping and pinching patients as well as them taunting and mocking patients in vulnerable situations.

Inappropriate restraint was commonly used showing patients in severe distress as well as locking up patients they regarded as “annoying” and “hard work” into seclusion rooms for up to weeks at a time.

Greater Manchester Mental Health NHS Foundation Trust (GMMH), which runs Edenfield, told Panorama it was taking the allegations “very seriously” and had taken “immediate actions to protect patient safety”.

A number of staff members were sacked and suspended, and the trust has worked with Greater Manchester Police, the independent healthcare regulator the Care Quality Commission and NHS England.

GMMH chief executive Neil Thwaite has now announced his resignation from his role and acknowledged the problems related to Edenfield in a statement.

He will continue as CEO for the next few months, serving out full notice while the trust begins “recruitment arrangements”.


Mr Thwaite said: “Following the awful failings highlighted at Edenfield and other challenges, the last six months have been incredibly difficult for everyone and through engaging with staff, service users, carers and stakeholders, we have worked on our plan to get the organisation on the right path for recovery.

“Now we have launched our improvement plan, which will be implemented over the next two years, I feel this is the right time to hand over the reins to a new CEO.

“The plan strengthens our approach to ensure the safety of our service users and staff, ensuring high quality care.”

Mr Thwaite began his tenure as chief executive of in 2018 after working as the trust’s deputy CEO and director of service development.

The trust said during his time as chief executive he has led the it through the pandemic and ongoing recovery, secured £105m worth of funding for the much-needed replacement of its inpatient unit in North Manchester, welcomed Wigan services.

He has also championed mental health and substance misuse issues across the Greater Manchester system, the trust added.

GMMH chair Bill McCarthy said: “Neil is a compassionate, visible leader in our organisation and across our system and I have enjoyed working with him during the last four months.

Source: Bury Times, 15th April 2023

The system is failing and these people deserved so much more

Manchester Evening News look at the fall of Greater Manchester’s Mental Health Trust – they ask what went wrong and why are many of the board members who presided over the failures listed in this piece are still leading the trust?

In recent weeks, Greater Manchester Mental Health Trust (GMMH) was served a stark reckoning, with inspectors laying bare their failures. On Friday, the trust’s chief executive announced his resignation.

It follows a litany of other reports, highlighting a catalogue of tragedy.

Recent years paint a picture of struggling people coming through the doors in the worst state of their lives. They were desperate for help, but the system built to look after them failed.

And, while sick patients were left in unacceptable conditions, the people at the top of the trust – whose job it was to ensure help was available for those who truly needed it – never heard desperate pleas for support.

Instead, they became wrapped up in praise from distant regulators. They busied themselves expanding the stretched trust further still, despite staffing levels becoming unsafe.

One beleaguered unit became ‘its own world’, with its own ‘combative’ set of rules flourishing as it was cut off from outside influence. Meanwhile, trust leaders began to ‘believe their own propaganda’ as they were showered in false praise – and nothing changed.

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Humiliation, verbal abuse and assault

Right now, GMMH is subject to a slew of investigations. Police, independent, internal – many of them stem from the revelations aired in a September episode of Panorama. The trust was rocked by the shocking programme featuring footage recorded by an undercover BBC reporter embedded in one unit on the grounds of the former Prestwich Hospital, where GMMH now has a number of inpatient units, from March to June of last year.

The hour-long programme about the Edenfield Centre captured apparent humiliation, verbal abuse, mocking and assault of patients – plus alleged falsification of medical paperwork.

GMMH was thrust into a storm of NHS intervention, police enquiries and public condemnation in the hours, days and weeks after the damming scenes.

The latest results of one of those investigations came last month.

Claims were made in a Panorama programme that patients at the Edenfield Centre were abused (Image: BBC)
The Good Governance Institute was drafted by the trust in the wake of the Edenfield scandal to carry out an independent review under the heading ‘why did we not know?’.

On March 27, a meeting of the board was told that their own staff were simply unequipped to be in senior management. The stark review laid out a ‘combative management’ style, and a trust ‘believing its own propaganda’, which ultimately failed to see the shocking conditions it was cultivating.

Board members, including chief executive Neil Thwaite, hung their heads as they appeared bewildered and ashamed by the shocking findings, which appeared to come as a surprise to some.

‘It has not served you well to believe your own propaganda… [take some] time off from cup half full for a bit’, Professor Andrew Corbett-Nolan, the Chief Executive of the Good Governance Institute, solemnly told the group.

“Edenfield became its own world,” investigators explained.

Over a period of years, the centre became ‘closed to external influence’, breeding a distinct ‘Edenfield management style’ that was ‘combative’ and at odds with other parts of the trust.

Secret footage appears to show member of staff ‘tickling murderer’ at mental health unit – as Panorama uncovers alleged mistreatment of patients
Inside Edenfield, ‘clinical leadership had become confused and dysfunctional’ prompting a rift between the people actually working with patients – doctors, nurses, carers – and the leadership team meant to support them

Huge turnover among senior medics left a lack of authority and ‘staff who had stepped up to keep the service going were often too junior with little experience beyond Edenfield’, said Professor Corbett-Nolan.

“The poor physical environment and low staffing levels became normalised and accepted as ‘just the way things were,” he added.

‘Red flags’ were missed, and the trust’s leadership did not ‘draw professional curiosity’ from the constant turnover in senior consultants.

GMMH has accepted the damning findings of the report and apologised ‘unreservedly’.

“We owe it to all our service users, their families, carers, and our hard-working staff to put things right,” an unnamed spokesperson said in a public statement released this week.

The trust says it has ‘already begun to make progress to improve patient safety, create a better working environment for our staff, and strengthen our leadership and governance’.

Panorama appeared to show one Edenfield staff member ‘napping’ on a wall during a shift
But, as poor as things were within the Edenfield Centre, the scandal was only one symptom of the deep-rooted issues within GMMH, the Good Governance report found. Unsafe levels of staffing became a hallmark of the trust, according to the summary – and often went unchecked

Leaders came to rely on ‘temporary fixes’ and failed to solve their staffing problems, putting even more pressure on those clinicians left trying to care for patients.

And, when data was presented to senior management which should have raised alarm bells, it had been so heavily grouped together that it no longer included the key details which would have shown the trust’s failings.

But, while the information senior leaders received may have been lacking, they follow on the heels of a catalogue of concerns raised by coroners, whistle-blowers within the trust, and the families of those wrapped up in its failings.

Ticking time bombs

Short-staffing is not just a problem for doctors and nurses struggling through their shifts. It has left dangerously mentally ill people without support, leading to ultimate consequences.

While staffing levels dwindled to ‘lower than acceptable standards’, it was the people struggling with their mental health who were left in limbo. They had reached out to ask for help – but in some cases the results were disastrous.

In December 2020, the case of Zak Bennett-Eko reached Manchester’s courts. The then 22-year-old had taken his 11-month-old for a walk in a pram before unimaginable horror unfolded.

Bennett-Eko cast his little boy, Zakari, into a river in Radcliffe and ultimately killed him. He was plagued with nightmarish hallucinations that the baby had turned into ‘the devil’ and their final walk together was filled with the delusional confirmations he needed to kill his son.

Jurors found Bennett-Eko unanimously guilty of manslaughter by reason of diminished responsibility, but not before three psychiatrists took to the witness box to try and make sense of the incomprehensible – revealing confused and woefully lacking treatment of a man suffering from severe paranoid schizophrenia.

Zak Bennett-Eko asked to be sectioned before killing his 11-month-old baby during a psychotic episode, a review found (Image: MEN Media)
Though he had regular appointments with the doctor, Bennett-Eko was a young man with a learning disability without the words to articulate the nature of his illness.

Altogether, Zak Bennett-Eko went to his GP, A&E and the mental health liaison team six times in 2019, begging for help with his deteriorating mind. On one occasion, he specifically asked medics to section him, as he had been threatening to kill himself in the presence of his partner, the mother of baby Zakari.

Zakari William Bennett-Eko, who died in Radcliffe on September 11, 2019, aged 11 months (Image: MEN Media)
This request was never fulfilled. Instead, Bennett-Eko came away from one of his visits, having been referred back to his GP, with the medical notes ‘no emergency, no urgency’.

Tributes to Zakari in the wake of the tragedy (Image: MEN Media)
Multiple investigations have now been launched following baby Zakari’s tragic death – including by GMMH.

Immediately after the trial in 2020, when asked to define what moments in this timeline they had specifically investigated, the trust declined – which became a pattern in the Manchester Evening News’ attempts to investigate what and how ‘lessons will be learned’ from the Radcliffe horror. Trust bosses told the Manchester Evening News that ‘an action plan’ has been put in place to ‘prevent any similar incidents in the future’.

Again, when asked by the Manchester Evening News to clarify what ‘lapses in care’ were identified, what specific improvements have been made, and what progress has been made, the trust declined to comment further at the time.

When the M.E.N. asked this week, GMMH referred us to our own coverage of baby Zakari’s inquest, when a coroner concluded that there were missed opportunities to provide mental health support, which could have prevented the psychotic episode which led to the killing. The trust did not share any further detail about the internal review.

Emily Jones was stabbed to death aged 7 at Queen’s Park in Bolton (Image: MEN Media)
That same month, December 2020, another infamous trial was in full swing – that of Eltonia Skana, the killer of seven-year-old Emily Jones. Skana suffered from paranoid schizophrenia and had delusional thoughts which could lead to violence.

On March 22, 2020, she snatched Emily from her scooter in Queens Park, Bolton, and fatally slashed her neck with a craft knife.

Skana, 30, had been under the treatment of mental health services. She had been assigned a nurse but was living at her home in Bolton.

And, when her nurse went off sick, Skana was not seen by any other mental health professional for three months in the lead up to her horrendous attack on Emily, a jury was told during her trial.

When police later raided her home they found a month’s worth of unused anti-psychotic medication. She had twice been sectioned before and had a history of violent incidents.

“She was like a ticking time bomb – if it wasn’t Emily it would have been somebody else,” Emily’s father, Mark Jones, told the M.E.N.

As Emily passed on her scooter, Eltonia Skana – who has severe paranoid schizophrenia – quickly rose and grabbed the youngster before attacking her with a craft knife she had bought earlier that day (Image: MEN Media)
Following Emily’s death, an internal review by GMMH found the incident ‘could not have been foreseen’.

The trust’s report said Skana did not fall into this ‘high risk’ category.

She is currently serving a life sentence with a minimum of ten years and eight months in prison, along with a hospital order which means she will not be sent to prison until doctors deem her fit. She was found guilty of the manslaughter of Emily, by means of diminished responsibility.

Mark Jones, Emily’s father, has said Skana was a ‘ticking time bomb’ (Image: Manchester Evening News)
Three youngsters died in the same hospital

Running parallel to the two manslaughter convictions were yet more deaths. But this time, the fatalities were those of GMMH patients themselves. Three such patients lost their lives in one horrendous nine-month period three at inpatient mental health units at the site of the former Prestwich Hospital – the same site that would eventually draw the attention of Panorama.

As revealed by the M.E.N., Rowan Thompson, 18, died at the mental health hospital in Bury, in October 2020, followed by Charlie Millers, 17, in December, and Ania Sohail, 22, in June 2021.

In a six-day inquest held at Rochdale Coroners Court, jurors heard that Rowan Thompson had ‘severely low’ levels of potassium before their death. The jury was told of old out-of-service phone numbers and email address that meant blood tests were not communicated properly and about staff who ‘made up’ details of observations.

They concluded these actions amounted to ‘neglect’.

Rowan Thompson (Image: MEN Media)
Ania Sohail ordered medication from four different websites and had it delivered to her family’s home, Rochdale Coroners’ Court heard.

She snuck them into her room at the former Prestwich Hospital site. Despite numerous incidents of self-harm and a previous overdose less than two weeks earlier she was on a ward with the ‘lowest level of security’.

An inquest heard Ania last picked up the drugs the day before she died while on unaccompanied leave and snuck them into her room at the former Prestwich Hospital site. It had been her first day of unaccompanied leave following a previous overdose less than two weeks earlier, amid numerous incidents of self-harm ‘several times a week’.

Inpatient wards run by GMMH in Prestwich, where the three youngsters had been staying (Image: Manchester Evening News)
Ania collapsed while eating lunch on the ward and died the same day from a medication overdose.

Charlie’s death came in December 2020. The former Manchester College pupil had a history of self-harm and was under observation at the time he became fatally ill.

He had been seen with ligatures around his neck three times before he was found alone and unresponsive, with a fourth ligature around his neck. He died five days later.

In January of this year, Charlie’s inquest was delayed for police to carry out further investigations – after it emerged hospital records may have been ‘altered’ after his death.

Detective Superintendent Lewis Hughes requested for the hearing to be delayed, telling Rochdale Coroner’s Court: “Some entries may have been edited which may have an innocent explanation but that requires further investigation.”

Marc Thompson and Sam Millers – family members of those who died – campaigned for NHS England to investigate GMMH (Image: Manchester Evening News)
GMMH was ordered to commission an ‘external report’ about the three deaths, and after an unannounced inspection in September 2021, a watchdog said it was ‘very concerned’ about the safety of people using the services at GMMH.

The Care Quality Commission – the health equivalent of Ofsted – found there were not always enough nurses, that bank or agency workers used at the site did not always have the essential training to keep patients safe from avoidable harm, and that one ward was dirty and smelly.

Gill Green, Director of Nursing and Governance, responded by welcoming the findings, accepting there were areas for improvement ‘such as levels of qualified staff on wards, which many NHS trusts are struggling with, however we have strong contingency plans in place to ensure we remain safely staffed’.

Inquests where GMMH was criticised

The deaths of Rowan, Charlie, Ania, Zakari and Emily are not the only ones that have led to GMMH coming under fire. This is a non-exhaustive list of some of our coverage in which the trust was criticised:

Olivia Garvey, 24, was found dead at a hotel in Salford in 2020. A GMMH report found three occasions where her treatment could have been escalated and concluded the trust ‘lost oversight’ of her care due to ‘unprecedented staff sickness

Daniel O’Neill, 29, was found dead at his home in 2020. He had been admitted to mental health units eight times before his death. Despite his case requiring three visits from a care co-ordinator per week and family members raising concerns about his deterioration, Daniel went months without being contacted by his carer and reviews went uncompleted. The coroner ruled a conclusion of suicide, to which neglect was a contributory factor, saying there were ‘gross failings and as such, sub-optimal care’, a GMMH-authored report admitted several mistakes

Alex Turner, 24, went missing from a mental health ward in 2019 and was found dead on a railway line the next morning. Just a week before his death, he had been discharged from a different unit despite repeatedly warning staff he would take his life if released. The trust admitted failing to come up with a care plan following the discharge, failing to record information significant to assessing Alex’s level of risk, and failing to fully assess the escalating risk Alex was posing to himself

Marie Scott, 57, went missing in 2017 and her remains were found two years later. She had been in hospital multiple times for self-harm and attempted suicide. The coroner slammed GMMH for a ‘background of failures’. Among them, there were no documented steps for her supervision in the community when she had been discharged from hospital and no alternative plan if she did not engage with the home-based treatment staff, plus each assessment only focused on how she was feeling there and then when the assessments took place

Mark Bramhall, 51, died in 2022 after setting fire to an armchair following a battle with paranoid schizophrenia. GMMH admitted there was a potential his case should have been escalated. The trust also said there had been cited issues around note taking in reference to his care, which they said had since improved, as well as highlighting that nationwide there are not enough experienced staff to deal with complex cases like Mark’s

Anthony Schofield, 52, was found dead after an overdose at home in 2019. The coroner warned there was a risk of future deaths without action from GMMH, finding there had been no comprehensive risk review done by staff with knowledge of Anthony’s previous inpatients stays, there was no clear plan to deal with his deteriorating condition, and there was a failure by home-based treatment staff to learn more about his growing suicidal thoughts and plans

Fizza Ahmed, 39, was found dead in woodland in 2022 days after leaving for hospital after attempting to take her own life. Just last week, on April 5, a GMMH internal review found that shortcomings by the trust did ‘on the balance of probabilities’ directly lead to her death amid lacking communication among staff in charge of Fizza’s care

‘A very clear desire to present a positive, optimistic image of the organisation’

As traumatic events were about to unfold across 2020, GMMH was receiving praise.

“The trust was seen, and saw itself, as successful. It enjoyed a high degree of trust within the local system and was encouraged to expand,” the Good Governance findings say.

“The local commissioners regularly monitored standards for adult forensic services [which provide treatment, rehabilitation and aftercare for people who are mentally unwell and who are in the criminal justice system] but this did not flag exceptional concerns at Edenfield.

“In addition, the CQC had previously given the trust a ‘Good’ rating and at the conclusion of the latest inspection visit in July, just prior to the Panorama programme, did not raise any significant concerns. At the very least, this did not spur the trust to be self-critical and focus on the right priorities.”

The Edenfield Centre
The CQC report which branded GMMH ‘Good’ was published in January 2020 and found that the trust had done outstanding work with substance misuse patients. The trust was rated as Requires Improvement in relation to its community mental health services for young people and working-age adults, but was given a Good rating for categories relating to in-patient care.

Shortly after that, the fallout from the pandemic, and associated lockdowns, created a colossal spike in demand for mental health admissions and referrals. Mental charity MIND has called the national situation ‘a second pandemic’, as the number of calls to its helpline surged.

Making the situation worse, a workforce report on the mental health sector penned by the British Medical Association (BMA) in September 2020 found that demand for services nationally had been rising before the pandemic – between 2016-2019 there was a 21 percent increase in people who contacted the NHS for help – but staffing levels had not been keeping up.

The number of nurses, midwives, health visitors and support staff has fallen across the country since 2009 and the BMA said workforce shortages affected staff workload, wellbeing, morale and the ability for staff to provide good quality of care.

GMMH proved no exception. Board meeting minutes in March 2020, before the onset of the pandemic, showed a gap of hundreds of staff compared to the levels the trust itself deemed appropriate.

Greater Manchester Mental Health Trust headquarters in Prestwich (Image: Gary Oakley/ Manchester Evening News)
In reporting done by the M.E.N. in January 2021, the trust was asked about its staffing and whether it had been affected by the pandemic. GMMH did not provide specific details, but a spokesperson said that the situation was ‘one of the most challenging climates we have ever had to face’.

One senior member of staff told the M.E.N. that ‘barely any’ of the various community teams in the region boasted a full complement of nurses. She believed this meant that there were hundreds of people who had approached their GP and been assessed for care but were now stuck in limbo awaiting treatment.

Community nurses – who provide support for people with manageable conditions – had as many as 30, 40 or even 50 patients relying on them for regular visits, the senior member said at the time, some with serious mental health conditions which could have made them a danger to themselves or others if they were not properly cared for.

The M.E.N. asked GMMH about the number of patients at the time in 2021 who had been assessed but had not assigned a nurse and about the number of patients a typical community nurse would be expected to care for. We did not receive an answer. Andrew Maloney, Director of HR and Deputy CEO for the trust, said the organisation was working to adapt to the challenges posed by the pandemic, adding that ‘despite [the challenging climate], our services have remained safe, service users well-cared for and we have maintained safe staffing levels throughout the COVID-19 pandemic’.

Sam Millers, the mother of Charlie (Image: MEN Media)
A year later, in June 2022, the CQC inspected two of Manchester’s community-based mental health care teams after receiving information from whistleblowers concerned about the standard of care. Adult and working age patients ‘struggled to contact the service for support or when in crisis, leaving people at risk of harm as they had no way to tell staff their mental health had worsened’, the inspection found. The service was also chronically understaffed amid high turnover rates, according to investigators.

In total, there were 428 patients waiting for assessment, 221 patients waiting for treatment across the two teams and more than 260 patients without a care coordinator – someone to plan and be in charge of their treatment.

Deborah Partington, the trust’s Chief Operating Officer at the time, admitted demand had shot up during the pandemic, but said: “In line with the national picture, recruitment of registered professionals for community mental health teams is increasingly difficult and this inevitably puts pressure on the capacity of services.”

Skana was not seen by any other mental health professional for three months in the lead up to her horrendous attack on Emily (Image: Mark Jones)
Still, even as the CQC was raising its concerns in September 2021 following the deaths of Rowan, Charlie and Ania, the ratings for GMMH overall did not change and remained as Good.

And despite the evidence of short-staffing, GMMH continued to try and present an ‘optimistic image of the organisation’. As the Good Governance report explained this week: “There was a very clear desire to present a positive, optimistic image of the organisation which made dissent from this view difficult to surface.

“There was a long-standing drive for continuous growth and expansion which were considered totems of the trust’s success.”

‘Clearly there were service failings the trust leadership had not known about or understood’

In September 2022, the trust was hit with a Panorama bombshell and the consequences were seismic. Regulators and national bodies which had previously praised GMMH urgently reviewed their ratings. Later that November, the Manchester Evening News revealed that NHS England had placed the trust in the Recovery Support Programme, the ‘equivalent to the former special measures’, according to multiple senior NHS sources.

GMMH is currently without an official CQC rating after the watchdog suspended the grading system while it carries out further investigations, but in a report published after the Panorama episode aired, it was given an Inadequate rating for its safety levels.

Bill McCarthy has taken over a chair of the trust after the departure of Rupert Nichols, who left after the Edenfield revelations (Image: GMMH)
“The subsequent CQC final report [following Panorama] and well-led findings have shown up ineffectiveness within the assurance and governance system. Clearly there were service failings the trust leadership had not known about or understood, particularly the implications of the staffing levels,” said the Good Governance review.

“The issues should not be surprising given the speed the trust had grown and the expectations placed on the leadership to sort out complex, long-standing issues in Greater Manchester.

“Services were bit by bit coming under significant pressures from multiple sources, e.g. national financial pressures and recruitment difficulties, the pandemic, etc.”

In the wake of the Edenfield revelations, more GMMH-run services seemed to come under close scrutiny – again ending in serious concerns.

Woodlands Hospital in Little Hulton (Image: Manchester Evening News)
In a CQC report published in February, wards for older people with mental health problems at Woodlands Hospital in Little Hulton were downgraded from a good to inadequate safety rating. The report found that nursing associates – not registered nurses – were left in charge as there was a lack of qualified nurses.

Just this week, another area of GMMH registered a complaint about staffing problems. Child and Adolescent Mental Health Services (CAHMS) in Wigan were taken over by the trust back in 2021.

Responding to a query about staffing levels Rachel Green, associate director of operations at GMMH, told Wigan Town Hall: “We are not fully staffed, I don’t know about anywhere in mental health that is fully staffed.”

‘Inexcusable behaviour and examples of unacceptable care’

The chair of the trust, Rupert Nichols, resigned in November after ‘inexcusable behaviour and examples of unacceptable care’ were exposed at the Edenfield mental health unit, attached to the same Prestwich site where Ania, Rowan and Charlie were treated on other units. He was replaced by Bill McCarthy.

Neil Thwaite, who remains as chief executive of Greater Manchester Mental Health NHS Foundation Trust (Image: UGC MEN)
One senior executive member of staff has been suspended pending an internal investigation at the end of 2022 and has since retired, the M.E.N. can reveal. The trust has not made a formal statement, has not publicly shared their name or disclosed the reason for the departure.

Just days ago, Neil Thwaite, who has worked for the trust since 2006 and been chief executive since April 2018, announced he will be stepping down in due course. He will serve out full notice whilst the trust commences recruitment arrangements, GMMH confirmed on Friday.

Neil commented: “Following the awful failings highlighted at Edenfield and other challenges, the last six months have been incredibly difficult for everyone and through engaging with staff, service users, carers and stakeholders, we have worked on our plan to get the organisation on the right path for recovery.

“Now we have launched our Improvement Plan, which will be implemented over the next two years, I feel this is the right time to hand over the reins to a new CEO. The plan strengthens our approach to ensure the safety of our service users and staff, ensuring high quality care.”

Many of the board members who presided over the failures listed in this piece are still leading the trust.

Source: Manchester Evening News, 17th April 2023

GMMH pilot project to reduce reliance on mental health services and promote eventual independence set for expansion following initial success

A pilot mental health service in the north west could be set for an expansion after its first eight months was heralded a success. The service comes in the form of the Home Engagement and Rehabilitation Team (HEART) at Greater Manchester Mental Health NHS Foundation Trust (GMMH) which was set up to reduce reliance on mental health services and promote eventual independence.

From its initial launch last June to the February of this year, HEART has dedicated up to 2,500 hours of support to 15 patients, with six service users able to achieve successful discharge from long-term hospital stays and a further four expected to join them within the next quarter.

HEART provides intensive support to patients with complex needs throughout the discharge process; this could include everything from general physical and mental health care, all the way to providing guidance on budgeting, cooking or housing arrangements.

Unlike many traditional community mental health teams, HEART works with small caseloads but through extended working hours, allowing for enhanced support from dawn till dusk.

GMMH say this allows HEART – a team made up of psychology professionals, occupational therapists, care co-ordinators, recovery workers and senior practitioners – to deliver more personalised and tailored support based on a specific patient’s needs.

This, combined with the additional ground work done prior to discharge on the wards to build trusting relationships and establish continuity of care, speeds up discharge, smooths integration into the community and ultimately keeps long-term patients out of hospital.

GMMH’s Head of Operations for the Rehabilitation Division, Nigel Hird, said: “The HEART team provides intensive support to individuals who face barriers to discharge. We help solve these barriers, which could include anything from housing and finances to physical health concerns or establishing day-to-day routines. 

“In the first eight months of our pilot, we have demonstrated that this support, which is tailored to the individual needs of our service users, is effective in supporting people to leave hospital and integrate back into the community safely. This has allowed us to help people, who were previously reliant on mental health inpatient units, to progress, whilst freeing up mental health beds for those who need them. 

“Looking to the future, we hope to demonstrate that this intensive support model allows not only for an increase in discharges for individuals with complex needs, but also in a reduction in the rate of readmission longer-term. In time, we hope to roll this support service out to other GM areas, to maximise these benefits for residents.”

The team currently only operates in Manchester and Salford but is hoping for a wider launch into other Greater Manchester areas soon.

Source: NHE, 22nd March 2023

What went wrong at scandal-hit Greater Manchester mental health unit

Greater Manchester Mental Health Trust has been criticised by investigators

Secret footage appears to show member of staff ‘tickling murderer’ at mental health unit (Image: BBC)

‘It has not served you well to believe your own propaganda… [take some] time off from cup half full for a bit’. In the wake of claims of mental health patients being abused in hospital, Greater Manchester Mental Health Trust has been slammed as independent investigators pick the service apart. 

Staff who were unequipped to be in senior management, a ‘combative management’ style, and a trust ‘believing its own propaganda’ were listed among reasons for shocking staff behaviour towards patients at the Edenfield Centre, ‘exposed’ by a BBC Panorama programme. 

The Edenfield Centre is in the grounds of the former Prestwich Hospital and was the subject of a BBC Panorama programme that claims patients were abused. In the weeks following the episode, 30 staff were facing disciplinary action and a dozen were sacked soon after, the Manchester Evening News understands.

READ MORE: Independent review of troubled mental health trust launched following concerns for patient safety

Some staff were filmed by an undercover Panorama reporter embedded in the unit from March to June of last year. The footage in the one-hour programme, aired in September, captured apparent humiliation, verbal abuse, mocking and assault of patients – plus alleged falsification of medical paperwork.

A patient called Joanna was filmed apparently being pinched twice by a member of staff, and, against the rules, three male patients are found in one room watching porn, it is claimed. A member of staff was apparently filmed having a nap on a wall during her shift.

The trust commissioned the Good Governance Institute to conduct a review of systems and processes within the Edenfield Centre and across the trust in the wake of the Panorama programme, under the heading ‘why did we not know?’

Secret footage captured by a Panorama reporter

“Edenfield became its own world,” investigators from the Good Governance Institute told leaders of Greater Manchester Mental Health Trust (GMMH) at a board meeting yesterday (March 27). Over a period of years, the centre became ‘closed to external influence’, breeding an ‘Edenfield management style’ that was ‘combative’ with other parts of the trust.

Inside the centre, ‘clinical leadership had become confused and dysfunctional’ prompting a rift between clinical staff and ‘management. Huge turnover among senior medics left a lack of authority and “staff who had stepped up to keep the service going were often too junior with little experience beyond Edenfield,” said Professor Andrew Corbett-Nolan, the Chief Executive of the Good Governance Institute, presenting his findings to the board.

“The poor physical environment and low staffing levels became normalised and accepted as ‘just the way things were.’” 

The constant turnover over consultants ‘did not draw professional curiosity from trust leadership’, meaning ‘red flags’ were missed.

Panorama uncovered alleged mistreatment of GMMH patients

Beyond the troubled centre itself, the independent reviewers came up with a host of reasons why the centre had been allowed to decline so far despite being part of what was seen to be a successful organisation. Greater Manchester Mental Health Trust was receiving sustained positive feedback from health watchdogs, including the Care Quality Commission, and was put in a position of trust in the region.

However, the Good Governance Institute found that the trust prioritised growth and positive external judgements as signs of success, instead of being ‘spurred to be self-critical’. Matters were made worse by data being reported to executive board members in a ‘highly aggregated way’, meaning there was no indication of areas of concern and not enough detail needed to know where to change staffing levels, for example. 

The Edenfield Centre on the site of the former Prestwich Hospital is the subject of an investigation by GMP after alleged abuse of patients

“There was a very clear desire to present a positive, optimistic image of the organisation which made dissent from this view difficult to surface,” added Professor Corbett-Nolan.

Concerns were also raised during the hours-long board session that the ‘Edenfield management style’ has ‘imprinted’ higher up in the trust as staff from the centre received promotions, one board member spoke of worries that those workers were still in positions of authority. 

Unsafe levels of staffing is a hallmark of the trust, according to the Good Governance summary – and often went unchecked as ‘when standards of safe staffing became problematic, they were not appropriately monitored, allowing normalisation of lower than acceptable standards, placing undue pressure on staff and reliance on temporary fixes’.

“This was specifically prominent a feature within Edenfield,” said Professor Corbett-Nolan’s notes. “There is no escaping the fact that the staffing issues at Edenfield were critically low, exposing service users, staff and the trust to undue risk and this was not acted upon.”

The Good Governance discoveries came with a warning: “Sadly, this picture is not as exceptional as the public may think. This is a national issue and not unique to this trust.”

This is especially true for GMMH, said the presentation, as “the issues should not be surprising given the speed the trust had grown and the expectations placed on the leadership to sort out complex, long-standing issues in Greater Manchester.

“Services were bit by bit coming under significant pressures from multiple sources, e.g. national financial pressures and recruitment difficulties, the pandemic, etc.”

The findings come ahead of the more extensive Good Governance Institute report due to be published tomorrow. The report is one of a slew of measures which were taken to save the beleaguered mental health services following Panorama, including a police investigation which is ongoing. 

The chair of the trust, Rupert Nichols, resigned in November after ‘inexcusable behaviour and examples of unacceptable care’ were ‘exposed’ at a mental health unit, he said. Later that month, the Manchester Evening News revealed that NHS England placed GMMH in the Recovery Support Programme, the ‘equivalent to the former special measures’, according to multiple senior NHS sources.

The presentation gave way to discussion of what the immediate steps are to change the trust, with a number of board members saying action needs to be happening faster, especially to boost staffing levels. Professor Corbett-Nolan told the board that it was heading ‘in the right direction’, but it should ‘get on with it’ and implement recommendations made by the institute now.

Source: Manchester Evening News, 28th March 2023

New GM police and Pennine NHS mental health scheme sees reduction in A&E admissions

Schemes to prevent people in mental health crisis ending up in hospital as well as save police vital time when responding to crimes are being piloted across the North West. It is believed between 20-40% of police time is spent dealing with mental health related calls and incidents, with figures in Manchester peaking during 2021, with more than 38,000 concerns submitted by officers. 

Source: ITV NEWS, Wednesday 5 April 2023

Schemes to prevent people in mental health crisis ending up in hospital as well as save police vital time when responding to crimes are being piloted across the North West.

It is believed between 20-40% of police time is spent dealing with mental health related calls and incidents, with figures in Manchester peaking during 2021, with more than 38,000 concerns submitted by officers. 

Some police chiefs think the reliance on officers is down to a lack of mental health services in the community, with them increasingly being seen as the first resort for people in a crisis. 

The Mental Health Joint Response Unit run by Pennine Care NHS Foundation Trust and Greater Manchester Police (GMP) involves a mental health practitioner and police officer attend mental health crisis call outs to provide the right support, in the right place.

The team has so far helped more than 2,000 people in just a year, and staff say if a mental health specialist had not been with them 800 of those would have been taken to hospital, with a further 607 detained for their own safety.

The scheme sees a mental health practioner based in a response car with a police officer. Credit: ITV News

The role of the clinician is to assess patients at the scene to ensure every appropriate community-based care option is considered, so that A&E, or an admission to a secure section 136 suite (place of safety) are a last resort for those who really need it.

The service operates seven days a week from 5pm to 1am.

Rachael Osbourne, a mental health nurse, helped launch the scheme in Tameside. She believes working alongside the police helps prevent unnecessary hospital admissions. 

Rachael said: “There are nights when there are six or seven jobs happening at once. 

“When that happens… we have to decide as a team how to prioritise those calls and what the immediate risk is.”

How has it helped?

  • Between 31 January 2022 and 22 February 2023, more than 1,965 people were supported across Bury, Heywood, Middleton and Rochdale, Oldham, Stockport, and Tameside (the 5 boroughs covered by Pennine Care)
  • In that period, there were 800 A&E avoidances and 607 section 136 avoidances
  • The cost per 136-suite admission, across partners, is around £2,030. Based on the 607 reported avoidances it’s estimated to have saved £1,232,210. (This doesn’t include the time saved by avoiding an unnecessary A&E trip.)
  • The most frequent outcome was providing mental health advice and support on the scene (504), followed by signposting Pennine Care’s 24-hour helpline (380)
  • Funding has been secured until July 2023, with further discussions underway
  • In 2022, the service was crowned the North West Champion in the ‘excellence in mental health’ category of the NHS Parliamentary Awards. It also won the brilliant partnership award at the 2022 Pennine Care People Awards. 

Sean and Rachel work closely together, attending calls outs where mental health is a concern. Credit: ITV News

A similar service is provided by Greater Manchester Mental Health NHS Foundation Trust (GMMH) and GMP across the other five boroughs of Greater Manchester – Bolton, Manchester, Salford, Trafford, and Wigan.

In 2022, the three organisations (GMP, Pennine Care and GMMH) supported more than 2,600 people across Greater Manchester.

PC Sean Taylor who has also been involved in the pilot since it started said: “It can get very, very busy but people who are in crisis can’t help it, and I personally would much rather they ring and ask for support than struggle in silence.”

If PC Taylor was working alone he might have to wait with people in A&E or put them in a cell to keep them safe, but having Rachael on a call out with him means she is able to access health records, give medical advice and make referrals.

“There are many different ways that things could potentially end,” PC Taylor added after attending a call out to a welfare check on a woman with a history of self-harming.

“If the police are involved with the ambulance, or without the joint response vehicle, the only two ways we could realistically look at are either a voluntary attendance at A&E or, if she was in a public space, to utilise powers under section 136 if immediate intervention is required.

“In this case we were able to do an assessment and establish if there was any risks and see if there was any support we could offer.”

They believe by working together and pooling resources – people in crisis are being offered the help they need as soon as they need it.