Greater Manchester Mental Health (GMMH) NHS Foundation Trust is pioneering the care and support of people with mental health issues. This summer, it was ranked the second most research-active mental health trust in England.
The national recognition is well deserved. In the past financial year, the trust took part in 158 clinical research studies, which involved more than 2,000 of its patients. The trust had the highest number of patients taking part in research in any mental health trust last year outside of London. The statistics illustrate Manchester’s belief that its research is “real world”, according to Prof Nav Kapur, from the University of Manchester, who has a global reputation in suicide prevention and is a consultant in adult psychiatry at the trust. He says: “I like to think that everything we are involved in has a practical focus. When I look at the research that is going on in Manchester, it’s vibrant and exciting and has the potential to change lives. And any organisation that is research-focused is also forward thinking, innovative and always looking for the latest ways of treating its service users.
“Work carried out by colleagues and I showed that mental health services changes – such as 24-hour crisis teams, dual diagnosis services and involving families in reviews after suicide – may have saved 200 to 300 lives per year nationally.”
GMMH was created in January last year, when the Greater Manchester West Mental Health NHS Foundation Trust acquired Manchester Mental Health and Social Care NHS Trust. The new organisation has 851 patient beds, services in 130 locations across the region, and runs more than 700 community and out-patient clinics a week. In the last year it treated 53,000 patients.
The trust has a track record of contributing to suicide prevention research and policy both nationally and globally. It is a national centre of excellence for specialist psychiatric forensic services and for children and young people’s services. It also provides mental health support to prisons in the north-west of England.
But Manchester also excels in other areas. It is one of only three mental health trusts in England to offer specialist care and support to hearing-impaired and deaf service users. It has also established six specialist research units to expand its clinical excellence. The units specialise in research into psychosis, dementia patient safety, the impact of trauma on mental health, the use of digital technology to support children and young people with mental health issues, and another unit that focuses exclusively on youth mental health.
Kapur leads the suicide work of the government’s National Confidential Inquiry into Suicide and Safety in Mental Health and has chaired mental health guideline groups for the National Institute for Health and Care Excellence. He says: “I think what is so unusual about Manchester is just how strong the research is – its breadth and its quality – and how it is embedded in the NHS. One of the things the trust is really keen on is making sure that we are getting our research back into the clinical workforce. The plan going forward is that I will be taking some of the learning from our research and going and spending face-to-face time with nurses and clinical teams in the places they work. Together we’ll think about the clinical challenges they face and how the latest research can help them provide better care.”
The trust’s excellence in clinical research is matched by the quality of its senior management team and some of its services. Trust leadership was ranked as “outstanding” by Care Quality Commission inspectors in the latest report. The leadership team was described as “inspiring”. Inspectors also highlighted substance misuse services and child and adolescent wards as examples of “outstanding practice”. They praised the rapid access to alcohol services for patients attending emergency departments and the use of community-based activities for substance misusers. The development of advocates to support young inpatients was also singled out, and how the patients were encouraged to volunteer or even find part-time work.
Dr Jonathan Dewhurst is GMMH’s clinical lead consultant psychiatrist in substance misuse services. He manages addiction consultants, GPs with a special interest, junior doctors, nurse prescribers and the multi-disciplinary teams. He is also the consultant’s voice with senior management. Dewhurst says: “I do think that, as a trust, we are at the cutting edge. I think the real strength in our substance misuse services is the partnership between operational and clinical – we are clinically led and operationally partnered.
“Our service to tackle head-on the issue of repeat stays in accident and emergency wards for people living with alcohol addictions was pioneered in Greater Manchester. Our rapid access to alcohol detoxification acute referral (RADAR) ward was the first of its kind in the country and has a 97% successful detox rate, while 75% of people discharged from the RADAR ward are not admitted to hospital services in the following three months. Findings from an independent evaluation by Liverpool John Moores University has estimated that the service could save the NHS up to £2m based on 80% occupancy at the unit.”
Dewhurst says being given the outstanding practice recognition was a real boost, as substance misuse services can often be perceived as not being part of core mental health services. He says: “We were totally buoyed by that recognition.”
The “outstanding” label given to trust leaders is also well founded. Dewhurst came to Manchester eight years ago as a newly qualified consultant and since then has progressed to his current management role. He’s been supported at every step – from the networking system established to support newly qualified consultants to being funded via the NHS Leadership Academy to complete an MSc in healthcare leadership.
His managers encouraged him to apply for election as a member of the addictions faculty of the Royal College of Psychiatrists. His dissertation project – which looked at supporting substance misuse service teams with their own wellbeing at a time of austerity – was so successful that the trust is now developing a coaching network to support the wellbeing of staff across the trust, as this also improves patient care. Dewhurst says: “I do feel well led and supported, and not just in terms of my clinical supervision. If tomorrow all our substance misuse services disappeared, I would still stay here because I know the trust would continue to invest in me and support me to deliver outstanding patient care.”
