Assurance Review of the actions taken by Greater Manchester Mental Health NHS Foundation Trust and Pennine Care NHS Foundation Trust

Both PCFT and GMMH should clarify the MAPPA status at the point of transfer to other services for patients with forensic histories. This should also include identification and involvement of probation/NOMS for appropriate patients.

a. The Trust must provide clear guidelines for risk assessment and care planning for the titration of Clozapine in the community.
b. The Trust and NHS Manchester CCG must develop and agree guidance for GPs on the administration of Clozapine and the limited function of blood tests for titration.

The Trust AWOL policy should be amended to ensure that any decision to discharge an AWOL patient in their absence is explicitly risk assessed, supported by a detailed decision making tool, and reported on centrally to ensure practice is monitored.

The Trust should assure themselves and commissioners that arrangements are in place to provide appropriate medical cover on the acute adult in-patient wards to ensure medical oversight and continuity of care.

The Trust must ensure that discharge planning arrangements on the adult acute in-patient wards comply with Trust policy, and that arrangements are made to appropriately grade those patients with complex needs and often forensic and/or substance misuse histories who are at high risk of disengagement from mental health services, and who should receive assertive and proactive care to prevent them being lost to services, even if discharged whilst AWOL.

NHS Manchester CCG should assure themselves that the Trust is identifying the cohort of patients at most risk of disengagement from services, who have complex needs and often forensic histories with a background of drug abuse. This identification should then lead to the Trust being able to provide an assertive care pathway for this group with escalation routes into appropriate inpatient beds and access to appropriate clinical and forensic support and advice when needed.