The John Denmark Unit is one of only three NHS centres which provide mental health services for people who are deaf. We were accompanied on the inspection by British Sign Language (BSL) interpreters. We had received information of concern in respect of the number of staff employed on the unit that could actually communicate with patients by the use of the British Sign Language (BSL).

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 had received information of concern in relation to care and welfare of young people within the adolescent division at Prestwich Hospital. We made the decision to carry out an unannounced visit to the Gardener Unit and Junction 17 in response to these concerns.

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 carried out this inspection alongside Her Majesty's Inspectorate of Prisons (HMIP). The Care Quality Commission and HMIP routinely coordinate inspections of prisons and healthcare providers.

The mental health team at HMP Hindley YOI aimed to mirror and provide the same support and treatment that would be offered to young people suffering with mental health problems living in the community.

Prison staff told us that they had good working relationships with the mental health team. They told us that mental healthcare staff were supportive in managing young people’s behaviours including advising prison staff on developing strategies for managing and understanding these behaviours. Young people told us that staff had helped them to understand their behaviours and their feelings.

Young people told us they had been involved and included in their care and support plan.

Young people told us that staff had helped them to understand their behaviours and their feelings.

One young person said,”…they’ve helped me a lot, it’s been really good and I think I’ll be ok when I’m released”.

The Inreach team was made up of five senior mental health nurses, one of whom was the team leader. All staff had extensive experience of working in the criminal justice service. The team was also supported by a visiting psychiatrist. The team was established in 2008 and was dedicated to improving outcomes for prisoners with mental health problems.

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.”

We reviewed the results from the national survey: What service users said about care in hospital 2009. The trust's scores for this outcome were all within the expected range. A trust's score that falls within this expected range cannot be said to be any better or worse than what we would reasonably expect when looking at how all other trusts have performed and the number of people that responded to the survey.

We reviewed the results from the national survey: What service users said about community based care 2010. The trust's scores were all within the expected range.

We carried out this inspection alongside Her Majesty's Inspectorate of Prisons (HMIP). The Care Quality Commission and HMIP routinely coordinate inspections of prisons and healthcare providers.

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.