A "significant cultural shift" is required at the NHS trust responsible for a borough mental health ward where shocking footage of abuse of patients was filmed, a review has found.
In September 2022, BBC Panorama aired a documentary after undercover reporter, Alan Haslam spent three months working at The Edenfield Centre in Prestwich as a healthcare support worker, and caught a catalogue of disturbing incidents on camera.
Among harrowing scenes, staff were seen mocking, slapping and pinching patients and inappropriate restraint was commonly used.
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”.
NHS England asked Professor Oliver Shanley OBE to lead an independent review of the trust following the Panorama programme and the findings have now been published.
The review found a "significant cultural shift" is needed but noted that "we have seen some signs that the changes are starting to happen".
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After speaking with more than 400 people and documenting what the review found, the report said: "We hope that this review will support GMMH to provide high quality services to the people and communities they serve.
"We know from listening to so many people, that this is what their staff want, it is what their patients, families and carers want, and it is what their communities deserve.
"A fundamental change in emphasis is required to achieve this. The priority must be on people, on quality, and it must be on listening to those who use and work in their services.
"The trust has many positive attributes, not least its many talented staff. It must focus on enabling those staff to thrive.
"This will require a significant cultural shift if the required changes are to happen successfully. The scale of this should not be underestimated.
"We have seen some signs that the changes are starting to happen and, if sustained, this is a positive step forward.
"We heard from some that staffing at the trust is too constrained to meaningfully change culture.
"Our view is that culture starts with the board which dictates the tone of the organisation, what is important, the extent to which staff feel listened to, and the priority given to continuously improving services.
"The partner organisations that work alongside the trust must also focus on supporting GMMH to make improvements and model the compassionate leadership that is required to achieve sustainable change.
"These will not be achieved by ticking a box in an action plan; the change will be made by creating a vision and a future for the trust that people believe in.
"We hope the trust will use this review to reflect on what has happened and to now focus on the future and the changes that need to be made."
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A series of recommendations have been published in the report.
A NHS England North West spokesperson said: “We welcome the publication of the independent review and are grateful to Professor Shanley and his team for this report, as well as the patients, families and carers, and staff, who engaged with the review, for the thorough work it represents, and the clear focus on learning from the issues that led to it being commissioned.
“NHS England is committed to the delivery of high quality care for all patients and commissioned this independent review to look into all the issues and allegations raised by patients, their families and carers and in the media, and took immediate action to carry out a rapid review to prioritise support and take steps to protect patients and improve patient safety.
“This involved helping the Edenfield Unit to reduce the number of patients it was caring for while improvements were implemented through our recovery support programme and the allocation of an improvement director.
“We now owe it to every patient cared for by the trust and the staff working for them and across the NHS, to ensure the review’s recommendations are implemented, and sustained and genuine improvements are made in the care being delivered to patients."
In response to the report, GMMH chief executive Jan Ditheridge said: “We are truly sorry for the events described in the report.
"We worked openly and constructively with Professor Shanley and the team during their time at GMMH last year, we take the findings seriously and accept the recommendations.
“We cannot change the past, but we are committed to a much-improved future – one in which all service users and carers feel safe and supported, and our people are able to do their best work.
“Our improvement plan sets out a range of actions that are addressing the issues raised in this report.
"Many of these actions have been completed but we know there is more to do to ensure all of our communities get high quality and safe care all of the time.
“Service users are already safer, staff are more supported, leadership and governance is stronger, and our culture is getting better – for example, we have recruited more than 350 nurses in the last six months alone, and we have two full time Freedom to Speak Up Guardians and a network of new champions appointed, giving our people a voice and clear ways of raising issues and driving progress.
“We are working with the review team, partners, and colleagues to fully implement the recommendations ensuring our service users and their carers are central to everything we do.”
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