Macclesfield District General Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we did not rate this key question. At this assessment the rating has remained as Good from the 2018 inspection.

This meant the effectiveness of people’s care, treatment and support achieved good outcomes.

The service demonstrated strong multidisciplinary teamwork to assess needs and encouraged women to live healthier lives. Evidence-based care and treatment followed national guidance and best practice. Staff followed the Mental Capacity Act standards.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed five care records during our assessment which demonstrated care plans were reviewed with the pregnant women and their preferences and needs were considered and discussed.

Women presenting in the maternity service were assessed and triaged by trained staff and placed on care pathways depending on clinical risk and needs. Staff completed risk assessments at appropriate times and a good standard of record keeping.

The service had access to specialist mental health support teams. Staff understood how to seek guidance and advice to support women with mental health concerns.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Clinical guidelines and pathways were based on national guidance, such as The National Institute for Health and Care Excellence (NICE) and The Royal College of Obstetricians and Gynaecologists. We reviewed a number of care pathways, including postpartum haemorrhage (PPH), induction of labour and assisted birth and found these were based on best practice guidance.

Staff used nationally recognised maternity triage assessment tools and used national maternity early warning system (MEWS) and newborn early warning system (NEWS) to assess and respond to any change in people’s condition, in line with national guidance.

Staff made sure people who used the service had enough to eat and drink including those with specialist nutrition and hydration needs. Staff used nationally recognised screening tools to monitor people at risk of malnutrition. Women were given a choice of food and drink, and their nutritional needs were monitored and assessed by staff. Staff supported mothers with breastfeeding.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We saw there was effective communication between multidisciplinary teams across the service. Daily staff huddles and handover meetings took place to ensure staff had up-to-date information about risks and concerns. Staff at all levels took part in routine multidisciplinary team meetings to plan and deliver safe care and treatment.

Supporting services such as scanning, pathology, diagnostics, community midwifery teams were available to support women along their pregnancy journey.

Care records and our observations showed that there was routine input from midwifery, medical staff and allied health professionals in the delivery of maternity care and treatment.

Obstetricians and midwives worked along side each other on the delivery ward and had a daily handover meeting to discuss patient care plans.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service had health promotion information displayed on notice boards and had information leaflets that were readily available across the areas we inspected. Women were referred to specialist support if needed for smoking cessation, alcohol or drug abuse.

Women with weight concerns were given advice on healthy eating and referred to dietitians or signposted to specialist support services.

The service had specialist midwives to support pregnant women with mental health, learning disabilities, neurodiversity, safeguarding and breast feeding when needed.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The maternity service implemented saving babies lives care bundles and carried out audits to monitor outcomes against indicators such as fetal growth assessment and management, reduced fetal movement awareness, reducing preterm birth and reducing smoking in pregnancy.

Outcomes for women who used the service were positive and reviewed using a red flag system for labour and postnatal wards. Red flags included delays in care, pain relief, admission and monitored staffing. These were reported to governance for review and identified areas for improvement.

The service had completed clinical audits to improve outcomes. These included patient record reviews, gap analysis of standards and recommendations for the service. Actions plans for gaps and improvement were monitored and reviewed. For example, the Ockenden audit (an independent review of maternity services at an NHS trust by the former Secretary of State for Health). The actions were completed following our on-site assessment July 2025.

The service had seen a reduction in post-partum heamorrhage since the service reopened.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Consent/Mental Health Act and Deprivation of liberty safeguards training was 69% for obstetricians and 98% for midwifery staff as of June 2025.

We saw staff understood women’s rights and decisions around consent. Staff understood the importance of making sure women fully understood what they were consenting to and the importance of obtained consent before they delivered care, support and treatment.

Written consent was sought for certain procedures, such as elective cesarean sections. We saw staff gained consent from women for care and treatment in line with legislation.

If a women lacked capacity to make her own decisions, staff told us they sought consent from an appropriate person (advocate, carer or relative) who could legally make decisions on her behalf. When this was not possible, staff made decisions about care and treatment in the best interests of the women and involved her representatives and other healthcare and legal professionals and recorded this in the patient’s record.

The service had a lead safeguarding midwife. The trust safeguarding team supported staff for complex safeguarding concerns and guidance around consent, mental capacity and best interest decision making processes.