Macclesfield District General Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created and promoted high-quality, person-centred care.

The service was well-led with inclusive leadership and strong governance structures. Staff felt supported and able to speak up. Leaders understood key risks and worked collaboratively with partners to improve care. However, the service did not have a clear vision for the future.

We have not awarded this service a score for Well-led.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

At the time of our assessment there was no formal vision or strategy for the service. The provider had re-started the maternity service and there was an ongoing period of transition. The service was currently in a period of stabilisation and reviewing staffing numbers to ensure there were sufficient staff.

Staff did not know what the provider’s vision was as it had not been developed. The providers values were:

• Treat each other with respect and dignity.
• Commitment to quality care
• Show compassion
• Improve lives
• Working together for patients
• Make everyone count.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There were clearly defined leadership roles for the maternity services covering medical, midwifery and pediatric teams. Leaders had the skills, knowledge and experience to perform their roles. The service had specialist midwives with specific responsibilities, such as recruitment, safeguarding, governance and audit. The service was led by a Head of Midwifery, a clinical lead Obstetric/Gynecology consultant and a Neonatal consultant.

Staff told us senior leaders were visible in the service and approachable for patients and staff. A supernumerary shift coordinator was in place on each shift.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

The trust had a freedom to speak up (FTSU) policy that provided guidance for staff to raise concerns internally and externally. The policy outlined the roles and responsibilities of the FTSU ambassadors, guardian and champions.

The trust had a FTSU guardian who was a member of the governance team.

Staff we spoke with told us of their experiences in raising concerns about an external matter and how the champions, ambassadors and guardian had supported them in raising their concerns externally.

Staff felt well supported by the FTSU champions, guardian and managers in raising concerns. The main concern raised during our assessment was about staffing which had been escalated to senior management.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had three staff networks, cultural diversity, disabled and carers and an LGBT+ network.

Staff we spoke with felt supported and flexible working agreements were in place to account for personal circumstances such as caring responsibilities and health issues.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The maternity service had a governance lead who had recently started in this role. The provider had a draft improvement plan to include changes to reporting, documentation and audit.

The provider had made improvements to the service which included a second theatre (one for elective and the other for emergency) in line with recommendations and standards.

The service had a risk register at ward, directorate and board level. Risks were scored and reviewed at ward and divisional meetings. The call bell system was on the risk register and awaiting replacement. Staffing and the electronic record system were also on the risk register. A staffing paper was presented to board to increase the establishment and at the time of the assessment a decision had not been made. A dedicated electronic record system business case was in progress. Risks were shared in staff huddles.

The service complied with the clinical negligence scheme for trusts (CNST).

However, some mandatory training figures were below 80% due to staffing pressure on some shifts and some staff had been pulled onto clinical duties from admin time to maintain safe care and treatment. This was not on the risk register.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

We received limited feedback from partners for the service.

The service worked alongside multidisciplinary teams within the local authority, police, inpatient psychiatry and neonatal where required. We saw an example of this during our assessment where mother and baby were supported during and after the delivery.

The community midwifery teams covered East Cheshire area and supported post-natal care for women discharged from other local hospitals

The service moved from local maternity and neonatal system (LMNS) to Cheshire and Merseyside central dashboard to review themes and trends against the region.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had introduced ways of improving the service in all areas of the maternity service. For example, theatre staff had a clear process in place for staff to escalate concerns about the noise levels known as’10,000ft’ This helped to reduce the noise and aid concentration.

Staff told us they had supported changes such as the triage documentation. Staff had taken the best ideas from the locations they had been re-deployed to and used them to improve the Macclesfield maternity triage paperwork.

Patient leaflets had been updated following patient feedback.