Macclesfield District General Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of regulations 9, 16 and 20 in relation to timely care and treatment, complaints and duty of candour.

There were significant shortfalls in access and flow with delays to admissions impacting on the emergency department and poor discharge planning compounded by to discharges delays caused by transport and medicines. Complaints handling and duty of candour compliance were poor. Planning for future care, including end-of-life decisions, was also inconsistent.

We have not awarded this service a score for Responsive.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The records we reviewed for patients with a learning disability did not always contain a hospital passport, meaning staff were unable to tailor care to that individual’s needs and priorities. The breaches of the Mental Capacity Act outlined in the consent to care and treatment section meant that patients care was not always person-centred.

Staff used a reasonable adjustment care plan to identify risks to patients. Staff could give examples of how they had delivered person centred care, such as arranging for a patient with complex medical needs to visit the pond in the hospital grounds to see the ducks.

The service audited compliance with person centred care as part of their monthly quality audits. For the last 6 months all medical wards had scored above 75% consistently.

We observed posters on the wards explaining how to access an advocate for people who felt they needed it.

The service adjusted visiting times for some patients for example those in the last hours of their life, or who required a carer due to their condition. The service used signage to indicate if patients were at end of life and tried to provide a side room for them.

The service was part of “John’s Campaign”, supporting carers of patients who lived with dementia offering open visiting hours and involvement in care planning.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

During our assessment, we saw patients deconditioning whilst spending long periods of time being nursed in the emergency department corridors. Patients were spending more than 10 hours on trolleys and waiting room chairs once a decision to admit had been made due to no beds being available on the wards.

The service had virtual wards for frailty, respiratory, general medicine and cardiology and staff had access to patients’ GP records for continuity of care.

Leaders told us that they had developed a pathway for patients who came to the emergency department with pneumonia who required follow up and could be seen by the respiratory clinic instead of being discharged back to their GP so that they would have continuity in their care.

We saw multiagency working to access community services including homecare, residential or nursing beds.

We scored the service as 2. The evidence showed some shortfalls. We scored the service as 2. The evidence showed some shortfalls. The service did provide information to people; however, this was not always up-to-date information in formats that were tailored to individual needs.

Wards had patient information leaflets and boards; however, we saw examples of these that were outdated and no longer in line with national guidance, with one set of leaflets from 2018.

On the gastroenterology ward, we saw a patient information leaflet dated 2021 was in use and did not reflect current guidance.

Staff gave patients and their loved ones a leaflet with the information for the ward such as the times of ward rounds, mealtimes and what uniforms staff roles wore.

We scored the service as 2. The evidence showed some shortfalls however, the service did make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The service’s performance in complaints averaged 68.5% over the six months prior to inspection, which was below the Trust’s 90% target. However, performance was variable and had improved over time, ranging from 16% in January and 29% in February and went on to achieve 100% compliance in March, April, and May. Despite this improvement, the Trust did not have effective systems to respond to complaints, as responses were consistently outside of the Trust’s targets. This was a breach of regulation 16.

The service’s compliance with duty of candour for quarter 4 2024/2025 was below target at 77.5%. This was a breach of regulation 20.

We saw complaints information on wards and patients told us they knew how to make a complaint or raise a concern and when they had raised concerns these had been addressed promptly. People said that they had been apologised to for any shortfalls in their care that they raised. The Patient Advice and Liaison Service (PALS) also visited inpatient areas weekly to speak with patients and their loved ones about their experience and to identify any concerns so that they could be resolved quickly.

Complaints were investigated by senior leaders within the service. Managers would share complaints and compliments and any learning with all staff through face-to-face meetings, newsletters and emails.

We saw examples of how the trust had implemented changes in response to complaints. For example, following concerns raised by a patient the trust implemented training on the use of inflatable pressure wristbands used after cardiac procedures.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure that people could access the care, support and treatment they needed when they needed it.

We identified areas of poor access and flow through the hospital, with bottlenecks at the medical assessment unit (MAU) impacting on long waits in ED.

Patients who required specialised care such as chest drains or NIV, were admitted directly from the emergency department to the ward.

The joint working between the hospital bed team and the transfer of care hub was not effective as they were working to different goals. This has been included in further detail in the equity in access section of the report. The two services used different figures for how many patients in the trust were ready for discharge and/or had No Criteria to Reside (NCTR). The bed management team counted patients classed as medically optimised for their NCTR figures, and the transfer of care hub only counted those patients who were medically optimised and had been seen by therapies.

Throughout the assessment there was no clear figure on who was NCTR and who was not. We were given different figures that ranged from 30% of patients in the hospital to 28 patients in total which on estimate was around 7%.

We saw that discharge planning did not begin at the point of admission and a lack of structured and planned access to therapies in particular compromised flow through the hospital.

Discharge to Assess had been introduced in December 2024, however this was only commenced if and when the patient was on a specific pathway e.g. for rehabilitation or a short stay patient. This meant there was no discharge planning from admission for other patients who did not meet this pathways criterion.

We found issues with access to transport from the discharge lounge, and we saw patients spending long periods of time in the discharge lounge to be discharged, many were awaiting their prescribed medicines. We also saw a patient who was transferred to the discharge lounge who could not be discharged as their living arrangements had not been assessed.

Leaders told us that the top 3 reasons for delayed discharge since March 2025 were delayed medical reviews, transport and medicines to take home. The data showed that 110 patients were delayed awaiting medical review of need for supported discharge, 108 patients delayed by access to transport services and 63 patients delayed by waits for medicines. We observed all 3 of these issues causing delays during the inspection.

These issues in equity in access were a breach of regulation 9.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider had not undertaken equality impact assessments on all of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff told us that there were delays for Allied Health Professional (AHP’s) particularly SALT and that therapy input was a theme in delayed discharges. This meant that patients with swallowing issues would be more likely to experience delayed discharge.

The trust had learning disabilities and autism strategy goals which we saw displayed on posters; however, we did not see that the care given to patients with learning disabilities was always in line with these.

Staff within the service and the wider organisation understood and could give examples of people who were most likely to experience inequality in experience or outcomes within their community.

Staff were trained in equality, diversity, inclusion and human rights, with medical care staffing at 95% compliance.

We scored the service as 2. The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We observed from review of records and heard from staff that planning for the future was poor, with RESPECT used inconsistently and DNACPR conversations taking place when patients had deteriorated and were no longer able to contribute to the plan for their future, when there had been missed opportunities for these discussions at an earlier stage. Late acknowledgment of end of life had also been highlighted in complaints.

Staff audited DNACPR documentation annually. The 2023 and 2024 audits showed staff mostly completed DNACPR documentation appropriately.

However, we heard of an example of a patient on a ward with a long length of stay due to waiting for a highly specialised bed in a facility out of the area and how the staff were working with him and the therapies team to ensure his rehabilitation was not halted by the wait.