Macclesfield District General Hospital

On this page

• 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 rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service delivered consistently good outcomes, with effective assessments, evidence-based care, and strong multidisciplinary teamwork. Patients’ needs were well documented despite a recent IT system change, and national guidelines were embedded in practice. Staff worked closely with mental health teams and other specialists, ensuring coordinated care and smooth transitions. People were supported to live healthier lives, and outcomes were monitored through audits and surveys. Consent processes were robust, and patients were involved in decisions about their care.

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 23 patient care records; 3 were of people with a presenting mental health issue.

Despite the trust moving to a new electronic patient record system only 2 weeks previously we saw records were up to date and showed detailed assessments were undertaken leading to effective ongoing care meeting people’s needs. Staff told us that training on the new IT system had gone well and they had been well supported during the transition.

Staff could add flags to patient records to identify patients with additional needs or who might require additional support. This included alert flags for patients with allergies, mental health needs, people with learning disability, autism or dementia. They could also record Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms, which created a personalised recommendation for clinical care in emergency situations, where patients were not able to make decisions or express their wishes. We saw evidence of this on patient records during the inspection.

People who used the service told us that staff discussed their needs with them, and they were involved in how care and treatment was planned. Patients were offered pain relief and refreshments while they waited to be seen by a clinician. Staff used recognised tools to assess pain for patients and those who were unable to communicate verbally.

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 policies used in the department were developed and reviewed in line with National Institute for Health and Care Excellence (NICE), the Royal College of Emergency Medicine (RCEM) and other relevant bodies. Policies and protocols were accessible on the hospital’s intranet.

The service had governance processes to ensure national legislation, evidence-based best practice and required standards were reviewed and were registered to participate in national clinical audit programmes. If needed, local guidance/working practices were updated and communicated, with training, to the emergency department staff. The service reviewed Getting It Right First Time (GIRFT) reports, which provided clear actions and best practice recommendations to improve patient outcomes.

We observed that national guidelines were referred to during the doctor’s handovers, showing they were embedded in the department.

There were a variety of up to date, evidence-based pathways used in the department such as the management of deep vein thrombosis (DVT), surgical abscess, anaemia, hypertension, stroke and mental health. We found these were understood by staff and were being used effectively to manage patients’ care.

Patients told us staff had informed them about their plan of care. Patients said their nutrition and hydration needs had been met during their wait in the emergency department, regardless of the area they were boarded or waiting in. Patients and their relatives who were waiting for treatment in the waiting area had access to water and hot drinks. All patients had access to hot food.

We reviewed patient records and found these to be detailed with important information which linked with current good practice on how to support people with their health conditions. These included interventions staff had made, and advice sought when required.

The trust had an agreement in place with the neighbouring mental health trust to provide psychiatric and mental health support to patients in the emergency department. This enabled staff to protect the rights of patients subject to the Mental Health Act and follow the Code of Practice. At handover meetings, staff routinely referred to the psychological and emotional needs of patients, their relatives, and carers.

Staff had access and support from occupational therapists, safeguarding teams, pharmacy staff, speech and language therapists and dieticians.

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.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We saw multidisciplinary working with services, such as occupational therapy and diagnostics to identify the most appropriate care and treatment for patients.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment and support. The trust used an electronic patient record (EPR) throughout the hospital, which had been recently implemented. Therefore, hospital teams completed the same record for each patient. This meant patient information was accessible for all, easy to find and helped facilitate better communication between healthcare professionals. Staff said this had led to a more coordinated and patient-centred approach to care. In addition, other system partners used the same IT system making information sharing more efficient and effective. Feedback from staff was extremely positive regarding the EPR system.

The ED team worked closely with the psychiatric liaison team from the local mental health trust. The team provided mental health assessments for patients within the ED environment and provided support for the ED team. The team were based at the hospital which made contacting them straight forward. ED staff were also able to access the child and adolescent mental health services (CAMHS) for young people 24 hours a day 7 days a week. Staff within ED were complementary about these and other supporting agencies they worked closely with. For example, regular partnership in practice meetings took place between ED staff, the local mental health trust, the local ambulance service, police and commissioners.

The frailty team attended the emergency department as required to review and assess patients who could be cared for in the frailty unit. Chronic pain teams, learning disabilities teams and dementia support were available.

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, reduce their future needs for care and support.

The service had relevant information promoting healthy lifestyles and support in the department. Staff assessed each patient’s health requirements when admitted and provided support for any individual needs to live a healthier lifestyle. There were information leaflets in patient areas, and these addressed appropriate topics including cancer, mental health, nutrition, alcohol abuse and how to access services other than the ED.

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 service took part in the urgent and emergency care survey 2024, a patient experience survey conducted by the Care Quality Commission (CQC) in England. Its aim was to assess patient experiences in emergency departments (ED) including wait times, communication, and overall quality of care. The service performed the same as the England average for all the questions.

The service participated in Getting it Right First Time (GIRFT) a national initiative by NHS England to help emergency departments (ED) in England improve their performance. Data supplied by the trust showed they had made improvements in relation to discharges and the implementation of treatment function codes.

The trust had a ward accreditation scheme, which assessed each area, ward or department at various increments of time based on their previous rating. For instance, wards scored as amber (showing some shortfalls) would be reassessed in 6-9 months’ time and wards scored as blue (outstanding) would be reassessed annually.

Every month a condensed version of this assessment was undertaken on every ward to monitor continuous compliance. At the time of our assessment the ED department was mostly amber whereas the MAU was mainly green or blue across the 17 assessment criteria.

The service had a good understanding of their local community and how they used health and care services. Leaders actively contributed to discussions with the wider health and care system on how services could be improved for their local community and targeted non-English speaking patients, homelessness, mental health, learning disabilities, gender identity and drug and alcohol misuse.

The service had registered to participate in national audits which included Time Critical Medications and Mental Health Self Harm audits for 2025-26.

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.

Consultants were able to describe the process of consent according to trust and RCEM guidelines. Consent was recorded within the patient record and there were provisions and protocols in place pertaining to patients who did not have capacity to consent.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They supported patients who lacked capacity to make their own decisions or when experiencing mental ill health. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

Staff gained consent from patients for their care and treatment during triage in line with legislation and guidance and this was clearly recorded in the patients’ records.

When patients could not give consent, staff made decisions in their best interest, taking into account patients’ wishes, culture and traditions. The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in service users’ best interest when applying to deprive the service user of their liberty. Managers monitored the use of Deprivation of Liberty Safeguards (DoLS) and made sure staff knew how to complete DoLS applications.

Staff were supported by the trust safeguarding team for guidance around consent, mental capacity and best interest decisions making processes.

Compliance for consent training for medical and dental staff was at 72.4%. Dementia training compliance was 51.7%. Compliance for consent training for nursing staff was at 91.8%. Dementia training compliance was also 91.8%.