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 requires improvement. At this assessment the rating has remained requires improvement.

The service was in breach of legal regulations in relation to complaints, duty of candour and person-centred care.

There were significant challenges, including poor compliance with complaints handling and duty of candour, long waits for admission, and failure to meet key performance targets. Patients often spent extended periods in corridors or MAU, and ambulance handovers exceeded national standards. Access and flow were compromised by bed shortages and complex discharges. However, staff provided person-centred care, provided tailored information, and support for diverse needs, and worked with partners to maintain continuity. Planning for future care and equality initiatives were evident.

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 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients told us they had received an appropriate assessment of their health needs. Patients in temporary escalation areas told us staff met their emotional and health care needs. Patients told us they were consulted about their treatment plan and care in general. Patients told us they had their tests completed and treatment plan explained to them, and they were satisfied with the standard of care, referring to staff as “doing the best they can in the circumstances” but acknowledging the wait time saying, “It could be better.”

Staff considered patients' individuals needs and preferences. They undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure ulcers. Patients were provided with food, blankets, pressure-relieving equipment and additional pillows.

Patients in the paediatric ED had access to sensory toys, feelings and emotion puzzle cards, books and games.

An advocacy team was available to support those patients with additional needs and requirements.

We saw positive interactions between staff and patients with complex needs to ensure they remained settled in the department. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs.

There were also link workers available to provide additional support and advice to staff for supporting patients with learning and mental health difficulties.

We scored the service as 2. 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 including on 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 ED team engaged with other healthcare providers both within and external to the hospital to ensure that patients received appropriate follow-up care. However, patients referred to speciality teams within the hospital waited many hours to be reviewed and transferred to appropriate wards.

People’s individual needs and preferences were considered and acted upon, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care.

All patients attending the department were registered on the EPR and staff completed the documentation of hospital handover using an electronic system.

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

External partners, such as GPs, community nurses, and social workers were involved to enable continuity of care and support for discharge. The department had formal agreements with other NHS Trusts and tertiary centres to facilitate seamless transfers of care where required.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared within the EPR, in accordance with the Accessible Information Standard.

The waiting rooms within each area had a board on which waiting times where manually displayed and updated regularly. We observed that staff made regular announcements to inform patients of what the waiting times were and gave them the names of staff managing the shift should they need to raise any concerns.

The treating clinician was responsible for providing the discharge advice and ensured it was in an accessible format for the patient. When altering or adding medication, this was written down for the patient as well as communicated to their GP via electronic discharge letter sent straight to the surgery.

The trust had a printable accessible information poster and leaflet within its policy. Patients had access to information leaflets regarding medicine and treatment plans if they required them.

We saw a wide variety of resources including leaflets, and interpreter services were available to ensure the patients understood their care and treatment, if required.

We observed appropriate conversations between medical staff, patients and family members about treatment plans and options. We saw there was a private family room where staff could take families and carers, when delivering bad news.

Staff told us they had received General Data Protection Regulation training (GDPR) and could explain their duties regarding confidentiality and data sharing.

Staff had access to GDPR and equality and diversity policies on the intranet. Staff could also ask for advice from the trust Caldicott Guardian. A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people's health and care information and making sure it is used properly.

We scored the service as 1. The evidence showed significant shortfalls. The service did not show full adherence to the complaints policy, limiting assurance that complaints were resolved and learning shared without delay, despite people being able to give feedback easily.

The service’s performance in complaints averaged 62.5% 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 37.5% in January and February and went on to achieve 100% compliance in March, May, and June. 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 63.4%. The trust did not meet targets for timely response to adhere to the requirements of the Duty of Candour. This was a breach of regulation 20.

Patients and families were supported to raise their concerns with the department. In the first instance this was to escalate to staff and leadership team. If they were unable to provide a resolution, patients were signposted to Patient Advice Liaison Service (PALS).

Staff understood the policy on complaints and knew how to handle them. Managers investigated complaints and identified themes.

We saw complaints information on the UEC departments 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.

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

The PALS team visited the ED daily and provided an outreach service to speak with patients in the department about their experience, to identify concerns, and facilitate early resolution of any concerns or complaints.

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.

The ED operated 24/7 year-round, ensuring constant access for patients in need. However, people faced significant delays in accessing care, support, and treatment in the service. Staff were not always able to ensure that patients received timely care and support due to delays in access and ongoing capacity pressures.

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

Once a decision to admit a patient into the hospital had been made in the emergency department, most patients were streamed to MAU. The purpose of MAU was to allow patients to be ‘streamed’ in a timely way from the emergency department, however we saw examples of patients waiting more than 10 hours after the decision to admit had been made.

We found that the trust did not have a robust process to facilitate access and flow through MAU, instead relying on an individual to facilitate flow through the unit. We were told patients were expected to spend 24-48 hours on MAU, however during our assessment we saw evidence of longer length of stays on MAU, there was 1 patient who had been on MAU for 7 days. Staff told us that the MAU’s admission criteria was not always followed and gave an example of a patient admitted as a step-down from critical care.

The increased demand and poor flow in the department was a consequence from beds being not vacated by patients with complex discharges from hospital ward beds and delays for people who were medically fit to go home but had no immediate care provision in the community. This had a significant impact on the performance of the emergency department and the ability to be responsive to patients and meet their needs in a timely way as patients could not be moved through to the appropriate ward.

The average time to triage for adults presenting with acute physical or mental health for the last 12 months was 42 minutes which is above the national target of 15 minutes. During the same period, it was 13 minutes for paediatric patients.

The department had not been meeting the standard 4-hour performance target which meant patients had not always been able to access emergency services when needed or receive treatment within agreed timeframes and national targets. Over the last 12 months the percentage of admitted patients achieving the 4-hour target wait had been 15%. During the same period the percentage of admitted patients who waited between 4-12 hours from Decision to Admit (DTA) to admission was 20%. The percentage of admissions from ED who waited over 12 hours from DTA to admission in the last 12 months was 26%. The trust did not meet and respond to the needs of all people using the service because key performance targets in urgent and emergency care were not met. This was a breach of regulation 9 person-centred care.

NHS England’s UEC Care Plan 2025/26 sets a maximum of 45 minutes for ambulance handovers to Emergency Departments. The UEC averaged 43 minutes for the previous 12 months based on ambulance service data.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

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 worked hard to remove any barriers to access for patients. Staff listened to people who had concerns or complaints and sought ways to improve the service.

Patients had access to digital information with QR codes displayed around the service for easy access to advice leaflets. For those unable to access digital resources, leaflets could be printed upon request. Staff actively signposted patients and carers to additional services, including community pharmacies and dentists.

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

We scored the service as 3. The evidence showed a good standard. People were supported to make informed choices about their care and plan their future care, including at the end of their life while they had the capacity to do so.

Staff had access to the trust wide resuscitation policy and demonstrated a clear understanding of the trust do not attempt cardiopulmonary resuscitation (DNACPR) policy and ReSPECT documentation. The ReSPECT process created personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations were created through conversations between a person, their families, and their health and care professionals to understand what mattered to them and what was realistic in terms of their care and treatment.

We saw patient care records were personalised and took account of the patient’s needs, wishes and feelings. We reviewed DNACPRs forms during our assessment and these had mostly been completed correctly.