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 promoted high-quality, person-centred care.

The service was well-led, with a clear vision, inclusive leadership, and strong governance structures. Staff felt supported and able to speak up, and equality and diversity were actively promoted through training and staff networks. Leaders understood key risks and worked collaboratively with partners to improve care, despite capacity challenges. Regular safety meetings and risk management processes ensured oversight. Innovation and continuous learning were encouraged, with initiatives like nurse-led discharge and partnership-driven improvements.

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 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

There was a trust wide strategy and vision. We saw the trust’s vision and values on display around the hospital, visible to staff and visitors. Most staff we spoke with were able to list the trust values.

The trust’s strategy for 2022-2026 included plans on reducing health inequalities, creating a sustainable workforce and a clinical strategy.

The UEC division had a strategy programme and provided examples of how improvement programmes in the service contributed and linked into the overall trust strategy.

Staff reported the team worked effectively together, with staff across all areas respecting each other and working together to provide the best possible care and treatment to patients. We observed positive and caring interactions between staff and their patients and their relatives who used the service. We also noted good collaboration and communication between ED staff of all grades and disciplines.

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.

Nursing and medical staff across the emergency department understood the key risks to patients within the department. They could describe the challenges faced; however not all staff were able to explain the improvement actions being undertaken to improve capacity and patient flow. Staff told us the emergency departmental leads and senior managers were approachable, visible, and provided them with good support.

Staff understood the reporting structures and leaders understood their key roles and responsibilities. Leaders also fully understood the key risks and challenges faced by the emergency department. Leaders were able to demonstrate how they worked as part of a multidisciplinary team within the service and how they collaborated with partners such as local NHS ambulance and mental health trusts. They told us they worked well together and there was regular engagement to review performance and identify improvements to services.

Leaders had the appropriate range of skills, knowledge, and experience to carry out their roles. There was a triumvirate leadership structure at departmental and divisional level with medical, nursing, and operational leads. There were clear reporting structures and key roles were supported by deputies or associate roles to support succession planning.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had a freedom to speak up (FTSU) policy which provided staff with details of what they could speak up about, who to speak to and what the process would be if they did. The policy outlined the roles and responsibilities of the FTSU ambassadors and guardian.

Most staff we spoke with told us they were aware of the Freedom to Speak Up (FTSU) process, who the guardian was for the trust and who the ambassadors were in the division. The FTSU process was explained to new members of staff on their induction.

We saw posters with the freedom to speak up guardian and how to contact them. The trust did not have a full-time freedom to speak up guardian, it was a second role for a member of the governance team.

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.

Staff had training in equality, diversity, and human rights with a compliance rate of 93.9% across the service and staff had a good understanding of the cultural, social and religious needs of patients and demonstrated these values in their work.

The trust had 3 staff networks, cultural diversity, disabled and carers and an LGBT+ network.

We spoke with nurses that worked at the trust who had been on the international recruitment programme; they said they felt valued and welcomed.

The results of the 2024 NHS Staff Survey were generally close to the national average for staff from all other ethnic groups at the trust. The trust did show a slightly better experience in providing equal opportunities for career progression for other ethnic staff (53%) when compared to the national average (50%). This was an increase of 9% compared to the previous year.

Outcomes for all other ethnic groups had also shown improvement in comparison to the previous year’s results. We did not have a breakdown specifically for UEC.

We received the following system partner feedback 'we commend East Cheshire Hospital Trust for its ongoing work in this domain and encourage continued efforts to ensure that all staff feel valued, supported, and empowered within the organisation’.

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.

Structures, processes, and systems of accountability, including the governance and management of partnerships, joint working arrangements and shared services, were clearly set out, understood and effective. Staff were clear about their roles and responsibilities.

The service had a risk register with risks identified at department, divisional and board level depending on the risk score. The risk register was reviewed and monitored and rated in terms of likelihood and consequence. The trust had risk management processes which meant that risks were escalated appropriately from the ED up to board level when required.

The service held monthly Safety Quality Standards (SQS) meetings attended by senior clinical leads, operational managers and pharmacy teams amongst other services, covering all aspects of the UEC services. The service’s SQS forum fed back to and provided assurance into the Directorate SQS ensuring oversight of governance across all of the UEC. There was also a weekly Senior Manager meeting which included discussion of operational challenges and risks.

The service held bimonthly clinical governance meetings in the ED, attended by medical, nursing and operational staff to review incident reports and complaints and were supported by the trust PALS department.

The service held weekly patient safety meetings which were chaired by the head of nursing and included the acute matron team and members of the Clinical Governance & Patient Safety team. This meeting focussed on incidents, investigations and risks.

Daily safety huddles, board rounds and bed meetings enabled sharing of information and escalation of patient risks and capacity and resource issues.

Leaders understood challenges to the service but did not always have resources and space to manage the priorities and issues the service faced. Capacity constraints within the services and across other parts of the hospital impacted on patient flow in the emergency department.

The service had policies and procedures for escalation and care of patients in non-clinical areas, to mitigate the main risks from crowding. The hospital had processes to monitor performance and quality against national targets and standards.

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 shared information and learning with partners and collaborated for improvement.

The department collaborated and worked in partnership with stakeholders to support the delivery of the service and support joined up care. They shared information and learning with partners to improve the service.

Staff liaised and interacted daily with senior ambulance staff to regularly review any issues or concerns or improvement opportunities between services.

For patients with mental health care needs, the department worked closely with their local mental health trust to ensure a joint approach to the provision of mental health care and assessment for patients in the emergency department, including patient advocacy and risk management.

The department also worked closely with the local police and shared key information which supported safeguarding and consistency for service users and ensured concerns were identified and acted upon both timely and collaboratively.

Staff shared a recent major critical incident and reported it had been well managed; they were able to mobilise and clear space for the major incident patients.

We received limited feedback from partners for the service but the feedback we received was positive and included ‘colleagues consistently experience professional, respectful interactions that support joint decision-making and shared accountability where appropriate to do so’, ‘joint initiatives such as integrated discharge planning, mental health crisis pathways, and community response teams reflect a shared commitment to responsive, equitable care’, ‘our partnership reflects shared leadership principles that promote integrity, openness, and collaboration across the urgent and emergency care system’ and ‘there is a clear understanding of the value of partnership working, and the trust consistently contributes to a culture of shared responsibility and mutual support. This collaborative approach enhances the overall experience for service users and supports the delivery of seamless, person-centred care’.

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 and effective practice.

Leaders encouraged staff to contribute ideas for improvement and innovation, fostering a culture of continuous learning and service development. Staff were supported in identifying areas for enhancement, and the service actively pursued technological advancements to improve patient care and operational efficiency.

Following concerns raised from another service that provides educational, residential, and medical services to support adults and young people with complex needs including learning disabilities, epilepsy and autism, the ED team invited them to visit the service and walk the patient journey from ED to ward. Following the visit a formal teaching session was delivered to the junior doctors to improve the learning around learning disabilities and autism.

The service has developed the ‘Head Home’ (discharge from triage) which supported nurse discharge of paediatric head injuries using defined criteria reducing the need for children to wait to be discharged by a doctor.

The trust was selected to present its Professional Nurse Advocate implementation at the National PNA Conference in June 2025 as an example of good practice.