Alder Hey Children's NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last inspection we rated this key question as outstanding. At this inspection the rating has remained outstanding. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

Staff treated people with a high level of kindness, compassion and dignity. Feedback we received from children and young people on staff and staff attitude was unanimously positive. They felt that staff treated them as individuals and understood and respected their personal needs. They told us that staff worked with them to identify and deliver care, treatment and interventions that reflected their preferences and circumstances. Children and young people felt that staff were invested in their care and that they were empowered to take ownership of their treatment.

The service ensured that staff were well supported and worked to protect and enhance their wellbeing.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were discreet, respectful, and responsive when caring for service users. We observed 10 meetings during the inspection where staff were engaging directly with children, young people, parents and carers. In every meeting staff acted respectfully and with compassion. They provided space for individuals to discuss any concerns, give their views and opinions and contribute to decisions about care and treatment. Staff were responsive to requests and questions that individuals had and provided relevant information in an appropriate manner or format.

We observed 11 meetings during the inspection where staff discussed children, young people, family members and carers where they were not present. This included triage meetings, choice and partnership meetings, multidisciplinary meetings and team meetings. In each instance staff discussed children, young people, parents and carers in a respectful and professional manner. They demonstrated an excellent understanding of the individual needs of the services users under their care, including their personal, cultural, social and religious needs.

During our inspection we spoke with 3 children or young people and completed a focus group with 8 members of the Camhelions group. We also reviewed the results of patient experience surveys as well as feedback and compliments the services had received from children and young people. Service user feedback on staff was unanimously positive. Staff were described as kind, caring, compassionate and invested in the care they were providing. Children and young people told us they felt respected and valued as individuals and were empowered to contribute to their care.

Some young people fed back that they had not thought that anything was going to be able to help them until they engaged with the service and with staff. One young person told us that the service had ‘made a huge difference’ in their life. Children and young people fed back that staff had helped improve their confidence and given them the skills and tools to help them in everyday life including in school and in social situations. Children and young people reported positive relationships with staff. One young person stated that ‘I can trust my key worker with everything, and she shows no judgement towards me. She always listens and respects what I say. She genuinely cares and shows interest in me as a person.’

During our inspection we spoke with 12 parents and carers of service users. We also reviewed the results of patient experience surveys as well as feedback and compliments the services had received from parents and carers. Parent and carer feedback on staff was unanimously positive. They told us that staff were respectful to both them and their children and displayed a caring, compassionate and considerate manner when engaging with them. One parent fed back that they ‘couldn’t thank staff enough for their compassion, understanding and empathy’. Another parent stated that staff had ‘gone way above and beyond what could be expected’ and one described ‘world class treatment which was delivered in a compassionate way’. We saw compliments that the service had received from parents and carers describing how their child had been engaging more in school and seen improvement in their attainment as well as feedback about how their child was better expressing themselves and managing their emotions.

Parents and carers described positive relationships with staff and felt able to raise questions and queries. One parent we spoke with told us that staff had ‘always worked with them’ and ‘gone out of their way to see their point of view’. One parent fed back that their child’s key worker ‘always remembers my son and his interests. He feels at ease with her. The appointments aren’t rushed and are very child centred.’ Other feedback we reviewed included parents discussing how staff had been patient with their child when they struggled to listen or focus during appointments and describing how staff had been ‘extremely mindful’ of how anxious their child was when first attending. One parent noted how this had made things easier for them as a parent and helped alleviate their own anxiety and concerns over their child’s engagement with care and treatment.

The results of Friends and Family surveys submitted to the service between 1 March 2024 and 28 February 2025 were very positive. The number of respondents who rated the service as good or very good ranged from 89.47% in Sefton CAMHS (from 38 returned surveys) to 94.94% in the ASD services (from 692 returned surveys).

An evaluation of the introduction of the diagnosis of a Pathological Demand Avoidance Profile (PDA) within children and young people attending the ASD services showed that 90% of parents reported a positive impact on their child’s wellbeing.

Staff followed policies and procedures to keep service user information confidential. Interviews rooms in locations were soundproofed to give privacy. Service user records were stored securely, and computer systems were password protected.

Staff we spoke with demonstrated an excellent understanding of the individual needs of the services users under their care, including their personal, cultural, social and religious needs. They had a good knowledge of both the service’s own menu of treatment options as well as activities and support available from other organisations to help to meet these.

We spoke with 3 children or young people during our inspection and completed a focus group with 8 members of the Camhelions group. In addition, we spoke with 12 parents and carers of service users and reviewed the results of patient experience surveys as well as feedback and compliments the services had received.

Both the children and young people and the parents and carers we spoke with were positive about staff and felt that they treated them as individuals and sought to understand their specific circumstances and needs. They felt that staff had worked to accommodate their circumstances, promote engagement and deliver care in a way that supported them. For example, one parent fed back that staff ‘had always planned each session to accommodate my work and (child’s) school’ and that this had both encouraged and facilitated their engagement and the positive outcome they felt had been achieved with their child. The service had received positive feedback from both parents and teachers around the implementation of clinics within school settings. Parents felt this was a more personalised approach that recognised how the requirement to attend a hospital setting could create barriers to engagement.

Children and young people told us that they felt valued and respected as individuals and that their preferences in relation to care and treatment were considered by staff. This was reflected in how staff engaged with them. We observed 9 meetings during the inspection where staff were engaging directly with children, young people, parents and carers. In each meeting staff took a personalised approach and treated people as individuals. They were able to provide information in different ways to ensure that it was appropriate to each individual and discuss treatment options that met individual preferences and needs. We saw examples within the service’s social prescribing programme where safe environments were created for children and young people who were triggered by loud noises and spaces. We saw one specific example where staff working with a child had developed stories and care packages based on a movie character that the child liked. This had promoted and facilitated the child’s engagement with the care plan and helped her develop coping strategies that used the character overcoming difficulties as an inspiration.

Where consent had been given, children and young people with a learning disability or an autistic spectrum disorder were identified on the electronic patient records system with a flag. This indicator enabled staff to plan reasonable adjustments for the individual when they attended service. We reviewed feedback from parents and carers who described how staff had taken steps to make the service accessible to their children and how this had encouraged both their attendance and ongoing engagement. For example, one parent described how staff ensured rooms and areas where they met their child had reduced stimulus levels and avoided having to pass through busy areas. We saw an example where staff needed to utilise medical equipment in their assessment of a child with an autistic spectrum disorder. Staff worked with the child’s parent to agree how this could be managed and involved the parent in the required process. The parent described how the procedure was handled as being ‘100% the correct approach for (my child’s) needs’

Services were set up to meet individual needs. Locations the service was delivered from had disabled access and where they were not at ground level, lifts for those who required them. Staff knew how to access translation services, both for face-to-face translation and to translate documents and information.

Staff worked to ensure that children, young people, parents and carers had ownership of their care and treatment and were active participants in decisions and choices about it. They supported service users to understand diagnoses and to understand and manage their care, treatment and condition.

During our inspection we spoke with 3 children and young people and completed a focus group with 8 members of the Camhelions group. Children and young people told us they were encouraged to contribute to discussions and decisions about their care and treatment. In addition, we spoke with 12 parents and carers. They also told us that they felt involved in their child’s care, were able to contribute to discussions about it and had a voice in decision making. Staff were able to provide information in a range of different formats and languages to help support this.

We observed 9 meetings during the inspection where staff were engaging directly with children, young people, parents and carers. Staff facilitated their involvement and provided a space for them to contribute to discussions and respected their views and opinions.

Staff directed children, young people, family members and carers to other services and if required, supported them to access those services. Staff were able to offer service users a range of treatment options beyond the core offer including activities covered under social prescribing. They were also able to direct children, young people, family members and carers to a range of peer support and other support services where the child, young person, family member or carer felt they would benefit.

CAMHS services had an urgent pathway for referrals that met the criteria. This meant that children and young people identified as needing the urgent pathway had a Choice and their first Partnership meeting within 2 weeks of their referral. There was a tracking list of those waiting for appointment and if a child or young person on the urgent pathway breached the 2 week wait for any reason, they were added to a breach calls list and contacted by the duty worker. The purpose of the call was to check on the child or young persons welfare and to review their risks and circumstances. Where necessary a child or young person could be prioritised for an appointment.

Where required staff could refer children and young people into the Crisis Care service. Children and young people could also self-refer into the Crisis Care service. The Crisis Care service had a daily referral triage meeting and could offer same day appointments to those most in need and offered more intensive follow ups to support the individual through the crisis.

On a day-to-day basis CAMHS services operated a duty worker system to ensure that there was a practitioner able to respond to urgent calls and concerns.

Within the ADHD and ASD services there was an enhanced fast track pathway. This enabled practitioners to expedite the assessment process for children and young people who met the criteria for the pathway.

Staff we spoke with felt respected, supported and valued. They were unanimously positive about the service and the wider Trust as a place to work and were proud about working for the CAMHS services. Staff we spoke with described a caring and supportive culture. They were very praising of managers and senior leaders within the CAMHS services and gave multiple examples of how they had been supported through both personal and professional issues.

Alder Hey Children's NHS Foundation Trust had been ranked first in the North West for the question ‘would you recommend your Trust as a place to work’ in the national NHS staff survey. The Trust took an organisational health and wellbeing approach based on the NHS England Organisational Health and Wellbeing Framework. Staff had access to a range of wellbeing initiatives and the Trust Staff Advice and Liaison Service (SALS). SALS was accessible for all staff and offered advice, guidance and support. In line with the NHS People Plan SALS had rolled out a cohort of Health and Wellbeing Champions called SALS Pals who worked in all services including the Community and Mental Health division and the CAMHS services. Within the CAMHS service staff were encouraged to develop wellbeing initiatives, for example within the Sefton CAMHS staff had begun lunchtime wellbeing walks. Managers supported a range of reasonable adjustments and flexible working to support staff wellbeing and promote an effective contribution to the work of the team.

Staff morale was positive. Staff acknowledged the pressures of the job but felt supported and empowered to deliver care. Supervision and appraisal processes reviewed workload, caseload management and wellbeing. Staff appraisals included conversations about career development and development pathways were in place supported by training opportunities. Staff sickness and absence was low. Absence rates varied across teams and staff groups but averaged at 4.9%.

The provider recognised staff success within the service. Alder Hey held an annual staff awards ceremony and within the CAMHS service there was a Star award for individual staff who had demonstrated excellence or gone the extra mile for the service or service users. Within the Sefton CAMHS team there was an appreciation board where staff could leave comments of thanks and recognition for colleagues.

Staff were supported and kept safe when they were lone working in the community. There were Lone working policies and procedures to support this process including the use of risk assessments before carrying out home visits. Staff had access to a lone working app which meant that managers were always aware of where they were. The app also included an SOS button that alerted the manager if the staff member required support.