Alder Hey Children's NHS Foundation Trust

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 inspection we rated this key question as good. At this inspection the rating has remained good. This meant people’s needs were met through good organisation and delivery.

There was an excellent framework and effective programmes to support the involvement of children, young people, parents and carers in decisions about the service and to gather their feedback.

The service delivered person-centred care and ensured that people were involved decisions about their care and treatment. Staff provided appropriate, accurate and up-to-date information in formats that met individual needs.

The service promoted equity in access and worked to ensure that everyone could access care, support and treatment. Service user outcomes were monitored and the service worked to address inequalities in experience.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service delivered personalised care. Children and young people were treated as individuals and given space to express their opinion and choices. We spoke with 3 children and young people during our inspection and held a focus group with 8 members of the Camhelions group. Service users told us that they felt their care was personalised and that staff encouraged them to give their opinions and discuss their preferences. They felt involved in developing their care plans and in agreeing their treatment options and activities. We spoke with 12 parents and carers who supported this and told us that they felt staff considered their children’s personal needs. Parents and carers told us they also felt involved in decision making.

We observed 9 meetings during the inspection where staff were engaging directly with children, young people, parents and carers. Discussions in the meetings were holistic and personalised. Staff demonstrated a good understanding of individual service users’ history, presentation, strengths, goals and challenges. We observed 12 meetings where service user care was discussed but service users themselves were not present. In these meetings staff again demonstrated a good knowledge of individual service users. Staff considered service users’ personal preferences and circumstances within discussions and reviews of care and treatment.

However, we found that care plans were shared with children, young people, parents and carers in a summary letter form which did not always reflect the personalised nature of care that we observed in practice and discussed with staff and service users.

Within the Crisis Care Service we saw examples of how the service was trying to personalise care and where possible avoid admission to either the 136 suite or inpatient provision when it was not necessary. For example, there was a new framework and process in place with the Police that meant that when the Police had a child or young person they were intending to bring to the 136 suite they rang the crisis team first to discuss options and consider if an alternative intervention was preferable. This might include an urgent same day appointment with the crisis team. There was also an intensive home support component of the Crisis Care Service that could offer alternatives to admission to inpatient units to appropriate service users.

Staff had positive working relationships with external teams and organisations and worked together to provide care. Children, young people, family members and carers we spoke with were positive about how staff liaised with other services and helped coordinate care.

Staff supported children and young people to access education. Mental Health Support Teams (MHSTs) worked in schools to support children and young people with lower-level mental health and wellbeing concerns. There were programmes in place to provide physical health clinics and checks within schools to avoid children or young people having to miss education whilst attending appointments at the main hospital. The service had links with local Primary Care Networks to ensure that children and young people had annual health reviews.

There were strong links with local voluntary organisations to help support children and young people. These included organisations who formed part of the service’s social prescribing options and who helped provide volunteer and work experience opportunities.

There were formal pathways and processes to support the transition of children and young people into adult services and to provide phased transfer of care.

Staff made sure that service users could access information on conditions and diagnoses as well as treatment, support groups and other local services and how to give feedback or complain to the provider or other regulatory bodies. The service complied with the Accessible Information Standard. Information leaflets and posters on display in team buildings were predominately in English but translated versions were available. This included easy read versions. Staff had access to an Interpreting, Translation and Accessible Information policy to support them when translated documents were required.

Information leaflets within the service were co-produced with the Camhelions service user group. There was a Patient Information Leaflet Policy in place to support this process and promote service user involvement. The service and Camhelions group had also began to produce information videos as these were considered to be more accessible from some children and young people. For example, there was a video that introduced the service and told people what they could expect.

The Trust’s website’s accessibility statement detailed the different ways that their website could be accessed. Examples included the ability for text to be enlarged, to change contrast and font, and the ability to navigate most of the website using speech recognition software and listen to most of the site using a screen reader.

Information governance systems included confidentiality of patient records. Staff we spoke with were aware of factors around data protection and confidentiality. Staff completed Information Governance and Data Security training as part of the mandatory training programme. At the time of our inspection compliance with the training was 93%. Staff had access to a Trust Information Governance team for additional support and guidance was available in a range of policies including Information Governance and Data Protection policies.

Staff made notifications to external bodies as needed. They responded promptly and positively when follow up information was required, and they worked alongside stakeholders to ensure a useful flow of information was maintained.

Service users, family members and carers knew how to complain or raise concerns. Information on how to complain was advertised in reception areas and available in leaflet form. None of the service users or parents we spoke with had reason to raise a complaint but told us they would feel comfortable doing so if they needed to.

Staff understood the provider’s policy on complaints and knew how to handle them. Staff attempted local resolution as a first step and moved to a formal complaint if this was unsuccessful. Staff we spoke with knew how to support service users, family members and carers to access the Trust’s Patient Advice and Liaison Service (PALS) as well as the formal complaints process.

In the 12 months prior to our inspection (1 March 2024 until 28 February 2025) the service received 31 formal complaints. These covered a range of concerns including appointment delays, waiting times, rejected referrals and communication failures. 2 of the 31 complaints were still open and under investigation at the time of our inspection. 27 complaints had been resolved, with 15 upheld, 10 not upheld, 2 partially upheld. 2 complaints had been withdrawn. None of the complaints were referred to the Parliamentary Health Ombudsman.

Managers ensured complaints were investigated in line with the Trust policy. Feedback from complaints was shared with staff in team meetings and supervision. Learning from complaints was used to improve the service. For example, the service had made changes to referral and triage processes as well as introducing a mechanism on the electronic records system to help identify where there was dual parental responsibility for a child or young person and ensure only appropriate and relevant information was shared.

There was a divisional governance team that supported processes to monitor complaints, identify trends and share learning. Senior managers and clinicians attended monthly meetings where complaints, trends and themes were reviewed and where learning was shared across the service.

There was an excellent framework and effective programmes to support the involvement of children, young people, parents and carers in decisions about the service and to gather their feedback.

Children, young people, parents and carers could give feedback through a range of mechanisms. Reception areas included information on how they could feedback and displayed QR codes to surveys and questionnaires to support easy access and uptake. Staff encouraged and supported children, young people, parents and carers to give feedback and responded to it. There were forums and processes within the divisional governance structure to monitor and analyse feedback and to identify themes and improvement opportunities.

There was a Trust-wide involvement forum for children and young people called the Alder Hey Youth Forum. In addition, there were mental health specific forums that covered both the Liverpool and Sefton CAMHS services.

Children, young people, parents and carers had been involved in a range of quality improvement projects. These included projects which they had led themselves, as well as projects where they had worked with staff to coproduce improvements. For example, children and young people had been involved in agreeing the décor within services including producing murals and wall art, had helped design and develop information leaflets and the service’s website. They were involved in a project to develop videos to introduce the service and help reduce anxiety for children and young people who were due to attend for the first time. Children and young people had worked with staff to coproduce care pathways and interventions. In addition, in response to feedback children, young people, parents and carers had been involved in work to improve the way care plans were shared with them and their understanding of them. Children and young people were also involved in the recruitment of staff and sat on interview panels and completed focus groups with applicants.

During our inspection we held a focus group with 8 members of the Camhelions forum which was the service user group within Sefton services and observed one of their meetings. Members of the group were positive about their involvement in the service and felt that their feedback was listened to and acted upon. Within their meeting they held a workshop with staff from the crisis service which discussed areas for improvement. Members split into groups to discuss positives and negatives about the service and crisis provision and what could be done better. The sessions were led by children and young people themselves.

The service operated a single point of access and facilitated a range of referral options. Children and young people were able to self-refer or could be referred by family members or carers. There were referral pathways for health professionals such as GPs, for other healthcare providers including physical health services and for related stakeholders and partner agencies such as voluntary sector youth organisations and youth offender teams. In addition, the service provided Mental Health Support Teams (MHSTs).

MHSTs are part of a national programme to reduce inequalities and increase access to mental health support for children and young people. They work with schools to engage with children and young people who find it difficult, or are reluctant, to seek support from mental health services. They provide low level psychosocial interventions and other support to children and young people with low to moderate needs. They also provide a pathway into specialist community mental health services for those with a higher level of need.

The Alder Hey MHST’s worked with over 160 schools across Liverpool and Sefton, in collaboration with partner agencies within the Education Mental Health Teams (EMHT). The Liverpool MHST covered every primary school within the council boundaries and had working arrangements with 3 other voluntary organisations to provide support for secondary schools. Within Sefton council boundaries the MHST were commissioned to cover both primary and secondary schools. At the time of our inspection the service covered 80% of schools in the area. There were plans in place and ongoing work to achieve full coverage.

The service worked to remove barriers to access and met the needs of all service users, including those with a protected characteristic. Teams offered flexible opening times that supported before and after school appointments. Services were primarily offered at each teams’ base, but staff had access to alternative hubs and locations to support access and where required completed home visits. Locations the service was delivered from had disabled access and where they were not at ground level, lifts for those who required them.

Managers made sure staff and service users had access to interpreters or signers when needed. Staff had access to translation services including face to face, telephone and document translation. Staff we spoke with knew how to access these services and were able to give examples of when they had been used.

The service was implementing the Parent Carer Race Equality Framework (PCREF) including work around robust data collection and effective feedback mechanisms. PCREF is a new mandatory framework to support services to be anti-racist organisations and help co-produce and implement actions to reduce racial inequalities within their service.

The service was involved in the Trust’s implementation of the Patient and Carer Race Equality Framework (PCREF). PCREF is a new mandatory framework to support services to be anti-racist organisations and help co-produce and implement actions to reduce racial inequalities within their service. Within the service this included work around robust data collection and effective feedback mechanisms to enable a better understanding of who was accessing the service, how their outcomes compared, differences in the service user experience and feedback across different races and ethnic minorities. This information could then inform service developments to improve equity in experience and outcomes. The implementation of PCREF was being monitored within the Division’s governance structure.

Patient outcomes were monitored and evaluated within teams and within the Community and Mental Heath Division’s governance structure. This included consideration of disparity in outcomes across protected characteristics. Where further work was required managers and senior leaders could establish workstreams and ad-hoc projects to explore these. For example, the service had undertaken work to improve the accessibility of the crisis line for neurodiverse individuals.

The service had undertaken equality impact assessments of their policies and procedures to identify and eliminate health inequalities and barriers. All staff could access a range of impact assessment templates for use when developing policies and procedures.

Staff completed equality, diversity and human rights training as part of the mandatory training programme. At the time of our inspection, compliance with the training was 99%. Staff we spoke with had a good understanding of requirements around equality, diversity and human rights and were able to give examples of how they might support children and young people from different backgrounds, ethnicities or who were members of the lesbian, gay, bisexual or transgender communities. Staff used people’s preferred pronouns.

Staff supported children and young people to make decisions about their future and worked with them in advance to plan and manage discharge, transfer to another service or transition into adult services. Services offered ongoing support to children and young people throughout these processes.

Staff worked with children, young people, parents and carers to support discharge. Discharge planning began in advance and considered the needs and preferences of the child or young person. Staff worked to identify external support services that were available and gave advice and information on how to access them. Children and young people discharged from CAMHS in Liverpool and Sefton were offered ongoing support post-discharge to help them manage the transition. In Liverpool this involved the offer of monthly peer support sessions for up to 3 months with a parallel offer for parents and carers. Within Sefton there was a 3-month Patient Initiated Follow-Up scheme where children or young people could contact the service for support and speak to practitioners without the needs for re-referral. Within Sefton there was a post-diagnosis support service for children and young people who were diagnosed with ADHD or ASD to help them develop plans to help manage their condition and needs.

Staff worked with children, young people, parents and carers to support the transition into adult services. Planning for transition started in advance and was supported by joint appointments to promote consistency of care and minimise disruption to the young person. There was a Transition Lead based in the local adult mental health trust who supported more complex cases.

Staff provided children and young people with advice on how to manage in a crisis and contact details for the crisis service and crisis line if they needed them.