East Cheshire NHS Trust

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

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question as good. At this assessment the rating has remained as good.

This meant people were supported and treated with dignity and respect; and involved as partners in their care.

Staff treated patients with compassion and kindness and were focused on delivering high quality care to patients. Staff understood the individual needs of their patients, their potential risks and how these can be managed or mitigated. They also ensured that patients and carers understood the care and treatment being provided and involved them in care plans and risk assessments. Staff informed and involved families and carers appropriately.

Patients’ privacy and dignity were maintained throughout treatment. Patients thought the teams were accessible and supportive. Teams regularly received feedback from patients, and responses were over 90% positive.

The service understood their local population and the unique needs of each community.

Staff told us they felt supported by leaders, they were proud of the teams they worked in and flexible working was available to staff.

However, staff told us improvements needed to be made to ensure that staff had access to IT equipment that could be used safely and continuously while out in the community.

Staff assessed the health of all patients as part of their assessment, and patients felt involved in the process. Staff were competent and skilled to deliver care and did so in line with national guidance.

However, teams were completing audits inconsistently and it was not clear that leaders therefore had appropriate oversight of the potential risks or issues within those teams. The trust had implemented a quality improvement process to address the gaps in oversight and lack of staff engagement in audits.

Supervision was not completed consistently for staff, and this varied between teams.

This service scored 70 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness

We spoke to 16 patients and 4 carers. The patients we spoke to were very complimentary about the staff who cared for them, and they said staff treated them with kindness and compassion. The service was described positively by patients, and they felt they were treated with dignity and respect.

Staff were passionate about the care they were providing to patients. We observed staff attitudes and behaviours towards patients. Staff were considerate, respectful and responsive in supporting their patients, and provided help and advice where appropriate. Staff ensured that patients and their carers understood how to manage their treatment. For example, in the hand clinic staff made it clear to patients how long recovery would take, and how best to support their rehabilitation. Patients were also given printed out sheets that detailed the exercises to support their rehabilitation and staff gave them time to practice each exercise, so they would be confident in repeating them at home.

Staff understood the individual needs of patients, and considered their social needs, as well as their physical health. We also saw evidence of staff referring patients to other services where appropriate. In the Knutsford District Nursing team, staff highlighted the need for respite support for a carer of a patient and referred the patient to a local hospice service.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The patients we spoke to felt involved in their care plans. Many told us how staff would discuss their treatment options and felt that staff would make adaptations if required. Patients could contact the teams for advice and queries, and the responses from staff were prompt.

However, concerns were raised regarding the consultant cover for virtual wards. Staff stated that the two-week rota for consultant cover meant that there was some inconsistency as patients were under a different consultant every two weeks. This was also reflected in what patients told us, as they noticed there was a difference in how responsive consultants were between each fortnight.

Staff understood the make-up of the local population and understood their local needs. Each local Care Community had a local population dashboard that allowed them to develop projects that were tailored to the unique population needs. For example, in the Congleton and Holmes Chapel Care Community district nurses worked with therapies, social prescribers, and voluntary sector organisations for an Ageing Well Roadshow. This event focused on frail patients in the Holmes Chapel area, where the district nurses carried out blood pressure and atrial fibrillation checks, provided advice and referred patients for further investigation where appropriate.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients told us they felt supported by the service, they felt they were involved in decision about their care. Patients told us they were able to give their opinions on their care, for example patients told us felt confident to decline a suggested referral for additional social support, and their preference was listened to by staff.

Staff were person centred, we saw how they discussed individual patient’s choice, to ensure that patient’s had choice and control over their care and treatment.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff demonstrated an understanding of individual needs, and how patients could manage their individual risks, and how staff could help to mitigate and manage these. These included pressure sores, falls risk and dietetic interventions where necessary.

People told us that they could contact teams at any time, and their queries and requests were responded to promptly. We observed a variety of clinics and home visits, where staff took an individual approach to each patient, completing holistic assessments of patients. For example, in the audiology clinic we observed that staff considered how the effects of hearing loss may affect the patient’s social interactions.

Where appropriate, staff offered referrals to patients. Patients we spoke to confirmed they had been offered referrals for additional support. Patients found these referrals beneficial, such as accessing assessments for additional support equipment. Where patients declined these interventions, they felt their wishes were respected.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us that they felt supported, respected and valued by the leaders and management. They were proud of the teams they worked in and felt there was a positive culture within the trust. Managers recognised staff success through initiatives such as Thank You Thursday, where staff who went above and beyond for patients could be recognised.

Staff were supported by managers to access adjustments to support their work life balance, and staff spoke positively about their access to occupational health services within the trust.

Staff morale was mostly positive throughout the teams that we visited. The main areas of improvement staff identified was staffing and the issues they are having with IT equipment. These issues were identified by managers and were recognised within the service risk register.

Staff raised concerns about the electronic equipment they were required to use. The district nursing staff used tablet devices while out in the community to access records. Staff had concerns around the physical ergonomic risks of using these devices while in the community. Most community nurses also told us that they struggled to access records outside of the office, so they would read notes before appointments and only be able to record the notes when they returned to the office. These concerns were on the risk register, and leaders were aware, mitigation had been put in place, such as laptop tables, and a plan to increase access to laptops once funding was in place.