East Cheshire NHS Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question as good. At this assessment the rating has remained as good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff worked well between teams and specialisms, when additional care or support was identified for patients, referrals would be made to appropriate services, and staff spoke positively about the relationships they had with other professionals. Through each of the 5 care communities, staff helped to support patients to live healthier lives, working in partnership with other health, social and voluntary sectors services and organisations. This allowed patients to access a variety of initiatives to help improve their physical and mental wellbeing.

Staff had training on consent, including mental capacity act and deprivation of liberties. Staff ensured that consent was gained before treatment, and when a patient lacked capacity there were evidence of best interest decisions and a person-centred approach.

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 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 22 care records as part of the inspection. The service’s approach to assessment, planning and delivery of care and treatment was holistic. Staff completed comprehensive assessments of individuals, using specialist tools where appropriate. This included skin conditions, capacity and nutrition. Staff then developed care plans that met the needs identified as part of assessment.

Patients told us that they felt involved in their assessments, and they were given clear and pertinent information when they were referred into the service. Staff ensured any additional information or updates on care and treatment were provided in a way that suited the patient or carer. Patients were given advice about how to manage their conditions and signposted to additional services such as social services or hospice at home.

Staff updated and reviewed care plans when necessary, for example in the district nurses service, records showed that low risk patients had a 20-week review completed by senior staff, to ensure that their risk rating was current and reflected the patient's current treatment.

We scored the service as 2. The evidence showed some shortfalls. The service did plan and deliver people’s care and treatment with them, including what was important and mattered to them. However, the service did not complete audits in a robust manner to identify gaps in care or promote staff engagement.

Staff were competent and skilled to provide a range of care and treatment for their patients. Care was delivered in line with guidance from the National Institute for Health and Care Excellence. Staff also had access to additional specialist training, where required.

Staff ensured that patients had good access to physical healthcare and would refer to specialist or additional social services support when needed.

During the process of the inspection, we asked the trust for their clinical audits completed in the last twelve months. The trust was unable to provide this information, in response to the request they had identified that audit processes required improvement and had initiated a quality improvement project to enhance the end-to-end audit process. The trust identified that the tracking and assurance of the full audit cycle was inconsistent, there was gaps in oversight and low staff engagement, the lack of robust process meant that learning from audits was limited. The overarching aims of the project were to enhance effectiveness and efficiency, drive measurable improvements in patient care and promote staff engagement and accountability. The trust stated that they aimed to have achieved this by March 2026.

Staff told us they felt supported and had access to supervision and ad hoc sessions are available for staff, in addition to group sessions. However, supervision was not regularly completed within the teams due to staffing and workload pressures within the teams and the safeguarding team. In quarter 1 April to June 2024 60% of teams completed safeguarding supervision, in quarter 4 January to March 2024 no team supervision took place, and in quarter 1 April to June 2025, 83% of teams completed supervision.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Teams had positive relationships with external health and social care stakeholders. Staff worked effectively with primary care, social care and other NHS services, to ensure that the service was delivered to a high standard. Staff told us that they worked well with other services, and there were no concerns in accessing support and information when required.

We observed effective hand overs in the teams, staff shared thorough information, and other members of the team were shown to be knowledgeable about the patients being discussed.

Complex case management meetings had been introduced in two care communities, where an MDT of district nurses, community therapies, social workers, care co-ordinators, social prescribers, out of hours team, advanced community practitioners (ACPs) and the named nurse for safeguarding adults met weekly. The MDT had oversight of patients with an ongoing safeguarding concern or complex patients.

Information was shared between teams and services to ensure continuity of care. The service held safety quality standards meetings where service managers, care community coaches and team leaders met monthly and shared learning across the directorate.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Teams promoted healthy lifestyles and were able to signpost patients to additional support where possible. In the records we reviewed, there was evidence of patients being assessed and support provided for their individual needs.

The coaches from the trust’s 5 care communities worked in partnership with their Care Communities with a clinical lead GP, the service lead Coach, and representatives from social care, voluntary sectors and mental health. Through these care communities the service worked to support healthier lifestyles. One example in the Knutsford care community is Easy Movers, a programme designed in collaboration with Sheffield Hallam University to provide weekly exercise classes which have helped improve attendees’ overall fitness, mobility and increased social interactions.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used technology to support patients effectively, for example in the bladder and bowel service patients had access to an app which guided patients through pelvic floor strengthening exercises.

Teams were not regularly completing audits. Whilst we saw that managers of some of the teams were completing audits of care records, these were not being completed consistently by all teams. Audits highlighted where learning could be identified and ensured that when actions had not been taken there were documented reasons for this, such as a patient’s refusal.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff ensured they took all practical steps to enable patients to make their own decisions. Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff recorded consent in patient’s records as part of the initial assessment. Care records also detailed information regarding people’s capacity. There was evidence of best interest decisions and mental capacity assessments, that were decision specific, person-centred and involved all relevant parties.

Staff completed consent training which included MCA and Deprivation of Liberty Safeguards (DoLS), the completion rates were at 90% and above. As part of their safeguarding supervision, we saw that MCA understanding was reviewed with staff.