East Cheshire NHS Trust

On this page

• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement.

This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Systems and processes were not always in place within the service to ensure good governance. Audits were not always completed or used to identify and drive improvement within services. Completion rates for mandatory training were low and supervision was completed inconsistently, which leaders lacked systems in place to ensure staff had the skills and support required to do their job.

However, the trust had a shared vision, values and culture, and leaders and staff applied them to the work of their teams.

The teams could evidence good partnership working, with GP services, social services and other voluntary sectors services.

The service was committed to improvement and completed a range of quality improvement projects to improve outcomes for patients and increase learning for staff. Teams were encouraged to take part in QI projects, and patients had a better care experience as a result.

The trust worked to provide an inclusive environment for staff and patients. Staff networks were accessible for staff, and reasonable adjustments were available to support staff.

This service scored 62 (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 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.

Staff understood the trust’s visions and values and worked to incorporate them into the day-to-day care of patients. Staff felt that senior leaders also exemplified the values of the trust. Team working was embedded in the services we visited, and staff could give examples of how they worked together to support patient’s care and treatment.

Managers had a good understanding of the services they managed. They could explain how the teams worked to provide high quality care and understood the risks within their services and how they were managed.

Staff were able to contribute to changes within the organisation and were involved in making suggestions to change and improve the organisation.

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.

Leaders were knowledgeable about the context in which they delivered care and treatment, and had the skills, knowledge and experience to lead effectively. Team managers were visible among the teams and had an active presence.

Overall staff felt listened to by leaders at all levels of the trust. Staff spoke positively about their managers at a local level and felt they were accessible.

However, some staff felt that the community services could be better integrated with the acute services, to make those staff more knowledgeable about the care provision of the community services. Work was being done to raise the profile of community services within acute services.

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 mostly fostered a positive culture where people felt they could speak up, and managers understood the importance of creating a culture where staff felt safe to raise concerns.

Overall, staff were aware of freedom to speak up, and leaders could give examples of when staff had raised concerns through freedom to speak up, and the process for dealing with this. However, when visiting a team, a member of staff raised concerns with us about the culture of their team, which was escalated to the executive board to be addressed.

Patients and carers had opportunities to give feedback on their care through surveys. In community services, teams were requested to have 10 patients complete a survey every month, as well as having the opportunity to complete Friends and Family test. Responses from these surveys were positive, with over 90% positive responses for community nursing, rehab and therapy and specialist services.

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.

There was a range of staff networks to support staff with protected characteristics, and we saw posters promoting these groups around the hospital sites. The trust’s, directorate’s and team’s plans to address workforce race equality and workforce disability standards were in place.

Managers and staff confirmed that they had access to reasonable adjustments and, where these were being used, how they had been developed to ensure individuals could carry out their role and balance their work and home lives.

The trust had an anti-racism statement in place, which was a commitment to creating a safe, respectful, and inclusive environment for all patient and staff.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

The systems and processes to ensure leaders had oversight was poor, particularly regarding audits, training and supervision. Local care record audits were completed inconsistently between teams, some care communities completed audits regularly, but other teams did not. Similarly, teams were not completing clinical audits regularly, there were gaps in the oversight of the process, low staff engagement in process and, as result, identifying risk and learning from audits was limited. The trust had launched a quality improvement project to address this, although it was not in place at the time of the inspection.

There was a lack of oversight for training which mean that completion rates for mandatory training modules were low, which meant that staff did not have the required competencies to do their roles. Similarly, the frequency of supervision was not defined by the trust, which led to infrequent and inconsistent supervision. The lack of systems in place meant that leaders could not be assured all staff had accessed supervision through the year or how frequently staff accessed supervision. This was a breach of regulation 17: good governance.

Concerns that staff raised matched those on the risk register. The main areas of concern identified were around staffing and IT equipment. These risks were clearly identified, and mitigations and actions were in place to reduce and address the risk. However, although concerns around the estates had been identified, the IPC concerns we found regarding the clinic room for the hand therapies was not on the risk register. When these concerns were raised with the board, they were able to confirm that a quote for the work required had been received.

Although leaders were aware of the risk, staff did not always have access to IT equipment needed to do their work, for example, the tablet devices staff used when in the community had poor connectivity, so staff struggled to review care records, and there was a risk of back and neck injuries to staff using them, when in confined spaces such as their cars. Also, the laptops on carts in the therapies service in Macclesfield quickly lost their battery and would crash when staff were using electronic records. There was also an incident during the inspection where assessments completed by staff were lost due to an error with the system, and staff were unable to recover them. Staff took appropriate action and reported the incident.

Staff were confident with the arrangements for working with other teams within the provider and externally to ensure that patient needs were met. Staff told us they worked well with other teams, for example the specialist community teams worked in the same office as the social workers on the Macclesfield site, which enabled communication and support to be clear and straightforward.

Managers implemented learning from reviews of incidents, complaints and safeguarding and ensured this was cascaded to all teams. There was a framework of what should be discussed at team meetings to ensure that essential information was shared. This was replicated in the safeguarding supervision, that ensured recent updates and new training was shared to all teams.

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 share information and learning with partners and collaborate for improvement.

The service evidenced partnership working through their five Care Communities, each addressed the inequalities and demographic needs of their local populations. The care communities worked in partnership with GP clinical leads, the voluntary community sector, mental health services and social care. Working together they provided a variety of initiatives in the local community to support the health and wellbeing of residents. Trust staff within the care communities took a variety of roles, leading projects or providing support to other projects. This work all formed part of the Cheshire East Blueprint 2023, where partners in the Cheshire East health and care system work together to improve health outcomes for communities.

Many patients told us how they had been supported to access additional services that can support their health and wellbeing, either being referred into other services, or signposted to third sector organisations.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff and managers were committed to continuous learning and improvement of services and used quality improvement methods to assess and implement these changes. The trust had a QI toolkit and staff could access training opportunities in relation to this.

Examples of the trust’s QI projects included:

The trust was using enhanced practice development in care homes which provided education for care homes to help manage any deterioration in resident’s health. This had resulted in a reduction in emergency department attendances by 30%. Staff had been nominated for two awards by a national nursing magazine for, Patient Safety improvement and Care of Older People.

The trust had implemented a 90 Day Pressure Ulcer Challenge which gave teams a framework to come up with their own solutions to address pressure ulcers. The Bollington, Disley Poynton Care Community’s project had high-risk patients wear a pressure ulcer wristband which alerted other services to the risk without the need for accessing the electronic patient record system that hospital staff could not readily access. Hospital staff could then contact the district nurse team for a full handover. The team had received funding for the wristbands, and these were due to be implemented.

Trainee ACPs in the Congleton and Homes Chapel Care Community had a project developing ‘how to’ guides on causes and risk factors of deep vein thrombosis (DVT), with the aim to improve DVT screening and documentation.

The audiology service, which included adult hearing services, complex adults with tinnitus and the paediatric audiology services received accreditation by the Improving Quality in Physiological services (IQIPS) on 20 June 2024. The trust noted that this accreditation was part of the service’s drive to ensure best practice and ensuring the efficiency of the service.