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 the 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.

Staff had training on consent, including the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff ensured that consent was gained before treatment, which included from both the child or young person and their parents with evidence of a person-centred approach.

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

Supervision was completed consistently for staff, and the frequency of it varied between teams.

This service scored 71 (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 2. 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 9 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 the assessment.

During the referral for assessment and for assessment to treatment families could access both digital and non-digital information to educate and support parents in supporting the social and emotional well-being of children and young people. Assessments could be completed face to face or through video calls, and information could be provided and received via text messaging.

Parents and carers told us they participated in children and young people’s assessments, and they were given clear and relevant information when they were referred into the service. Staff ensured any additional information or updates on care and treatment was provided in a way that suited the patient and parents, and in accessible formats or when their first language was not English. Patients were given advice about how to manage their conditions and signposted to additional services such as social services or local charities.

Staff generally updated and reviewed care plans when necessary. However, we found examples in records kept by the complex care team of incomplete daily routines for patients or communication. For example, if patients participated in educational or other activities.

We scored the service as 3. 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 (NICE). Staff also had access to additional specialist training, where required.

We saw teams followed NICE and other professional body’s (British Society of Audiology, Royal College of Speech and Language Therapists, Royal College of Occupational Therapists and Chartered Society of Physiotherapy) guidance in supporting the social and emotional well-being of children and young people, with integrated services, information sharing, and multidisciplinary training to support children, young people and involve families. This included the early identification of developmental needs assessment to provide early support and educate parents, for example on using equipment.

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

In 2023 the Trust undertook an audit entitled ‘Are the trust paediatric teams meeting NICE guidance for the follow up and ongoing monitoring of preterm babies’. A recommendation from this audit was that the Trust would pilot a preterm infant assessment and early intervention service to monitor those children born preterm over a two-year period.

In 2024 to 2025 the Trust took part in 7 paediatric national audits, 4 of which were National Confidential Enquiry into Patient Outcome and Death (NCEPOD)reviews. Audits included Children and Young People’s Asthma Secondary Care, The National Clinical Audit of Seizures and Epilepsies for Children and Young People (Epilepsy 12), National Paediatric and Diabetes Audit. In 2024 to 2025 13 local audits were registered at the Trust, these included acute childhood limp, ever sepsis in children under 5, audit presentation Supporting Treatment and Appropriate Medication in Paediatrics (STAMP), an NHS program to ensure the appropriate use of psychotropic medicines for children with learning disabilities and autistic people.

Staff told us they felt supported and had access to supervision and ad hoc sessions on safeguarding was available from the safeguarding team for staff, in addition to group sessions. Supervision was regularly completed when the teams achieving over 90% compliance rates within the teams.

From the 1 April to 30 June 2025 90% of teams completed supervision and annual appraisal rates were at 50% across the teams in the services.

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 tertiary 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. An example of good teamwork was paediatric audiology supporting the ear, nose and throat (ENT) outpatient clinic and taking referrals from this and seeing children and young people immediately for further assessment and then sharing the outcome with the consultant whilst at the ENT clinic, so the patient and parent did not need to the clinic for an outcome. The children and young people’s inpatient service supported the complex care team health care assistants working in patients homes outside of the service hours offering advice and guidance. There was also a pathway in place for complex care patients to be assessed on the POBS unit without going through the accident and emergency department and worked with the children’s community nursing team.

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

Safeguarding supervision meetings had been introduced in the complex care team, and there was a multidisciplinary team (MDT) approach observed in the community paediatric autism and neurodevelopment assessment pathways, where an MDT of hospital at home staff, community therapists, social care staff and where necessary the named nurse for safeguarding adults met weekly with the lead medical consultant. The children’s safeguarding team offered supervision to the complex care team, hospital at home team and allied health. Supervision was provided to the district nursing teams by the named nurse for safeguarding adults and they also attend the complex forum for each care community to discuss cases of complexity. This meeting was also attended by social care, district nurses and patient’s GP.The MDT had oversight of patients with an ongoing safeguarding concern or complex patients.Safeguarding supervision figures at the time of inspection was 67%.

Information was shared between teams and services to ensure continuity of care. The service held safety quality standards meetings where service managers 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 healthier lifestyles and were able to signpost patients and parents to additional support where possible. In the records we reviewed, there was evidence of patients being assessed and support provided for their individual needs. Other services for children and young people with a range of long-term medical conditions included asthma, allergies, diabetes, cardiac anomalies, endocrine conditions, epilepsy,and developmental disorders.In addition, the local mental health services provided child and adolescent mental health service (CAMHS) for community and inpatient services.

We scored the service as 3. 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 community paediatric service and complex care team parents and young children had access to assessments, MDT meetings and reviews via video calls or telephones, so they did not need to attend an appointment in person and save time and distress to patients with complex needs. Technology could be made available for families who may not have access to mobile telephones or tablets, either at local centres or through loans of equipment.

Audits included quality improvement projects. For example, the paediatric speech and language therapy transition to electronic records, which was audited for compliance in recording. In 98% of cases the contact, report/s, and assessments on the electronic records system was recorded against the correct patient, and consent to liaise with other professionals was documented reliably. In 98% of cases consent was documented in the case history in the patient’s notes.

The complex care team completed audits on the health and safety of patients’ homes where Trust staff provided care. Audits included the health, safety and use of equipment, medicines, and training compliance. 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 medicines dosage or time of administration being changed and staff not being aware.

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. We observed staff seeking consent from patients and parents to provide care and treatment. 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 parental consent being sought in the best interest of patients’ care and treatment.

The paediatric matron undertook an annual audit of compliance with the Mental Capacity Act (MCA) and a review of practice in 2024/25 was undertaken in April 2025. The audit report demonstrated that mental capacity to consent for medical treatment was considered, and staff working with the young people recognised patients aged over 16 made decisions for themselves and were given the appropriate information to consider their decisions.The audit included the complex care team, community nursing and paediatric specialist nurses for epilepsy and diabetes. A review of patients’ notes found all children and young people aged over 16 had a completed annual decision form. For the children’s community nursing team, compliance was monitored on their monthly record keeping audit.

During 2024, there was a project undertaken on transition to adult services. Part of this was supporting families to develop their knowledge and know what to do to support the young person who lacked capacity and the legal framework around this. For paediatric specialist nurses for epilepsy and diabetes, each team had their own transition arrangements, so a retrospective review of the case notes was undertaken. The diabetes team had a larger cohort of patients over 16 all of whom had capacity and all discussions and clinic appointments were made directly with the young person from ages 14 to 15 as part of the transition process. Two actions were identified from the audit. One was to complete an annual audit starting in April 2026 and the second to incorporate MCA training into the paediatrics essentials training session and embed this into the safeguarding level 3 training.

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.