East Cheshire NHS Trust

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• 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

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question as good. At this assessment, the rating has remained as good.

This meant people’s needs were met through good organisation and delivery.

Care was person centred, patients were treated as individuals, and their views were considered in all elements of their care. Parents were confident in the care being provided and felt able to raise concerns or complaints should they need to.

The NHS has no national targets for community children's and young people's services thatfocus on specific areas of physical health, rather than a single, overarching set of goals. For children with specific conditions likediabetes,targets includeincreasing access to continuous glucose monitors and insulin pumps for deprived and ethnic minority children, and improving National Institute for Health and Care Excellence (NICE) care process adherence for type 2 diabetes.The service was monitoring waiting times, and patients were seen within 18 weeks. The Trust was working to improve waiting times and decrease missed appointments, through quality improvement projects and the use of technology. The service expected that this would help to improve access to services, reduce the waiting times for appointments and ensure clinic times were well utilised.

Information provided to patients was clear and understandable, staff supported patients to understand information where necessary. Information was provided in accessible formats. For example, the complex care and community nursing teams provided information and individual care plans in accessible formats. Community physiotherapy, occupational therapy and speech and language therapy provided information and guidance online in accessible formats. At locations where care was provided, posters and leaflets about health and social wellbeing visible for patients. Although information was all provided in English, staff confirmed they were able to access translation services, as necessary.

The service collaborated closely with the wider community to help address health inequalities within the community, to ensure equity in access and experience.

This service scored 75 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients were treated as individuals. Parents felt their opinions were listened to when making decisions about patient’s care and staff considered their individual needs, as well as patients who were their children. Parents told us that staff discussed their child’s care plans with them and explained any jargon, to ensure they understood them clearly.

The care plans we reviewed included the views of patients and parents. Staff responded promptly to patient and parents’ requests, for example in the complex care team equipment referrals could be provided next day. The team also had access to urgent supplies of equipment for patients out of hours.

We observed how staff discussed individual patients during handovers. Staff considered each patient and their family’s needs. Staff were knowledgeable about their patients and their community.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Patients and parents were supported to have choice and control over their own care. Caseloads in the community nursing and complex care team were small. The children and young people’s inpatient service supported the complex care team health care assistants working in patients homes outside of the service’s 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.

In addition, community physiotherapy, occupational therapy and speech and language therapy provided information, advice, and guidance online for patients to access while waiting to be assessed by these services. This included advice to parents to support children to do exercises to strengthen muscles, advice on dietary requirements and on developing social skills. The community diabetes team provided access to continuous glucose monitors and insulin pumps for children and young people.

The Trust provided us with referral to assessment and assessment to treatment times for 01 April 2025 to the 24 July 2025.The community paediatric diabetes nurses did not have a waiting list. Patients were taken on from the day of diagnosis until they transitioned to adult services. Patients had the nurse contact details and could contact them at any time. In addition to this the nurses had regular contact with patients in line with the diabetes best practice guidance.

In the community paediatric autistic spectrum disorder (ASD) pathway referral to assessment time was measured by referral to consent time. To ensure the Trust had had the most up to date information about the children referred to the pathway and children were ‘held’ until there was a space for them to join and move through to diagnosis. There were 127 children on the holding list at the time of inspection, with a mean wait of 72 weeks to be invited to join the pathway. We noted that not all children who had been referred would consent to go on the pathway. There was a triage process in place, so those children were prioritised if there were other significant issues such as safeguarding or looked after children. The referral to treatment average time, once invited and consented to join the pathway from consent to outcome/diagnosis was 16 weeks.

The community paediatric epilepsy nurse did not have a waiting list, and patients were added to the caseload from the day of diagnosis until they are transitioned to adult services, or the patient moved area. Patients had the nurse contact details and could contact them at any time. In addition to this the nurse had regular contact with patients, and this depended on the patients’ needs. For example, a new treatment started or moving school. All patients had an individualised epilepsy management plan which was updated at a minimum of annually but more frequently if their treatments or condition changed. The nurse supported the consultant in the hospital clinic and supported the patients between appointments.

The community paediatric allergies nurse was mostly hospital based and supported patients in the community, teaching schools about allergy management and training on auto-injectors. Patients had an annual review which included annual auto-injector training and review of their management plan. We noted there were no delays in patients attending reviews, but the Trust recorded a high ‘was not brought’ by parents’ rate. To address this from September 2025 the Trust was changing to booking appointments through a centralised booking centre, so ‘was not brought’ patients would be better monitored.

The paediatric audiology assessment pathway had a total of 458 patients on the waiting list, with appointment time breaches of 6 to 12 and 13 plus weeks. Waiting times were increased through outside factors, for example, a neighbouring Trust closed its paediatric audiology service and national guidance was revised, so service delivery was measured on new and follow up waits combined, as well as waiting time for appointments being a national issue. Prior to the national guidance being amended, the service maintained a 90% target for the previous quarter for waits for follow ups. The service had an action plan in place, which included a review of the staffing establishment, adult audiologists supporting the paediatric audiology pathway and meeting with the local integrated care board (ICB) in September 2025 to address waiting times. For paediatric orthotics from referral to first appointment was 54 days and the therapy teams were using a variety of methods to reduce their waiting lists. In the audiology and podiatry services waiting times were monitored by therapists, so could offer vacant appointments or cancellations to other patients.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service displayed information leaflets in English at all sites. Clinics had a variety of posters on subjects including support from charitable services, voluntary groups, and local authority children’s services.

There were no displayed information leaflets in other languages, however staff told us that they could access translations, and translator services if required.

At Pavilion House a quality board displayed information about the team, out of hours services, assessment and treatment pathways, local services, and patient feedback.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The trust undertook regular patient feedback surveys across the directorates including community services. The most recent local survey for community paediatric services completed from April to June 2025 showed patients were happy with the service, and responses had improved on previous years. 172 compliments had been received within the community children, young people, and families service in the last 12 months and only 1 complaint. A Friends and Family Test survey completed in the same time frame had over a 90% positive response rate, and the comments highlighted the professional caring attitudes of staff.

Parents told us they were confident to raise concerns with teams and knew how to make a complaint should they wish to.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Episodes of care and treatment were provided in a variety of locations across the trust, and patients and parents we spoke with did not raise any concerns regarding access to services. Locations were accessible for patients with mobility issues; all services we visited were on the ground floor or had lift access.

In 2025 the speech and language therapy services were transferred to another NHS service to provide increased access to services. These were Cheshire-wide and based on the principles of giving every child the best start in life​ and enabling all children and young people to maximise their capabilities and have control over their lives​, as well as addressing health inequalities. For Cheshire East communities this highlighted the service was needsled, prioritised early identification and intervention at all ages and stages, access was easier to navigate, and barriers removed. There was a spotlight on tackling malnutrition and dysphagia (difficulty in swallowing) using an MDT approach with increased cultural awareness. In addition, the service was improving public awareness by defining neurodivergence was a difference nota deficit. Providing timely, equalaccess to flexible services through reasonableadjustments and a more skilled workforce. Feedback from the service team was as this was a recent change in services, access to speech and language services had increased. East Cheshire had access to more speech and language therapists and referral and waiting times for assessment and treatment had reduced, while retaining the skills, expertise and relationships that had existed previously.​

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff had a clear understanding of patients’ individual needs. Teams delivered high quality care and worked collaboratively across the service, using the skills of nurses, therapists, advanced clinical practitioners, and the paediatric matron.

Through the care communities and the Cheshire East Blueprint 2023, which operated throughout the East Cheshire footprint, staff worked to address inequalities in access and outcomes. The Blueprint 2023 focuses on three key areas: healthy households which empowers households to live well for longer, healthy neighbourhoods which connects communities to access services and support, and health and care services which brings services together to better facilitate urgent and planned care.

Staff had training in equality, diversity and human rights, and the completion rates were over 90% for all staff.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment. We saw in records that patients who had family support had their needs represented through their family advocating on their behalf.

Staff created personalised care plans, which were discussed with patients and parents, to ensure their wishes and opinions were considered.

Staff provided patients with information about other services they could access when they no longer needed the service and had been discharged, or their care and treatment had been completed.