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 remained good.

Service management and consistent leaders and the culture they created usually supported the delivery of high-quality, person-centred care. However, although there were systems and processes in place, local monitoring and oversight of record keeping could be improved. Despite local audits being completed in the complex care team, the audit process for care records and medicines management had gaps and audits were not consistently tracked.

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 tertiary services, GP services, social services and other charity and voluntary sectors services.

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

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 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 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 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 participated 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.

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 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.

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.

Patients and parents had opportunities to give feedback on their care through surveys. 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 worked 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, directorates and teams had plans in place to address workforce race equality and workforce disability standards.

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 2 . 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 could improve regarding audits. Local care record audits were completed inconsistently in the complex care team despite completing clinical audits, there were gaps in the oversight of the process.

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 had access to 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, which 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 worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service evidenced a lot of partnership working that addressed the inequalities and demographic needs of their local populations. They 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 children, young people, and families, either 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.

Feedback from strategic NHS partners working alongside the Trust, valued the collaborative efforts made in delivering high-quality, accessible health services to children, young people, and families. The trust worked in partnership delivering services in patients’ homes, community clinics, and schools universal offer, including the healthy child programme. These contacts consistently met key performance indicator (KPI) targets, providing assurance that children in East Cheshire received appropriate support, and early identification of additional needs was taking place. Developmental reviews incorporated the ages and stages questionnaire alongside skilled professional assessments, enabling effective monitoring of child development. These interactions promoted opportunities for health promotion and facilitating the “Every Contact Counts” approach to delivering a key public health message.

The Trust was described as supporting integrated service delivery and demonstrated a strong commitment to integrated care by coordinating with other NHS partners health visitors, school nurses, and community practitioners to ensure continuity across services in East Cheshire. For example, maintaining strong links with midwifery services, including monthly liaison meetings between health visitors and midwives. Links between specialist care for children with complex needs in multidisciplinary collaboration, with the Trust facilitating joint working between specialist nurses, therapists, and paediatricians to provide holistic care. The Trust maintained contact with specialist educational needs (SEND) practitioners with key contacts for paediatric and therapy services and representation at the early years’ forum and on the 0–4 autism pathway, supporting compliance with National Institute for Health and Clinical Excellence (NICE) guidance.

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 quality improvement (QI) toolkit, and staff could access training opportunities in relation to this.

Examples of the Trust’s QI projects include:

The preterm baby clinic, a quality improvement project was commenced for the paediatric therapy team to develop the service to include specialist assessment clinics alongside the paediatric team to ensure that National Institute for Health and Clinical Excellence (NICE) guidelines were met. This service included improved communication links between special care baby units (SCBU), paediatrics, and paediatric therapies, including a clear criterion of those babies and families who were eligible for ongoing enhanced developmental surveillance.

Referral pathways were developed for SCBU through to Early Intervention services, a referral pathway for onward specialist referral to appropriate therapies/specialists, what was the most the most appropriate assessment tool to use, ongoing clinics at regular intervals in conjunction with Pediatrician’s reviews, early intervention clinics to provide specialist programmes and advice for families and training/information for parents/carers/nursery staff.

In addition, assessment tools and skills in early intervention required specialist training, which was completed by the physiotherapist and an occupational therapist in the community paediatric team. This additional service started in May 2025, and 6 children had been assessed at the time of the inspection. Feedback from staff was that the assessment of preterm babies highlighted where early intervention was needed and how the therapists were able to offer advice and guidance to parents on therapeutic exercise at home, and timely referral to specialist services.

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 the efficiency of the service. The Trust was providing additional training to a paediatric audiologist, to assess patients for cochlear implants and the extent of hearing loss at different frequencies as part of a multidisciplinary team assessment.