East Cheshire NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

East Cheshire NHS Trust provides a range of acute and community-based services, including emergency care and emergency surgery; elective surgery in many specialties; maternity and cancer services. The trust employs over 3000 staff and provides services across Cheshire, Greater Manchester and Merseyside.

The community health services include community nursing, intermediate care, occupational and physiotherapy, community dental services, speech and language therapy and palliative care. They also provide several hospital services in partnership with other local trusts and private providers, including pathology, urology and renal dialysis services.

Inpatient services are provided from Macclesfield District General Hospital which has over 370 beds. Community inpatient services provided from Congleton War Memorial Hospital. Outpatient services are provided in Macclesfield District General Hospital and community bases in Congleton, Handforth, Knutsford, Wilmslow and Poynton. The trust had five care communities as below:

• Chelford, Handforth, Alderley Edge and Wilmslow (CHAW),
• Bollington, Disley and Poynton (BDP),
• Congleton and Holmes Chapel (CHOC),
• Knutsford
• Macclesfield

We carried out an unannounced assessment of East Cheshire NHS Trust on 8 July – 11 September 2025. We carried out this assessment in response to information of concern. As well as the trust-level assessment, we assessed the following service groups:

Community health services for adults

• Community health services for children, young people and families
• Maternity
• Medical care (including older people’s care)
• Urgent and emergency care

Overall, the trust was rated as requires improvement for the well led key question.

We undertook a trust-level assessment (well-led review) of the trust which included an on-site visit on 9 - 11 September 2025. Prior to the assessment we observed the trust’s board and committee meetings on 19 August, 2 September and 4 September 2025. We also asked the trust’s partners for feedback and held several stakeholder interviews and a stakeholder engagement event.

We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust in the Single Assessment Framework. The trust level-assessment followed several assessments of the trust’s assessment service groups (frontline services) in July and August 2025. We undertook these assessments to ensure we had a thorough understanding of the full range of services provided by the trust ahead of our trust-level assessment.

Our assessments identified significant concerns in medical care (including older people’s care) and urgent and emergency care. We raised our concerns with the trust and asked for immediate action to improve services. We undertook a further visit to services as part of our on-site trust-level assessment activity in September 2025 to check that the trust had made improvements. We found that the trust had addressed some but not all the areas of concern we had previously identified.

We found areas for improvement within four of the eight quality statements and positive findings within four of the eight quality statements. We identified shortfalls which breached regulations in relation to the trust’s governance, strategy, and systems to monitor specific areas including infection prevention and control, mental health, mental capacity, ongoing fitness to work checks, and implementation of national guidance. We identified areas which did not breach regulation but were areas for improvement including workforce equality, diversity and inclusion; and environmental sustainability.

We have asked the trust for an action plan in response to the concerns found at this assessment.

The assessment team included a CQC deputy director, operations managers, inspectors, an executive reviewer and specialist professional advisors with experience of working in the assessment service groups we assessed, or with experience as senior leaders in the NHS.

We assessed quality statements within the well led key question. Each quality statement assessed is awarded a score. Details on how we score can be found on our website: https://www.cqc.org.uk/about-us/how-we-do-our-job/ratings

You can find further information about we carried out our assessments at: https://www.cqc.org.uk/about-us/how-we-do-our-job/what-we-do-inspection

We found the following breaches of regulation.

• The trust did not have effective systems to consistently assess, monitor, and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service in line with the regulations. (Regulation 17)
• The trust did not always ensure effective action was taken to address risks in services including areas of low compliance highlighted through internal governance systems. (Regulation 17)
• The trust did not have an effective and appropriately monitored strategy to ensure a shared direction for the trust and to drive improvements in services. (Regulation 17)
• The trust did not have effective oversight of the quality and safety of care provided to patients with mental health needs. (Regulation 17)
• The trust did not have effective systems to ensure the assessment, prevention and management of infection prevention and control (Regulation 12)
• The trust did not have effective systems to ensure services met the requirements of the Mental Capacity Act 2005 and to identify missed opportunities to safeguard service users. (Regulation 13)
• The trust did not have effective systems to support people using services to make complaints because responses to complaints were outside of the trust’s targets. (Regulation 16).
• The trust did not always ensure there were enough staff with the right skills, training and experience because of low compliance with specific mandatory training requirements. (Regulation 18)
• The trust did not have effective systems to ensure staff continued to be fit and proper for their roles because regular checks were not undertaken. (Regulation 19)
• The trust did not meet targets for timely response to adhere to the requirements of the Duty of Candour. (Regulation 20)

People's experience of this service

The CQC Adult Inpatient Survey 2024 results for East Cheshire NHS Trust were about the same as comparable acute trusts with score of 8.1/10 for overall experience. The CQC Maternity Survey 2024 results and Children and Young People’s Survey 2024 for East Cheshire NHS Trust were also about the same as comparable acute trusts. The trust scored 9.2/10 for overall experience reported by children and young people using the trust’s services, and 8.8/10 for overall experience for parents and carers.

Local surveys showed consistently high levels of satisfaction with most of the trust’s services inpatient and community services, except for the trust’s emergency department.