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
• Environmental sustainability – sustainable development

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

In a well-led trust, leaders should ensure a clear, shared vision and strategy across the organisation, and staff understand how their roles contribute to achieving these goals. The vision, values, and strategy are developed collaboratively with staff, service users, and external partners through a structured planning process. Both staff and leaders should foster a positive, compassionate culture focused on trust, understanding, and continuous improvement. They should aim to prioritise equality, diversity, and human rights and promote safe, high-quality, and compassionate care. Efforts should be made to address any workforce inequalities, with actions taken to resolve identified issues. Additionally, leaders and staff should assess and manage risks that could impact the delivery of the strategy, ensuring there are actions in place.

We scored the trust as 2. The evidence showed some shortfalls. Whilst the trust had a recently extended strategy, it was having limited impact on services and did not support a clear and shared direction for the trust. The trust did not always understand the challenges and the needs of people and their communities. However, the trust’s vision was well-established and there was a supportive culture within teams.

The trust had a strategy for achieving trust priorities and developing good quality care. The trust’s strategy had been recently extended. The trust’s strategy ‘Our Healthy Future Together’ was approved in September 2022 and originally intended to run from 2022 to 2025. Staff, patients, carers and external partners had the opportunity to contribute to discussions about the current strategy in a series of meetings, workshops and engagement events in 2022. This included meetings with GPs and other partners. The trust’s strategy development included work at the time to align the strategy to local plans in the wider health and social care economy.

The trust’s board reviewed the trust’s strategy in a board development session in October 2024 following the publication of the government’s ‘Independent investigation of the NHS in England’. The board resolved in January 2025 to extend the trust’s strategy into 2026 with minor amendments pending the publication of the NHS 10-plan and following engagement with the trust’s patients, staff and stakeholders.

The strategy committed the trust to five strategic themes and goals. Each theme included an identified measure of success and the key drivers. However, these were not always measurable, and the trust did not provide evidence to show there was a separate robust plan for delivery of the strategy with clear objectives and timescales.

The trust identified board level leaders to hold responsibility and accountability for delivering each component of the trust’s strategy and delivery plan. The trust monitored and reviewed how it delivered strategic objectives with a board-level report. The reports showed there was inconsistent and sometimes limited impact of the trust’s strategy on services.

Leaders described how the trust continued to face significant strategic decisions in relation to the sustainability and future of specific frontline services. There were inconsistencies in what leaders regarded as the strategic direction of some of the trust’s services and the trust overall. Leaders told us interdependences in strategic decision making at system and regional level impacted on the trust’s ability to establish a clear direction for some services.

The trust did not always have robust and realistic strategies for achieving the priorities and developing good quality, sustainable care across all sectors or to address strategic challenges. The trust had a Nursing, Midwifery, and AHP Professional forum which supported the trust to identify and address strategic clinical workforce challenges. However, the trust did not have strategies to address challenges in workforce including a nursing and midwifery strategy. The trust told us this was due to the trust awaiting the publication of the 10 Year NHS Plan and the Nursing and Midwifery Strategy for England in Autumn 2025 by NHSE, to ensure alignment with both.

The trust was the lead author of a multi-agency strategy for the provision of community health services. The principles and themes of this strategy were included within the trust’s strategic clinical plan and included the development of community health services.

The trust had a strategy for meeting the needs of patients with a mental health, learning disability, autism or dementia diagnosis. The strategy was supported by a number of sub-strategies which addressed challenges including digital, dementia, learning disabilities and autism, mental health, patient experience, quality and safety, and safeguarding. The trust had separate plans to respond to strategic challenges in procurement and to tackle health inequalities. The trust’s Domestic Abuse Strategy 2025-28 was aligned to a similar strategy implemented by the local authority. This was a more recent example of how the trust had aligned the trust’s sub-strategies to local plans in the wider health and social care economy.

Patients and the public had the opportunity to contribute to the trust’s Patient and Public Experience and Engagement Strategy 2025-28 through in person, paper and online surveys at trust locations and within the wider community. The key themes from the survey together with feedback from the Family Test, complaints and other local and national sources led to the development of the five goals of the strategy and the subsequent commitments within each goal. This was a more recent example of how the trust had engaged with people using services in developing a trust strategy document.

At the time of our assessment the trust had started to consult with stakeholders, staff and the public on the new strategy. Leaders told us they had received over 11,000 responses to the consultation exercise. The trust planned specific engagement meetings with partner organisations including primary care, hospice services and neighbouring NHS trusts.

We received limited feedback from partners about how the trust met the ‘shared direction and culture’ quality statement although some highlighted specific examples of how the trust had worked in collaboration with partners. We did not receive feedback about how partners were engaged in development of the current or new strategy.

The trust had an aspirational vision and a statement of values. The trust’s vision was established within the trust’s purpose statement which was ‘to deliver outstanding care and to improve the health of all the people we serve’. The trust had established six values which were:

• Treat each other with respect and dignity

• Commitment to quality of care

• Show compassion

• Improve lives

• Working together for patients

• Make everyone count

The trust’s values were well-embedded and had been established for some time. The trust had worked with 300 staff to develop behaviour statements outlining how the values were to be demonstrated within the trust. The behaviour statements also outlined how the trust’s values corresponded with the 6Cs of nursing (care, compassion, commitment, communication, courage, and competency).

Our assessment of the trust’s frontline services found most areas of the trust demonstrated a positive culture of collaboration, openness, integrity, respect, and collective responsibility. NHS Staff Survey results in 2024 showed high levels of engagement, with the trust achieving its highest response rate at 60%. The trust score for the ‘We are compassionate and inclusive’ People Promise element was significantly higher than the overall average for comparable trusts with the sub-element ‘compassionate culture’ scoring slightly higher than the average.

We wrote to all staff including bank staff and volunteers working with trust to ask for feedback on their experience. We received limited responses although some staff told us that there were pockets of poor culture within specific services, particularly within urgent and emergency care services. The feedback we received during our assessments of the trust’s frontline services was mostly positive about the culture within services.

The trust had mechanisms to identify and address behaviours that were inconsistent with the values of the NHS. The trust’s disciplinary policy had been introduced in June 2024 and grievance procedures were outlined in the trust’s Resolving Concerns at Work policy introduced in January 2025. These policies were introduced following ratification by the trust’s partnership forum, and in consultation with trade unions, operational managers and the trust’s human resources department. We reviewed three recent examples of disciplinary processes and three examples of grievance processes. All examples had been carried out in line with the trust’s policies with the processes completed within reasonable timescales.

The trust had mechanisms to ensure staff were fit and proper for their roles at the point of recruitment although there were shortfalls in how the trust checked this an ongoing basis. The trust had effective systems to monitor professional registration. The trust provided information about Disclosure and Barring Service checks for 3224 staff. The data showed 734 staff had no check date or DBS check number, 735 staff had a check more than 5 years ago and 186 staff had a check more than 10 years ago. The trust did not have a robust process, including self-declaration, to ensure staff, other than board leaders, remained fit and proper persons for their roles.

In a well-led trust, leaders should have the experience, capacity, capability and integrity to ensure the organisational vision can be delivered, and risks are well managed. Leaders should be visible at every level, lead by example, and model inclusive behaviours. High-quality leadership is sustained through safe, effective, inclusive recruitment and succession planning. Leaders must be knowledgeable about issues and priorities for the quality of services and can access appropriate support and development in their role. Leaders should be alert to any examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff. They address this quickly.

We scored the trust as 3. The evidence showed a good standard. The trust 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.

The trust’s board had an appropriate mix of skills and experience to ensure effective and visible leadership, including clinical leadership, across the trust. The board was comprised of executive and non-executive directors. There were five voting executive directors including the chief executive officer; chief people officer; chief medical officer; chief nurse, and chief finance, planning and estates officer. The chief people officer and chief medical officer jointly held the role of deputy chief executive. The executive team included the non-voting chief delivery officer, and the director of corporate governance who also held the role of board secretary. There were six non-executive directors including the trust’s chair. The board had sufficient non-executive directors to meet the requirements of the NHS England code of governance for NHS provider trusts by ensuring half the board of directors, excluding the chair, were non-executive directors whom the board considered to be independent.

The board benefitted from a long period of stability within the executive and non-executive team with most appointed prior to 2022. The trust’s non-executive team were appointed between 2022 and 2023.

The executive team held lead roles for specific priority areas. The chief nurse was also the director for infection prevention and control and the board level lead for safeguarding, mental health and maternity. The director of corporate governance was the senior information risk owner (SIRO).

The board were supported by a senior leadership team with the appropriate range of skills, knowledge and experience. This included deputy directors for estates, information, finance, medical, nursing, operations, and people.

The trust leadership team had a good knowledge of current priorities and challenges. However, leaders told us the leadership team lacked capacity. We heard the leadership team were stretched, with limited time to consider or to drive strategic direction, partnerships or quality improvement within services. The trust’s recently introduced digital clinical system was repeatedly cited by leaders as having stretched leadership capacity and as the reason for several gaps or delays of other areas of work.

There was a programme of board visits to services and staff fed back that leaders were approachable. The trust had a board development programme with eight learning sessions planned between April 2025 - April 2026. The board development programme included planned sessions covering equality, diversity and inclusion.

The trust complied with the fit and proper persons regulation for directors, with systems to ensure leaders were suitable for their role. We reviewed a sample of files for voting members of board. The sample included files of both executive and non-executive directors. All members of the board had received an annual appraisal within the previous year. The trust maintained a record of annual appraisal dates for both executive and non-executive directors.

Partners shared mostly positive feedback about their experience of working with the trust’s leaders.

Succession planning was in place throughout the trust. The trust had implemented processes to ensure succession planning at senior levels. Leaders told us deputies were supported to act up in interim leadership positions for an extended period ahead of formal recruitment processes.

Staff and leaders must act with openness, honesty and transparency. Staff and leaders should actively promote staff empowerment to drive improvement. Leaders should encourage staff to raise concerns and promote the value of doing so. All staff should feel confident that their voices will be heard. Leaders should ensure a culture of speaking up, where staff actively raise concerns and those who do (including external whistleblowers) are supported without fear of detriment. When concerns are raised, leaders should investigate sensitively and confidentially, and lessons would need to be acted upon. When something goes wrong, people should receive a sincere and timely apology and be told about any actions being taken to prevent the same from happening again.

We scored the trust as 2. The evidence showed some shortfalls. The trust’s freedom to speak up processes did not wholly ensure the independence and protected time required for the role. There were shortfalls in training for speaking up. However, people felt they could speak up and that their voice would be heard.

The trust had appointed a Freedom to Speak Up Guardian who undertook this role alongside their role of Deputy Director of Governance. The Freedom to Speak Up Guardian told us there was no protected time afforded for the dual role, although they ensured they were able to balance the responsibilities. The board had non-executive and executive leads for Freedom to Speak Up. The Freedom to Speak Up Guardian was supported by 56 Freedom to Speak Up Ambassadors. Staff also had access to a generic speaking up mailbox to raise concerns. The Freedom to Speak Up Guardian told us there was a plan to streamline the Ambassador role within the trust to a smaller number of colleagues actively undertaking the role.

Leaders were satisfied with the trust’s Freedom to Speak Up processes and felt they were appropriate to the trust’s size. We heard differing opinions within the trust’s leadership team on the value of formal Freedom to Speak Up processes although this was in context of leaders seeking to build a culture where all colleagues within the trust felt able to raise concerns without the need for a formal process.

The trust board received an annual report focussed on freedom to speak up. These showed staff increasingly using the trust’s freedom to speak processes as a way to raise concerns. Data provided by the trust showed 44 cases were raised by staff in 2024/25, an increase from 34 cases in 2023/24 and 25 cases in 2022/23. The trust’s reports identified reductions in the number of staff raising concerns anonymously and consistently found no member of staff had experienced detriment from speaking up.

The trust provided training in freedom to speak up although compliance rates were significantly below target. The trust’s annual report noted there was low uptake with training but did not provide the compliance rate. Compliance rates were not included within the mandatory training data submitted by the trust, showing that training in freedom to speak up was not mandatory.

The trust had a freedom to speak up strategy which was introduced in 2022. The strategy established key performance indicators for freedom to speak up based on feedback in the NHS staff survey. The trust’s Safety Quality Standards Committee received interim update reports which covered freedom to speak up numbers and identified themes and trends from concerns raised in the previous quarter. The most recently available report covering quarter 3 2024/25 showed that 18 concerns had been raised in this quarter with themes including bullying and harassment, attitudes and behaviour and quality and safety. Reports for covering more recent quarters were not provided.

NHS Staff Survey results for 2024 showed staff felt increasingly confident to speak up within the trust. The survey showed 65% of staff who responded felt it was safe to speak up if they had concerns within trust, an increase from 61% the previous year. The trust’s results were also 4% higher than the average for comparable trusts and in line with the average for trusts within the local integrated care system.

Staff confidence in the trust acting on concerns was slightly lower than the previous year, with 57% of respondents feeling confident that the trust would address concerns about unsafe practice compared to 58% the previous year. The trust’s results were 1% higher than the average for comparable trusts although lower than the average for trusts within the local integrated care system.

Partners felt the trust did have a culture where staff could feel free to raise concerns. There was mixed feedback and confidence in whether leaders would always take effective action to address concerns.

In a well-led trust, leaders should be committed to continuously improving the organisation's culture, focusing on equality, diversity, and inclusion. Leaders should actively address disparities in the experiences of staff with protected characteristics and those from marginalised groups, ensuring that interventions are regularly monitored for impact. Steps will have to be taken to remove bias from practices, ensuring fairness in opportunities and experiences for all employees. This includes reviewing policies and procedures to tackle structural discrimination and promote an equitable culture. Leaders also work to prevent and address bullying and harassment, particularly for those with protected characteristics, and ensure that disabled staff receive reasonable adjustments to support their roles.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not always prioritise supporting diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them. However, staff networks had been introduced to champion equality and diversity.

The trust’s Workforce Race Equality Standard (WRES) highlighted differences between the experiences of white and black and minority ethnic (BME) staff.

NHS Staff Survey results showed staff felt equality and diversity were promoted in their day-to-day work and when looking at opportunities for career progression. The trust’s results showed a slightly better experience in providing equal opportunities for career progression for other ethnic staff (53%) when compared to the national average (50%). This saw an increase by 9% compared to the previous year.

The most notable difference in experience between white staff and staff from other ethnic groups at the trust related to discrimination at work from a manager, team leader or other colleague. The trust’s results showed 17% of staff from all other ethnic groups had experienced discrimination from their manager or colleague, compared to 5.9% of white staff. The trust’s results were 1% higher than the national average. Whilst the result showed worse outcomes for staff from all other ethnic groups compared to white staff, the trust’s result had improved by almost 3% from the previous year. Outcomes for all other ethnic groups showed improvement in comparison to the previous year’s results.

Leaders self-assessed there were shortfalls in the trust’s approach to equality, diversity and inclusion although also highlighted some of the trust’s achievements. The trust’s Workforce Race Equality Standard 2024 report noted representation of colleagues from Black, Asian and Minority Ethnic communities had increased for a 5th successive year, representing 13.96% of the overall workforce. Leaders told us the trust had higher representation of colleagues from Black, Asian and Minority Ethnic communities than the local demographics.

The trust had implemented processes to support colleagues from Black, Asian and Minority Ethnic communities into more senior positions. The trust’s Elevate Leadership Development Programme had supported 6 colleagues into Band 6 positions within the trust. Data provided by the trust showed 87.25% of staff in clinical roles at Band 8A to Very Senior Management (VSM) were White, while 8.82% are Black, Asian or Minority Ethnic, and 3.92% of staff in clinical roles had not disclosed their ethnicity. During the year 2023/24 the Trust had 12 Board members, comprising of 11 White and 1 who did not disclose their ethnicity.

Our review of grievance and disciplinary processes identified shortfalls in how the trust had explored cultural issues including allegations of systemic racism on one ward. The case demonstrated the trust did not always have professional curiosity into potential cultural issues in frontline services. We escalated this to leaders during our assessment. The trust took immediate action including starting a cultural review of the service. Leaders told us there was a process to identify issues and themes, including impact on equality and diversity, from grievance and disciplinary cases although it had not operated effectively to identify the issues from this specific case.

The trust’s Workforce Disability Equality Standard results showed staff with a long-term condition or illness had worse outcomes than staff without, though their responses showed only a minor variance from the national average. The most variation between those with and without a long-term condition or illness was for the percentage of staff who were satisfied with the extent to which the trust valued their work. Approximately half of all staff without a long-term condition or illness felt the trust valued their work, whereas two thirds of staff with a long-term condition or illness felt the trust did not value their work. The trust had slightly higher than average than national average numbers of staff with a long-term condition or illness reporting bullying or harassment.

The trust collated data demonstrating the diversity of staff. This showed the trust employed staff from 59 nationalities, 1.8% of staff identified as LGBTQ+ and 4.4% identified as having a disability. Staff networks were in place promoting the diversity of staff. Networks were in place to represent staff who identified as LGBTQ+ (LGBT+ Staff Network), staff from a Black, Asian or Minority Ethnic community (Cultural Diversity Staff Network); staff with disabilities and carers (Disabled and Carers Staff Network). Staff networks were not integrated within the trust’s governance. Network chairs told us the trust had recently relaunched staff networks and there were improvements needed to embed the networks within the trust.

We received limited feedback from partners in relation to this quality statement, although some partners shared they felt the trust promoted equality, diversity and inclusion.

In a well-led trust, there should be clear and effective governance, management, and accountability structures in place. Staff should fully understand their roles and responsibilities, while managers hold staff accountable for their actions, behaviours, and performance. The systems designed to manage current and future performance, as well as risks to service quality, should take a balanced approach that allows for innovation and new ideas to be tested safely within the service. Data and notifications should be regularly and reliably submitted to external bodies as required, and there should strong systems in place to ensure the availability, integrity, and confidentiality of data and records. Information must effectively utilise to monitor and improve care quality. Leaders need to implement relevant quality frameworks, standards, and best practices to enhance equity in service delivery and address existing inequalities, ensuring better outcomes and experiences for those using the services.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes. Governance systems did not always operate effectively to identify and address quality and safety issues. However, the systems for identifying, recording and managing strategic risks and mitigating actions were well-established.

The trust had governance structures in place with systems, processes and regular meetings in place. The trust board was supported by four board committees. These were the audit committee; the finance, performance and productivity committee; the people committee; and the safety, quality and standards committee.

Senior leaders had two further regular meetings alongside the board’s formal committee structure. There was a monthly formal executive leadership team meeting, weekly informal executive team meetings, monthly formal executive and senior leadership team meetings and a bi-monthly clinical leadership board. Both the clinical leadership board and monthly executive leadership team meetings were chaired by the chief executive officer. The clinical leadership board was a forum chaired by the chief executive officer and attended by senior leaders including executive directors, clinical directors and clinical leads. The clinical leadership board had a wide remit and was described within the trust’s risk management strategy as having overarching responsibility for managing risks and for the Chief Executive to gain assurance on the operational business of the organisation by identifying risk and actions to mitigate risk.

Leaders had reviewed these structures. The people committee had been established since our last assessment. Leaders told us the people committee had been established to ensure there was effective governance and oversight of issues affecting the people working for the trust.

The trust’s safety, quality and standards committee was accountable for the oversight and governance of quality of care within the trust. This committee was supported by sub-committees for areas including safeguarding, medicines management, patient safety incidents, infection prevention and control, and mortality governance. The trust’s frontline services were organised into two clinical directorates. The directorates were ‘acute and integrated community care’; and ‘planned care and allied health and clinical support services’. Both directorates had their own directorate level safety, quality and standards committee.

We observed meetings of the trust’s board of directors; the finance, performance and productivity committee; safety and quality standards committee; and the people committee. Committee papers contained appropriate information although relied on lengthy narrative. We observed meetings were chaired effectively, although long agendas, substantial papers and limited meeting impacted on the time afforded to discussion of specific agenda items.

Senior management committees and the board reviewed performance reports. Performance reports were of good quality and identified areas of high-performance and persistent shortfalls using statistical process control. The trust was aware of its performance using KPIs and other metrics. This data fed into the considerations of strategic risk within the board assurance framework.

Non-executive and executive directors were clear about their areas of responsibility. There were six non-executive directors including the trust’s chair. Each sub-board committee had a non-executive director as chair and another as a voting member. Non-executive directors told us they were also members of working groups and other committees within their areas of expertise, although they understood their primary responsibilities were to the unitary board and as members of their board committees.

The trust had systems and processes in place to monitor and maintain safe staffing levels, however these did not always operate effectively. Services did not always have sufficient numbers of suitably qualified staff, and some services fell below national staffing standards. The trust did not have sufficient and appropriately qualified paediatric staff to meet the requirements of “Facing the Future: Standards for Children in Emergency Care Settings” within the trust’s paediatric emergency department. Staff told us they raised this consistently with leaders and had shared they did not feel the service was safe. We escalated this to the trust’s senior leaders and asked for the trust to take urgent action. The trust implemented interim measures to improve staffing within the department and agreed a long-term uplift in staffing shortly after our visit in September 2025.

The trust produced six-monthly Safe Staffing Reports in line with the requirements of the National Quality Board. The trust also produced Safer Staffing Exception Reports, with the latest report for July 2025 showing that the overall trust position for Registered Nurse cover during the day was 97.1% of expected staffing and overnight was 97.6%. The overall HCA staffing levels during the day were 96% of expected staffing, and overnight were 111.8%, with some wards reporting over 100%, reflecting additional staff provided to support enhanced care.

The trust relied on bank and agency staff to maintain safe staffing levels. In July 2025, 1,980 shifts were requested via bank or agency. Of these, 322 shifts (16%) were not filled, 494 shifts (25%) were filled by agency staff and 1164 (59%) were filled by bank staff. There were 970 HCA shifts requested in July to maintain safe staffing levels. Most shifts were requested due to vacancy and sickness and 216 were unfilled which equates to 22% of the shifts requested. The total number of shifts filled by permanent staff was not detailed in the trust’s safer staffing report.

The trust’s overall compliance with mandatory training was 81.1% which was lower than the target of 85%. There were shortfalls in compliance in specific modules across the trust, and in specific services. Information governance training was below the trust’s target. In frontline services including urgent and emergency care and medical care, we found shortfalls in specific modules corresponding to areas where we identified concerns including infection prevention and control, consent, and Mental Capacity Act. There were shortfalls in basic life support training in the trust’s medical wards.

The trust’s governance systems did not always protect the rights of people using services in relation to their mental capacity. Our assessment of frontline services in July 2025 found staff did not always follow the requirements and principles of the Mental Capacity Act. Staff did not always assess capacity appropriately. Records showed staff at times assumed patients lacked capacity because they had a learning disability. Best interest processes were initiated with decisions made on patients’ behalf without establishing whether patients lacked capacity.

We undertook further assessment activity in September 2025 and found some improvement in how staff followed the requirements of the Mental Capacity Act. All patients subject to Deprivation of Liberty Safeguards now had mental capacity assessments although the specific decisions were not always recorded. There was further improvement needed to how staff recorded best interest process and decisions. There continued to be variations in documentation between patients and between wards in relation to mental capacity and other aspects of care.

Appropriate governance arrangements were in place in relation to Mental Health Act administration and compliance. The trust had a service-level agreement with another NHS provider for support in relation to the Mental Health Act.

The trust had well-established systems for identifying, recording and managing strategic risks and mitigating actions. The trust board had sight of the most significant risks and mitigating actions were clear. Risks to the delivery of the trust’s five strategic objectives were monitored through a Board Assurance Framework (BAF). The trust had identified 7 strategic risks, of which 4 were assessed a posing high or significant risk (risk scores of 16-20). The BAF included details of the trust’s risk appetite. During our assessment, we observed consideration and review of strategic risk within the trust board and board committee meetings, showing that these processes were well-embedded. Leaders had consistent view of the highest risks facing the trust, and their concerns mostly matched the strategic risks identified on the BAF.

The trust had a risk assessment and risk register policy which had been implemented in August 2023 and was due for review shortly after our assessment. The trust had also implemented a risk management strategy in January 2025. The strategy set out management of clinical, organisational and financial risk within the trust. The trust maintained a corporate risk register to identify, record and manage risks and mitigating actions. This was presented to the board alongside the BAF and was reviewed four times a year by the board, and three times a year by the trust’s audit committee.

Leaders expressed confidence in the quality of data provided by the trust although recognised there were improvements needed to data security. Systems were in place to collect data from wards/service teams. Leaders told us there was work to reduce the burden of data collection on frontline staff and the introduction of the digital clinical system would lead to further improvements.

In September 2024, the Data Security and Protection Toolkit (DSPT) changed to adopt the National Cyber Security Centre’s Cyber Assessment Framework (CAF) with the new framework including additional cyber and information governance requirements. The trust had assessed compliance against 47 outcomes within the framework and declared it did not meet the minimum standards against 4 outcomes. An improvement plan had been developed to address the identified shortfalls. The trust commissioned an independent audit of their submission. This concluded the trust had correctly self-assessed against the twelve outcomes audited.

Information governance systems were in place although maintaining the confidentiality of patient records was an identified area for improvement. The trust had recently implemented a new digital clinical system which was secure and required passwords to access. The trust’s submission for the DPST identified further action was needed to secure systems and devices unrelated to the trust’s new digital clinical system. The trust identified there were three reportable data security breaches in 2024/25 and all had been reported appropriately to the Information Commissioner’s Office.

There were plans in place for emergencies and other unexpected or expected events. Leaders described how the trust tested emergency preparedness through simulations. The trust’s compliance with national emergency preparedness, resilience and response (EPRR) standards was 79% which was an improvement from the previous year and similar performance to trusts in the local system. The trust had an improvement plan to address the areas of partial compliance.

Where cost improvements were taking place there were arrangements to consider the impact on patient care. Leaders monitored changes for potential impact on quality and sustainability. The trust’s chief medical officer and chief nurse jointly led on quality impact assessment processes. The trust had a process which established the criteria triggering the need for quality impact assessments. The process also identified the processes for undertaking equality impact assessments in cases of service redesign.

Leaders submitted notifications to external bodies as required. However, there were shortfalls in how the trust handled requests for information. The trust’s responded to 70% of requests under Freedom of Information within the required deadline between May and June 2025. The trust responded appropriately to central alert system (CAS) notifications, closing 4 of 5 alerts within the required deadline in 2025.

Fire risk assessments had been completed in all trust-managed premises within the last two years. Our assessments of the trust’s frontline services identified fire exits were frequently blocked. This was escalated to the trust’s senior leaders who took immediate action.

We received mixed feedback from partners in relation to the trust’s governance. Some partners felt the trust had clear and well-structured governance, whereas others told us the trust’s governance did not always operate effectively to identify and address emerging and long-standing issues in services.

In a well led trust, staff and leaders should be open and transparent and should encourage collaboration with all relevant external stakeholders and agencies. Staff and leaders should work in partnership with key organisations to support care provision, service development and joined-up care. Staff and leaders should actively engage with people, communities and partners to share learning with each other that results in continuous improvements to the service. They use these networks to identify new or innovative ideas that can lead to better outcomes for people.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not have a strong focus on identifying and address health inequalities. There were examples of partnership working and collaboration for improvement although further work needed to improve system partnerships However, the trust had launched a process to engage with local people, communities and partners in the development of the new strategy. Partners were positive about their experience of working with the trust.

The trust did not have a strong focus on identifying and addressing health inequalities. The trust’s Health Inequalities Plan 2025-28 was in draft awaiting approval at the time of our assessment. The draft plan established the trust’s ambitions which were linked to the trust’s strategy and were designed to address health inequalities within East Cheshire. However, the ambitions detailed in the plan did not include measurable targets, action owners or specific deadlines. The trust provided an example of work to identify and address health inequalities in breast screening services which included details of specific actions.

We found inconsistencies in how leaders viewed partnerships and system working. Some described strong and valued relationships with system and local partners, whereas others felt system working had become deprioritised due to operational pressures within the trust. We heard from several leaders how pressures within the system were viewed to have negatively impacted the trust, leading to delays in strategic decision-making.

Prior to our assessment we wrote to over 60 partners and stakeholders to request feedback on their experience of working with the trust. We received positive examples of how the trust engaged and worked in partnership with voluntary sector organisations. Partners told us the trust’s senior leaders ensured the trust worked as a strong partner.

We undertook specific interviews with partners within the local health and care system and received mixed feedback in relation to how well the trust acted as a system partner. Leaders within the trust provided examples of how they engaged with the system including some who had lead roles for specific workstreams. This was not consistent across the trust’s leadership team with some leaders telling us they lacked capacity to engage with the system alongside the demands of their own role.

The trust had worked in partnership with a neighbouring NHS trust to implement a new digital clinical system which launched in June 2025. Leaders told us the implementation was deemed a success from the trust’s perspective with high levels of training compliance, intensive support for frontline teams and minimal service disruption. The trust moved into stage 3 (optimisation) in September 2025.

The trust delivered community health services in partnership with local providers through five of the eight Care Communities covering East Cheshire. These were virtual teams of health and care professionals working in partnership with Primary Care Networks of general practices.

The trust worked with partners to review services. The local Healthwatch undertook an independent review of the trust’s discharge to assess process between September 2024 and January 2025. The review found areas for improvement in communication for patients ready for discharge although highlighted most people were happy with the discharge to assess process. The review found inconsistencies in patient experience when transitioning back home or to care settings. The trust accepted the areas for improvement and committed within the report to address these and to share the good practice identified by the review.

Since our last assessment, the trust had established a partnership with a neighbouring specialist NHS trust. The partnership ensured patients living in East Cheshire, Derbyshire and North Staffordshire had access to specialist cancer care services at Macclesfield District General Hospital. Both the trust and their partner described strong working relationships.

Another trust provided a mental health liaison service within the trust and support for Mental Health Act Administration and compliance. The trust did not have a partnership arrangement or service level agreement in place for the provision of psychiatric liaison services with appropriate governance arrangements. Leaders told us this was due to the way this service was commissioned centrally across multiple areas in Cheshire and Merseyside.

The trust had processes to support people using services to raise complaints. Complaints were monitored through the trust’s governance systems. We reviewed four examples of complaints. The complaints were handled within the trust’s process and included an apology to the patient. The trust’s Safety, Quality and Standards committee received an annual complaints report and a quarterly ‘complaints, incidents, claims and patient experience assurance report’. The trust’s annual report for 2024/25 showed the trust had received 217 formal complaints, an increase of 92 from the previous year. The trust’s complaints handling performance had only slightly improved with 52% of complaints requiring an extension compared to 59% of complaints the previous year. The trust monitored the themes of complaints. The top three themes were clinical treatment, communication (verbal) and staff attitude/behaviour. The annual report provided examples of where the trust had made improvements to services as a result of complaints.

At the time of our assessment the trust had started to consult with stakeholders, staff and the public on the new strategy. Leaders told us they had received over 11,000 responses to the consultation exercise. The trust planned specific engagement meetings with partner organisations including primary care, hospice services and neighbouring NHS trusts.

The trust had processes to engage with and seek feedback from people using services. Monthly ward accreditation surveys were carried out across all inpatient wards, with 287 returned between April and June 2025. Results showed people using services were positive about cleanliness in services and were mostly positive about communication. The trust had a patient experience group which was a working group aligned to the trust’s safety, quality and standards committee. The patient experience group received a quarterly report on patient experience activities within the trust. The report included results of the trust’s Families and Friends Test (FFT) which highlighted consistently positive results across most of the trust’s services although lower satisfaction with the trust’s emergency department. The latest results (July 2025) showed 92% respondents using the trust’s community services felt their care was very good or good, compared to 68% of respondents using the trust’s emergency department. The trust provided details of an additional 40 local surveys planned or completed in 2025-2026 covering a range of services.

The CQC Adult Inpatient Survey 2024 results were published during our assessment. This survey looks at the experiences of 62,444 people, across 131 NHS trusts, who stayed at least one night in hospital as an inpatient during November 2024. Responses were received from 519 people using the trust’s services. The trust’s results were about the same as comparable acute trusts with score of 8.1/10 for overall experience. The CQC Maternity Survey 2024 received 92 responses from people using services at East Cheshire NHS Trust with the results about the same as comparable acute trusts. The CQC Children and Young People's Survey 2024 received responses from 103 people at East Cheshire NHS Trust. The results were also about the same as comparable acute trusts.

The trust worked appropriately with trade unions. Trade union representatives were positive about their relationship with senior leaders. They told us leaders were visible and approachable. There were bimonthly alternating formal and informal meetings between trade unions and senior leaders. Trade unions were engaged in policy development. Trade union representatives were less positive about the trust’s Freedom to Speak Up processes and told us staff in frontline services lacked confidence in this process.

The trust encouraged volunteering and was well supported by over 200 dedicated volunteers. Volunteers undertook 19 different roles within the trust including signposting and supporting patients and visitors to move around the hospital. The trust received an annual report on volunteering which noted two volunteers had moved from their role into fulltime employment within the trust.

In a well-led trust, staff and leaders should demonstrate a strong understanding of how to drive improvements, using a consistent approach that includes measuring outcomes and impact. They need to involve service users, families, and carers in the development and evaluation of improvement initiatives. There should clear processes to learn from both mistakes and successes, with leaders promoting reflection and collaborative problem-solving. Staff need to be encouraged and supported to develop their skills in innovation, guided by a strategic approach that emphasises continuous improvement. Leaders should actively listen to staff ideas and foster a culture of trust and openness. The service needs to also benefit from strong external partnerships, engaging in research and integrating evidence-based practices to enhance innovation and care quality.

We scored the trust as 2. The evidence showed some shortfalls. The trust did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The trust’s overall compliance with mandatory training was 80% which was lower than the target of 90%. There were shortfalls in compliance in specific modules across the trust, and in specific services. The trust’s overall compliance for fire safety training was 72%.

The trust had processes to identify, report and investigate incidents although these were not always effective. The trust had a patient safety and incident response policy which was overdue for review at the time of our assessment.

The Patient Safety Response Framework (PSIRF) was launched nationally in the autumn of 2022 and implemented by the trust in November 2023 in line with the required national deadline for transition. The trust’s implementation of PSIRF was externally audited in April 2024 resulting in substantial assurance. The trust’s implementation of PSIRF included recruiting two Patient Safety Partners. These are volunteers who provide patient and family representation in governance processes focussed on improving patient safety.

In addition to national priorities, the trust has also identified several local priorities in relation to patient safety incidents and resulting investigations within the trust’s Patient Safety Response Plan 2025-26. Local priorities identified included:

• Pressure ulcers acquired while receiving care from the trust
• Patient falls resulting in moderate or severe harm
• Medication incidents resulting in moderate or severe harm
• Recognising and responding to deterioration in medical condition
• Postpartum haemorrhage (PPH) >= 2500
• Infection control incidents
• Patient transfer or appointment problems resulting in a patient being “lost to follow-up”

The plan noted the trust’s achievements and ongoing areas for improvement in implementing PSIRF. The trust had not achieved a target to have 95% of staff trained in level 1 - essentials of patient safety by September 2024 with compliance at 86% by June 2025. Less than half of staff required to undertake level 2 – access to practice had completed the training by June 2025.

We reviewed five examples of patient safety incident investigation reports. The reports showed investigations took between 4-7 months to complete. There was inconsistent evidence of family involvement in patient safety incident investigation processes. The trust had appropriate processes in place to comply with the requirements of the Duty of Candour although compliance with timely adherence to the Duty of Candour was below target. The compliance with duty of candour for quarter 4 2024/2025 was 77.5%.

The trust had a backlog of patient safety reviews requiring review. There were 157 open reviews with 110 exceeding the trust’s 60-day target for completion. Most reviews were in relation to pressure ulcers. The timeliness of the trust’s submission of incident data to external sources had declined over time. Between September 2024 and March 2025, over 90% of submissions were made within 14 days of the event occurring. However, this had seen a decline in April 2025 to 78%. The trust’s 5-day compliance target to report incidents internally had improved but remained at 50% as of August 2025.

Audits were not used consistently to drive improvement within services. Data provided by the trust showed that as of June 2025 there were multiple instances of overdue audit actions. Of 6 national audit reports requiring a response (four-month response), 5 were overdue with no response over 4 months. In most cases recommendations for dissemination and comment were sent to their respective leads but were pending a response from the trust. The trust’s audit showed:

• 13 Priority Level 1 Audits pending confirmation of participation
• 18 Registered Local Audits rolled over from the previous year pending completion
• 25 Audit actions due completion

The Annual Quality Account stated the trust participated in 85% of audits that it was eligible for, though most audits for 2024/25 listed had data collection noted as still ongoing.

Leaders were satisfied that clinical and internal audits were sufficient to provide assurance however we identified teams did not always act on results where needed. Infection prevention and control audit compliance varied across the trust’s frontline services. Our assessment of the trust’s frontline services found persistent issues in infection prevention and control. This included staff practice in relation to hand hygiene, bare below the elbows, personal protective equipment, isolation of infectious patients and disposal of clinical waste. These issues were identified prior to our assessment in investigations of patient safety incidents and the trust committed to improve oversight and compliance. We escalated our concerns following our assessment in July 2025 and the trust committed to take further action including more frequent audits. We undertook further assessment activity in September 2025 and continued to find shortfalls in staff practice in infection prevention and control. Following our assessment, the trust launched a 90-day quality improvement programme to improve staff awareness and understanding of personal protective equipment, and achieve consistent PPE practices and sustained behaviour change in frontline services.

The trust had a process to assess the quality of care against national standards although compliance with the process was poor. The trust required a completed self-assessment against new guidance from the National Insitute for Health and Care Excellence to be completed within four months of publication. As of quarter one 2025/26, 16 assessments were overdue and 39 assessments identified areas of non-compliance within services against new standards. Only 7 assessments found the trust met all recommendations within new guidance. The trust’s overall assessment identified 502 guidance documents applied to the trust’s services, of which the trust was fully compliant with 388 (77%).

Patient-Led Assessments of the Care Environment (PLACE) involve local people (known as patient assessors) going into hospitals as part of teams to assess how the environment supports the provision of clinical care, assessing such things as privacy and dignity, food, cleanliness and general building maintenance and, more recently, the extent to which the environment is able to support the care of those with dementia or with a disability. Macclesfield District General Hospital showed notably lower PLACE scores for the assessed areas of food (combined), dementia, disability and privacy, dignity and wellbeing. Congleton War Memorial Hospital generally scored slightly higher than Macclesfield, though was still notably lower than the national average for disability and dementia. Knutsford and District Community Hospital was not included in PLACE data.

Leaders told us the trust participated in research on a small scale. The trust did not produce an annual research report for the board. Instead, there was a quarterly report provided to the research sub-committee of the trust’s Safety, Quality and Standards committee. The most recent report showed the trust had opened 12 research studies and recruited 660 participants. The trust achieved 95% against target for participant recruitment.

The trust did not have a unified quality improvement methodology aligned with the NHS improvement approach. The trust provided two examples of quality improvement to showcase how the methodology was operationalised within services within the last year. The examples used differing quality improvement methodologies and did not deliver impactful results within the intended programme duration although did lead to improvements in care:

• A 90 Day Pressure Ulcer prevention programme launched within Summer 2024 using the model for improvement and Plan, Do, Study, Act approach. Phase one of the programme supported wards and community teams to develop and test ideas to reduce the number of pressure ulcers. The trust’s Safety, Quality and Standards committee papers noted phase one was due for evaluation in September 2025. The programme achieved a decrease in the overall number of pressure ulcers and category 2 pressure ulcers reported within services since the programme was launched. However, the number of category 3 pressure ulcers had increased in the same period.
• A programme to improve clinical pathways for patients with Hospital Acquired Pneumonia and Community Acquired Pneumonia (HAPs CAPs) launched in Spring 2024 using the trust’s ‘framework for improvement’ (Define, Design, Decide, Deliver). The impact of the programme was not clear from the information provided by the trust, although improvements were noted in the number of patients receiving ‘perfect care’ (care meeting all required standards) in both hospital acquired pneumonia (80% as of February 2025) and community acquired pneumonia (70% as of February 2025). The trust told us there this was an ongoing area for improvement and so there had been a recent refresh of the programme with a new project charter to be completed by mid-August 2025.

The trust had systems to identify and learn from deaths. The trust’s Safety, Quality and Standards committee received a quarterly report on how the trust learned from deaths. The most recent report showed that in quarter one (2025/26) there were 119 deaths at the trust and a third of these were subject to a structured judgement review, which was higher than the trust’s target. The trust had good performance in completing structured judgement reviews, with 100% within the target of completion with eight weeks.

The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at trust level across the NHS in England using a standard methodology. NHS Digital describe SHMI as the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. The SHMI deaths occurring in hospital and deaths occurring outside hospital within 30 days of discharge. The SHMI does not make any adjustments for patients receiving palliative care and is not a direct measure of quality of care.

The SHMI for April 2024-March 2025 was 1.21. This was above expected range and data over time showed the trust’s mortality indicators were consistently above the expected range since 2022. The trust told us there were quality improvement projects underway to minimise avoidable mortality with workstreams for improvement in acute kidney injury, sepsis and management of pneumonia. Leaders described the trust’s mortality indicators as one of their long-standing risks and driven by complex factors including how the data was collected and specific issues presented by local demographics.

Since our last assessment, the trust had opened a new learning and development hub. This was a bespoke education facility and learning space for staff. Partners highlighted the hub to us as an example of how the trust had responded to feedback from students and created additional space to support learning.

We received limited feedback from partners in relation to this quality statement. We did receive examples of initiatives to support learning and development including nursing apprenticeship schemes, although these were noted as temporarily paused at the time of our assessment.

In a well-led trust both staff and leaders should recognise climate change as a major threat to public health and empower their teams to understand sustainable healthcare practices aimed at reducing the environmental impact of healthcare services. They should aim to promote a shared vision of delivering preventative, high-quality, low-carbon care, emphasising the health benefits of reducing environmental factors like air pollution, which can lower risks for conditions such as heart disease, stroke, and lung cancer. Green Plans should be implemented to make care settings as low carbon as possible, focusing on energy efficiency and renewable energy use. Additionally, leaders actively embed net-zero principles into care planning, ensuring resource-efficient, timely, and sustainable healthcare delivery.

We scored the trust as 2. The evidence showed some shortfalls. The trust had not complied with national directives in relation to Green Plans. However, the trust demonstrated how it understood any negative impact of its activities on the environment. There were examples of how the trust was striving to make a positive contribution in reducing environmental impact and supporting people to do the same.

In 2020, the NHS became the world’s first health system to commit to reaching net zero emissions. The Health and Care Act 2022 reinforced this commitment, placing new duties on integrated care boards (ICBs), NHS trusts and foundation trusts (referred to collectively in this guidance as trusts) to consider statutory emissions and environmental targets in their decisions.

An additional duty was placed on trusts in 2025 to publish and share a refreshed green plan by 31 July 2025. The trust had failed to meet this requirement. The trust told us that this was due to the significant impact caused by the implementation of the trust’s digital clinical system. The trust’s green plan for 2021-2024 was extended by the trust’s board in January 2025.

Leaders demonstrated a passion for environmental sustainability, describing how the trust had completed specific projects to reduce the trust’s impact on the environment. This included changes to buildings and improvements to infrastructure to reduce emissions. The trust had delivered a decarbonisation programme which included using 100% renewable energy since April 2021. The trust had a board-level lead for environmental sustainability and had established a sustainability group with accountabilities in procurement, estates, medicines, catering and facilities. The trust’s partners shared examples of how the trust had worked collaboratively to address environmental sustainability.