North Staffordshire Combined Healthcare 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

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

The service demonstrated a clear shared vision and inclusive culture grounded in transparency, equality, diversity, and human rights, with leaders at all levels showing integrity, openness, and the skills to lead effectively. Staff felt able to speak up, diversity was valued, and most teams met regularly to share learning, manage risks, and monitor performance supported by effective IT systems and partnership working. However, governance was not consistently applied, as one team lacked regular meetings, limited leadership visibility during a planned move, leading to uncertainty, increased pressure and low staff morale.

Overall, the service showed strong collaboration, encouraged innovation, and was committed to continuous learning and improving equitable outcomes for people.

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.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The trust’s vision was “To be outstanding in all we do and how we do it.” The trust’s 4 values included: Compassionate, Approachable, Responsible, Excellent. The trust had launched a framework to give examples of behaviour that would demonstrate this in day to day working lives. One staff member told us they considered the trust’s vision and values when deciding to work at the service. Now working there, they said they see staff actively living these values and felt reassured they had joined the right service.

Staff shared clear values and a common purpose. This created a respectful, inclusive culture that met the needs of the patient group. Care was person‑centred and evidence‑based, with staff working collaboratively to support wellbeing, stability and independence.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. An exception was identified through feedback from the Outreach team, which reported ineffective communication about an imminent service relocation.

Leaders and staff demonstrated a compassionate, respectful, and open culture. Most staff felt listened to and supported, with clear communication and mutual respect. This culture promoted trust and psychological safety within the team and enabled effective multidisciplinary working in the best interests of patients.

Staff could explain how they were working to deliver high quality care within the budgets available. Staff business meeting notes demonstrated monitoring of budgets against meeting the needs of patients and their communities.

Leaders had the skills, knowledge, and experience to perform their roles. They had varied skills and extensive experience of working within the service. Overall, staff gave positive feedback about their line managers.

Leaders understood the services they managed and could explain how teams delivered care and the challenges they faced. However, in one team there had been three staff vacancies and reduced staffing for a prolonged period, and it was unclear what short-term actions leaders had taken to mitigate the impact. Staff reported this was affecting morale, indicating leaders were not fully addressing staff wellbeing or involving the team in managing these pressures. While leaders were described as visible and approachable overall, staff in one team reported limited leadership presence, with one staff member stating they had only seen the team leader twice, including during the inspection. This reduced confidence and showed a lack of regular support and engagement from leaders.

Overall staff gave positive feedback about a supportive environment in which colleagues worked collaboratively, where team members felt supported, valued and heard.

Leadership development opportunities were available for staff at different levels. One team leader was undertaking a short-term development secondment to enhance leadership experience. Some staff had completed the Leadership Role in Quality, Innovation and Change course. In addition, staff had access to Talent and Leadership training through the electronic learning management system.

The trust had a 0.6 WTE Freedom to Speak Up Guardians, supported by the Chief Nursing Officer/Deputy Chief Executive.

There were 34 Freedom to Speak Up Guardian champions across services. Staff in this role promoted speaking up and signposted staff to support. No concerns were raised from staff across the service between April 2025 and April 2026.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. The service used a range of feedback mechanisms, including surveys undertaken during contact appointments, to encourage patients and carers to share their views and speak up about their experiences. For example, the Brain Health and Wellbeing Group contacted patients after group sessions to gather feedback. Patients reported making positive lifestyle changes as a result of attending, finding the groups useful, and said the information helped them and their families better understand what was happening and how to provide support.

Managers and staff had access to staff feedback and used it to inform improvements. The 2025 Community Directorate staff survey showed an overall decrease compared with 2024, with scores remaining the same for Compassionate and Inclusive and We Are Always Learning, and decreases in We Are Safe and Healthy, We Each Have a Voice That Counts, We Are Recognised and Rewarded, We Work Flexibly, We Are a Team, Staff Morale, and Staff Engagement. The survey outcomes identified what the service was doing well and areas for improvement; results were shared through a pictorial poster and cascaded to line managers to discuss with teams and agree actions. This supported an open culture where staff were encouraged to speak up and contribute to service development.

Patients and staff had opportunities to meet with members of the service senior leadership team and governors to share feedback. For example, at the Trust Board meeting 11 September 2025, a patient met with the governors, shared their personal experience and provided direct feedback.

The trust had a clear strategic approach to equality, diversity and inclusion (EDI), underpinned by its Inclusion and Belonging Strategic Plan 2024–2028, which formed part of the ‘Our Combined People Plan’ supporting delivery of the Workforce Strategy 2023–2028. This set out the trust’s ambitions and equality objectives to strengthen inclusion and belonging and deliver measurable improvements over the next three to four years.

Leaders demonstrated a commitment to embedding inclusive culture across the organisation. Initiatives included the development of Workforce Race Equality Standard (WRES) champions, alongside programmes such as Reciprocal Mentoring and the Anti-Racist Leadership Programme, aimed at addressing inequalities and promoting inclusive leadership.

The trust actively promoted awareness of equality and diversity through participation in national and cultural awareness events, including Pride Month, LGBT+ History Month, South East Asian Heritage Month, Black History Month and Disability History Month. Staff networks were established and accessible, providing support and a platform for staff voice.
Staff told us that managers were supportive of flexible working arrangements. Some staff worked part-time and said their line managers were flexible in agreeing working patterns, enabling them to balance work with personal needs.

The trust had systems in place to monitor and reduce inequalities for both staff and patients. This included monitoring service user representation and participation by ethnicity and religion, and focusing on improving access for marginalised groups, such as people experiencing homelessness and traveller communities.

Leaders undertook workforce equality monitoring to ensure the staff group reflected the diversity of the population served. There were key metrics in place to improve inclusive recruitment practices, with the aim of increasing representation across ethnicity, disability, and sexual orientation (including lesbian, gay and bisexual staff).

Staff held monthly business meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Staff reviewed incident reports to identify themes and patterns of incidents. Staff told us about recommendations and changes made following the death of a patient. However, staff from the Older People Outreach Team told us they did not have regular team meetings due to competing work priorities and workload pressures. Records showed there was only one set of team meeting notes between April 2025 and April 2026, with limited actions documented. Staff said the lack of regular meetings had been challenging and at times left them feeling under pressure.

Leaders had not ensured staff performance was monitored and improved. This included limited oversight of staffing deployment within one team, as well as inconsistencies in access to supervision and appraisals.

The 2016 CQC inspection found that staff did not all have access to clinical supervision and that supervision was not always recorded. This issue has not been fully addressed. A Trust review in 2025/2026 found that supervision compliance still needed to improve to reach 85%.

The service had systems in place to manage risk and quality, but there were gaps in leadership visibility and engagement. At the time of inspection, one team was planning to move premises and merge with a different team. During this period, staff reported uncertainty about future leadership, which limited reassurance and support. Leaders were aware of these risks and had begun improving communication and oversight ahead of the move, but these actions were not yet fully embedded. This meant the service could not consistently demonstrate effective leadership during the planned transition. Staff assessed and managed risk to patients and staff. Staff assessed and managed risks to patients and themselves well. Staff responded promptly to sudden deterioration in a patient health. When necessary, staff worked with patients and their families and carers to develop crisis plans.

Staff undertook or participated in local clinical audits. For example, audits were for medicines management, care plans, dementia service pathways. The audits were sufficient to provide assurance and staff acted on the results when needed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. The teams had effective working relationships with other relevant teams within the service and relevant services outside the trust.

Performance was measured against key performance indicators (KPIs) set by the trust. These KPIs related to visiting people who had been discharged from hospital, the frequency of care programme approach reviews, referral and recording the outcomes of visits and appointments.

Team leaders had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Staff had access to the equipment and information technology required to carry out their roles effectively, including electronic patient care records, Patient App (for managing patients’ appointments) and an electronic incident reporting system. The IT infrastructure, including the telephone system, worked well and supported effective communication and record-keeping, and the overall quality and safety of care.

Directorate leaders were well connected with external stakeholders, including commissioners, the Integrated Care Board (ICB), Healthwatch, and third‑sector and charitable organisations, to strengthen oversight and support continuous improvement.

Staff within the service had established strong and effective working relationships with neurology services, dementia and alzheimer’s services. These partnerships supported coordinated, person‑centred care. A local hospice provided specialist care and support for people with life‑limiting illnesses, as well as emotional and practical support for their families and carers, which enhanced the service’s ability to meet people’s complex needs

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Staff told us senior managers visited the service and knew about the trust senior leadership team.

The service participated in accreditation schemes relevant to the service and learned from them. The Memory service had received accreditation for MSNAP from February 2023 to February 2026. The service was in the process of renewing its accreditation and had submitted evidence demonstrating compliance with nationally agreed standards. An outcome was expected in July 2026. MSNAP is the UK national accreditation scheme for memory services (memory clinics) led by the Royal College of Psychiatrists.

Staff at the memory service used the Patient Aid app. The Patient App allowed patients to access and manage their care in one place, including viewing appointment details, letters, test results, care plans and questionnaires, receiving messages from clinical teams, and completing forms online, all via NHS login. The Patient App helped improve communication, reduce missed appointments, and give patients greater involvement in their care.

Staff within the Memory Service had been developing a fully interactive Mental State Examination (MSE) training tool designed to enhance the learning and confidence of junior doctors. The tool places staff in realistic scenarios that reflect real clinical situations. For example, where staff carry out a Mental State Examination in a patient’s home, they can also notice living conditions, safety risks, and social cues.

Staff within the Memory Service demonstrated a strong culture of innovation by developing a virtual reality system that enables staff to experience delirium from the perspective of patients, based on real lived experiences. This initiative supports improved understanding, empathy, and quality of care. The work had been shared with the Royal College of Psychiatrists, highlighting the service’s commitment to learning, continuous improvement, and contributing to wider best practice.

Staff were given the time and support to opportunities for improvements and innovation and this led to changes. A staff member in the Memory Service introduced the Transfer of Care (TOC) meetings to improve the patient journey from diagnosis to discharge. This ensured patients were involved in planning their care. TOC meetings involved the multidisciplinary team who worked together to plan support based on each person’s needs. This may include occupational therapists, psychologists, and external partners such as the Alzheimer’s Society. This approach improved teamwork, communication, and meeting patient outcomes upon discharge.

Patients were invited to take part in research groups. Invitations to become involved in research were displayed in patients waiting areas.