Mersey Care NHS Foundation Trust

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• 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 as good. At this assessment the rating has remained as good.

The service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders had the skills, knowledge and experience to perform their roles. Staff felt able to raise concerns.

The service had action plans to improve diversity in senior roles and published annual reports with extensive actions plans to increase equality standards amongst multi-ethnic groups.

The service had an effective governance structure and collaborated with local partners to achieve improvements.

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.

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.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. Staff discussed this in team meetings, posters were visible, and computer screensavers illustrated the service’s vision and values.

Staff said their own physical and mental health was recognised as important by senior managers to maintain and referred to increased away days to enable team building and enhance working relationships.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Staff spoke of how open and approachable senior managers were, they recognised and valued input from staff at all levels.

Medicines management staff we spoke with felt engaged with the services’ medicines strategy and could see how their role supported delivery of key objectives, aligned with the service’s perfect care goals. They spoke positively about how the medicines management team supporting crisis and community mental health services had come together following a period of organisational change. One staff member told us how they ‘used to feel isolated, now we have the new structure it feels like a team again.’

Staff could explain how they were working to deliver high quality care within the budgets available. Staff were aware that agency staff were not being used due to high costs involved and overtime availability had reduced.

The service had inclusive leaders with the skills, knowledge and experience to perform their roles. Managers had a wealth of experience within the service, and many had been promoted into senior roles.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. Managers described the day-to-day challenges of operational teams and had effective oversight of how they were managed.

Staff spoke about how visible managers were and how they consistently requested feedback in different ways. Managers attended patient and carer forums to gain insight into challenges.

Leadership development opportunities were available for all staff. We identified a strong emphasis of the service’s development of their own staff with a high proportion of staff promotion within grades. Staff consistently said they were supported with their development.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. Staff were aware of the freedom to speak up process but hadn’t needed to use it, because they would raise concerns through the usual process.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. Managers undertook a monthly review of friends and family survey results and met with Healthwatch to identify themes and trends.

Staff could meet with members of the provider’s senior leadership team and governors to give feedback. Staff said managers were highly visible with no hesitation about raising concerns directly.

The service’s Freedom to Speak Up (FTSU) policy emphasised the importance for all staff to be able to raise concerns and improve working relationships. A designated freedom to speak up guardian (FTSUG) was in place to raise concerns on behalf of a member of staff that has not been made through their manager. Between April 2024 and March 2025 there were 12 reports to the FTSU guardian, the main theme related to staff attitudes.

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.

The service had ‘equality and diversity champions’ with a focus on neurodivergence, learning disabilities, finance, freedom to speak up (FTSU) and culture. The service had 6 staff networks for employees to gain support from. For example, ex-armed forces, multi-ethnic and dyslexia/dyspraxia networks.

The service published their annual Workforce Disability Equality Standard (WDES) and Workforce Race Equality Standard (WRES) reports in April 2025. Their annual progress report included extensive action plans to meet WDES and WRES equality standards.

Examples of the WRES report findings included a requirement to improve multi-ethnic representation in senior roles. Board membership of black and ethnic minority slightly increased from 6.3% in 2024 to 6.67% in 2025. Positive feedback included a reduction of black and ethnic minorities being subject to formal disciplinary procedures when compared to white colleagues.

Staff were able to apply to work flexibly to enable them to work alongside personal circumstances such as caring responsibilities and health issues, underpinned by their flexible working policy. The WDES report showed that 76% of staff with a disability said adjustments had been made for them to carry out their work.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. Both WDES and WRES reports included data that illustrated the proportion of multi-ethnic and disabled staff across the service across clinical and non-clinical roles.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. The service acted on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

There was a clear set agenda of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. We observed verbal handover meetings to discuss risks with people using the service. Managers and staff spoke of regular team meetings with clear messages, learning from incidents was a key theme.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. Managers and staff said this was discussed in team meetings, during morning handovers and formalised through email bulletins.

Staff undertook or participated in local clinical audits. Examples were compliance of medicines standards, physical health checks for people using services. 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. Staff described how they work with community mental health teams (CMHTs) and external teams such as local authority safeguarding.

The service’s mental health care division held a monthly governance meeting. Examples of items for discussion included risks associated with medicines management, data improvements, risk register updates and feedback from people using the service and carers.

Staff maintained and had access to the risk register at each location. Any concerns raised by staff matched those on the risk register.

Each service had its own business continuity plan in the event of an emergency. These included specific actions to take following disruption to the service such as fire or severe weather with clear paths of escalation and were updated regularly.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure including an upgraded telephone system resulted in improved outcomes by use of voice analytics.

Information governance systems assured confidentiality of patient records. The service had specific policies to cover information sharing, governance and corporate data protection. Managers and staff were aware of the importance of confidentiality and sought advice when necessary.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Audits such as care plans and risk assessments were discussed during each morning’s handover meeting.

The service understood their duty to collaborate and work in partnership. They shared information and learning with partners and collaborated for improvement.

Directorate leaders engaged with external stakeholders such as commissioners and Healthwatch. Managers also engaged with various agencies under Multi-Agency Public Protection Arrangements (MAPPA) to discuss people who used services who could pose a risk to the public.

We reviewed an information sharing agreement between this service and a local NHS service for the purposes of antenatal care. The service also had appropriate provision for information sharing with statutory organisations such as police and local authorities.

The service worked with the integrated care board to support medicines optimisation across the interface between services, especially around high-risk medicines, managing medicine shortages and standardisation of clinic letters to GPs.

The service ensures that a Data Protection Impact Assessment (DPIA) was used before sharing information with an organisation for the first time, in accordance with its own information sharing policy. This ensured that information was being shared appropriately and recorded.

The service focused on continuous learning, innovation, and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. They actively contributed to safe and effective practice and research.

Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. We saw evidence of a wide range of improvements that have been made to improve patient care such as the introduction of a clinical competency framework for staff, improved access to psychology and more effective medicines management processes

Staff had opportunities to participate in research. The mental health division had a community quality improvement group who met monthly to discuss existing quality improvement actions and new ideas.

Innovations were taking place in the service. The first response hub used an interactive telephone system to improve access to clinicians and increase clinical support for staff and people who used the service. It led to a 41% reduction in after call work, 43% increase in calls being answered and 22% increase of calls being answered within 60 seconds. The trust had a Mental Health Crisis Assessment Service (MHCAS) for people to receive a mental health assessment as an alternative to attending emergency department at local NHS hospitals. MHCAS received referrals from other services to provide increased support to people during crisis.