East Cheshire NHS Trust

Ratings - Community health services for adults

• Overall

  Good

• Safe

  Good

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Requires improvement

Our view of the service

Date of the assessment was 5 to 7 August 2025.

We visited community health services for adults in Macclesfield, Knutsford and Congleton. We visited cardiopulmonary rehabilitation, integrated respiratory, bladder and bowel, neuro outpatients, rheumatology, musculoskeletal health, podiatry, audiology, Knutsford district nurses, virtual wards, hand therapy and urgent community response. We gave verbal feedback which we confirmed in a letter to the trust shortly after our inspection.

We spoke to 16 patients and 4 carers. We reviewed 22 patient care and treatment records. We attended home visits with district nurses, and observed clinics with physiotherapists, occupational therapists, podiatrists, and audiologists. We carried out tours of the environments at the sites we visited. We spoke to a range of nursing and therapies staff from band 3 to band 8.

East Cheshire NHS Trust has five care communities covering Macclesfield, Chelford, Handforth, Alderley, Wilmslow, Bollington, Disley, Poynton, Congleton, Holmes Chapel and Knutsford. Each care community has a care community coach, community nursing team leader and community therapy team leader. In addition to these services there is also an out of hours nursing team, virtual wards, urgent crisis response, pulmonary rehabilitation, palliative care, integrated respiratory, tissue viability, podiatry, stoma care, blader and bowel, and a transfer of care hub.

We had previously inspected community health services for adults in January 2018. As a result of that inspection, we had rated the safe domain as requires improvement. We had rated the effective, caring, responsive and well led domains as good. Our overall rating was good.

During this inspection our ratings changed. Our rating for safe improved and was rated as good. Ratings for effective, caring and responsive stayed the same and were rated as good. Our rating for well led declined and was rated as required improvement. Our overall rating stayed the same and the service was rated as good.

We found breaches of the regulations in relation to good governance.

• Feedback from patients and carers was positive and they were treated with dignity and respect. Patients and carers felt supported by staff, that treatment was explained clearly, and they felt able to ask questions and raise concerns.
• Managers investigated incidents and shared lessons learned with the whole team and the wider service. Staff completed comprehensive risk assessments which were regularly reviewed. Identified risks were managed or mitigated appropriately. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• People felt involved in plans about their care, and staff identified where additional support was needed external to the team and the service. Partnership working was very strong in the teams we visited, and the structure of the care communities helped to encourage engagement with the wider community. The trust listened to people who were most likely to experience inequity and aimed to develop services to address this. People working in services reflected the diversity of the communities they worked in.
• Staff adhered to infection control principles and had access and use of personal protective equipment where required.
• The service was involved in a range of quality improvement projects that showed their commitment to improving outcomes for patients, and engaging staff in improving the service.

However:

• Governance did not always operate effectively in the service. Managers did not consistently complete audits. Audit results were not always tracked and reported. There was limited evidence of audit activity being used to drive improvement within the service. This prevented comprehensive oversight meaning gaps in practice and learning could not be identified, and there was low staff engagement and accountability in this process.
• Supervision was not completed regularly due to staff pressure, and completion was inconsistent between teams.
• The staff mandatory training compliance rates were low for some training modules, including infection prevention control and medicine management awareness.
• The environment of some clinics needed to be improved. Furniture was not always in good repair and could not be thoroughly cleaned. In one clinic area the sink base was in poor repair, which prevented thorough cleaning, and staff could not use the sink to wash hands effectively in line with infection prevention and control standards.
• Staff did not always have access to the right IT equipment to carry out their roles. The trust had identified this as a risk within the service.

People's experience of this service

During the assessment we spoke to 16 patients and 4 carers. Feedback from patients and carers was mostly positive. Patients and carers said they felt involved in decisions about their care, and information was mostly provided in a way that patients could easily access and understand. They were happy with the information that was provided for additional support, referrals and signposting. Patients said they had no concerns about the care and treatment being provided or how their treatment was progressing. Staff responded promptly to requests from patients, and patients said they received quick responses to their queries. Patients spoke highly of staff, and felt they were kind, caring and respectful in all of their interactions.

Our observations during our inspection supported this. We saw that staff had a positive, caring attitude to the patients and their carers. Staff had a person-centred approach to care and their assessments were holistic.

Some patients commented on the lack of consistency with consultants within the virtual wards and felt the communication between themselves and the doctors was very different due to the two-week cover of consultants.