East Cheshire NHS Trust

Ratings - Community health services for children, young people and families

• Overall

  Good

• Safe

  Good

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

Date of the assessment was 29 to 31 July 2025.

We visited community health services for children, young people and families in Congleton and Macclesfield. We visited the complex care team, district nursing team, paediatric audiology, community diabetes team and community paediatrics, which included autism and neurodevelopment assessment pathways, community occupational therapy, community physiotherapy and the Trust’s safeguarding children team. We visited the children and young people’s inpatient unit, where a shared clinical facility was based in the Paediatric Observation and Assessment Unit (POBS). This was used by different services including community paediatrics and the community complex care team for meetings, handovers and storage of clinical equipment used by these teams. We visited services that provided support to community health services for children, young people, and families, which included specialist nurses in epilepsy, diabetes, and allergies. Throughout this report; the community nursing team are referred to as ‘district nurses’ as a generic term, whereas the paediatric role is a children’s community nurse or hospital at home team. We visited the children and young people’s inpatient unit and reviewed the out of hours support this service offered to the health care assistants working in patients’ homes who were supported by the complex care team. The Trust does not have a specific paediatric podiatry service, and we visited the podiatry service as part of our inspection of community health services for adults.

Following the announcement of the inspection on 24 July 2025, we were informed the Trust speech and language therapy services had been transferred to another NHS provider as part of a commissioner’s strategic plan for Cheshire wide speech and language therapy services. We followed up the transfer of this service to understand how East Cheshire would access it. The 0-19 services in East Cheshire were provided by another NHS Trust, so did not provide health visiting or school nurses. The NHS Trust providing the 0-19 service, provided us with feedback about that working relationship. We gave verbal feedback which we confirmed in a letter to the trust shortly after our inspection.

We spoke with 4 patients and 4 parents. We reviewed 9 patient care and treatment records. We attended home visits with district nurses, and observed clinics with physiotherapists, the diabetes service, occupational therapists, podiatrists, and audiologists. We conducted tours of the environment at the sites at Congleton War Memorial Hospital, Macclesfield district general hospital and Pavilion House, Macclesfield. We spoke with nursing and therapies staff.

We had previously inspected the service in July 2019, when we rated community health services for children, young people and families as requires improvement. The effective domain was rated as requires improvement because in the complex care service, the service had not met their responsibilities regarding legal and appropriate consent to care and treatment when patients had reached the age of 16. The well led domain was also rated as requires improvement because there had been gaps in the leadership teams, and governance processes were not well understood. At this inspection we found that the service had met their responsibilities regarding legal and appropriate consent to care and treatment when patients had reached the age of 16. Governance processes included auditing of consent.

During this inspection, our ratings changed. Our rating for safe improved and was rated as good. The ratings for effective and well led improved to good. Caring and responsive stayed the same and were rated as good. Our overall rating stayed the same and the service was rated as good.

• We found a breach of the regulations in relation to good governance. Staff did not always complete comprehensive risk assessments which were not regularly reviewed, so identified risks were not always managed or mitigated appropriately.

• Governance did not operate consistently in the service. Audits were not being completed in relation to recording important details in patients’ care records and care plans around patients’ communication needs and review of information and guidance around care tasks. This prevented consistent oversight of practice and delivery of care for some patients with complex needs, and learning could not be identified.
• Audits of medicine administration in patients’ homes was inconsistent and agreement between parents and staff required further clarity and oversight by senior staff to ensure they followed Trust guidelines and policy in this matter.

However:

• Feedback from patients and our observations showed that patients were treated with dignity and respect and were supported by staff. Parents said treatment was explained using plain English, and they were able to ask questions and raise concerns. Parents were positive about the online information available to them about autism and neurodevelopment assessment pathways, community occupational therapy, community physiotherapy, audiology, diabetes and speech and language therapy.
• Staff knew how to report incidents, which were investigated by managers. Learning from incidents was shared with individual teams and across services for children, young people, and families. Staff understood how to protect children and young people 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 established in the teams we visited, and care pathways were integrated, with responsive referral and access times for assessment and treatment.
• 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 participated in a range of quality improvement projects that showed their commitment to improving outcomes for patients, and engaging staff in improving the service.

• At Congleton War Memorial Hospital, we noted an automated external defibrillator (AED) in its storage case was left on top of a storage unit and had not been securely fastened to the wall or secured in its case with a security tag. Adjacent to the AED was an oxygen cylinder stored in a wheeled trolley. This oxygen cylinder was not securely locked, and the oxygen valve could be opened. In addition, there was no sign advising staff or members of the public that oxygen was being stored. We raised this whilst on site and returned before we left the site to check the matter had been rectified. We observed the AED was securely fastened in its storage case and to the wall. The oxygen cylinder had been placed in a secure room and an oxygen storage sign placed on the door.
• At Macclesfield District General Hospital, we observed clinical equipment waiting to be returned for service/repair, blood collection bottles and catheter tubing with expired dates of use on them. We raised this whilst on site and returned before we left the site to check the matter had been rectified. We observed the out-of-date items had been removed and clinical equipment returned for service/repair. In addition, the matron had reviewed and revised the governance process for monitoring expired equipment, including additional storage, so it was separated from frequently used clinical equipment.

People's experience of this service

During the assessment we spoke with 4 parents and observed 3 patients’ assessment and care. Our observation of patients’ care showed that staff sought consent from patients and used age-appropriate words to explain care giving procedures. During our observation of care from staff in the complex care team, district nursing team, audiology, and community paediatric teams we observed patients who did not use words recognised and responded to staff with smiles or gestures. Feedback from parents and carers was that staff sought their and children and young people’s consent and participated in decisions about their care. Information was available and or provided in accessible formats, with Information to support patients and parents. For example, for autistic people on the neurodevelopment assessment, community occupational therapy, community physiotherapy, audiology and speech and language therapy pathways. Information included activities parents could do with children prior to the service commencing. Information was also available to parents and carers on referrals and signposting to other services or organisations. Parents said staff were responsive to their queries and there was good communication between teams for children and young people who received care from a number of services. Parents and carers described staff as 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.