East Cheshire NHS Trust

Updated 4 October 2019

East Cheshire NHS Trust provides a range of acute and community-based services, including emergency care and emergency surgery; elective surgery in many specialties; maternity and cancer services. The community health services include; community nursing, intermediate care, occupational and physiotherapy, community dental services, speech and language therapy and palliative care. They also provide several hospital services in partnership with other local trusts and private providers, including pathology, urology and renal dialysis services.Inpatient services are provided from two hospital sites – Macclesfield District General Hospital (main site) and Congleton War Memorial Hospital. Outpatient services are provided in Macclesfield District General Hospital and community bases in Congleton, Handforth, Knutsford, Wilmslow and Poynton.

Updated 4 October 2019

Our rating of the trust stayed the same. We rated it as good because:

• We rated effective, caring, responsive and well-led as good, and safe as requires improvement. We rated 12 of the trust’s 13 services as good and one as requires improvement. In rating the trust, we took into account the current ratings of the six services not inspected this time.
• We rated well-led for the trust overall as good.
• Services we inspected had enough staff to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The trust controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They mostly managed medicines well. The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients enough to eat and drink. Managers monitored the effectiveness of most of the services and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. They provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• Services were planned and provided care in a way that met the needs of local people and the communities served. The trust also worked with others in the wider system and local organisations to deliver care. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. The trust treated concerns and complaints seriously, investigated them and shared lessons learned with staff.
• Leaders ran most services well and supported staff to develop their skills. Staff understood the trust’s vision and values, and how to apply them in their work. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The services engaged well with patients to manage services and staff were committed to improving services continually.

However:

• Within urgent and emergency care and outpatient services, patients could not always access services when needed and receive treatment within agreed timeframes and national expectations.
• Within the community inpatients service, people could not always access the service when they needed it and criteria for admission to intermediate care were not formally agreed. The adaptations of the environment and facilities for people living with dementia were limited within the community inpatients services.
• Within the complex care team in the children’s community 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. There had been gaps in the leadership teams and governance processes were not well understood in community children’s services.

Updated 4 October 2019

Updated 4 October 2019

Updated 25 June 2025

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.

Updated 25 June 2025

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.

Updated 4 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• During the inspection we noted not all medical emergency medicines and equipment were available. Immediate action was taken to address this.
• A dental specific sharps risk assessment had not been carried out.
• An audit of antimicrobial prescribing had not been carried out.

Updated 4 October 2019

Our rating of this service stayed the same. We rated it as good because:

• Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. The service had enough staff to keep people safe.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• People could not always access the service when they needed it and criteria for admission to intermediate care were not formally agreed.
• Optimal staffing levels were not always achieved as staff were moved when demands for staff elsewhere in the trust increased.

Updated 12 April 2018

We rated the service overall as good because:

• The trust had a dedicated specialist palliative care team who provided support to community staff and patients at the end of their life.
• Care and support was given in a respectful and compassionate way. Staff within the specialist palliative care team worked hard to support staff to ensure patients received the care and treatment they required.
• Managers planned and provided services in a way that met the needs of local people. They worked with local organisations and made changes to improve services and support patients more effectively.
• Staff were competent, knowledgeable and responded to patients and their loved ones’ needs. The majority of the team had completed mandatory training and all staff had received annual appraisals.
• The specialist palliative care team worked as an integrated team with hospital and community providers to promote continuity and consistency in patient care. The team also participated in local and national groups to share information and learn from peers.
• Staff knew what incidents to report and how to report them and managers were involved in investigating incidents and they shared any lessons learned.
• Staff across the service understood how to protect patients from abuse and how to assess patients’ capacity to make decisions about their care.
• The team attended daily board rounds and multidisciplinary team meetings across secondary and primary care in order to provide knowledge, support, input and consistency into patients’ palliative and end of life care.
• Medicines were managed and prescribed appropriately and equipment was available to patients at the end of their life. Equipment was mostly well maintained.
• Managers supported all staff through regular appraisals and supervision. New staff received a package of support including a mentor, induction, and list of competencies, which was flexible according to their previous experience and training.

However,

• End of life care plans reflected National Institute for Health and Clinical Excellence guidelines however these were not used consistently in the community..
• The service relied upon other organisations to collate and measure patient outcomes and although this was shared we did not see any service specific action plans to address areas for improvement.
• Although the majority of staff had received training on safeguarding, the Mental Capacity Act, and Deprivation of Liberty Safeguards the trust provided no evidence that two members of staff had attended or were going to attend level 2 training in adults safeguarding.
• Specialist palliative care services were not available seven days a week although community staff had support from a local hospice telephone advisory line or GP service at weekends and out of hours.
• Some staff felt the senior managers and executive team were not all visible within their service.