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 12 April 2018

Our rating of this service improved. We rated it as good because:

• The community adult’s service had made a number of improvements since our last inspection.

• There were sufficient numbers of staff across the community adults service to keep people safe, although caseloads varied by team. Staff were competent in their roles.

• Completion rates for mandatory and safeguarding training were high across the service’s range of specialisms. Staff were able to identify and knew how to report safeguarding concerns and incidents. There was governance oversight of incidents and complaints and learning emerging from these was shared with staff and teams across the service.

• Care and treatment provided was evidence based and we saw evidence of effective multidisciplinary working within the teams. This included specialisms working together to identify potential risks to patients and to avoid the development of a frailty ‘wrap around’ care service to keep people safe in their own homes or care homes and to avoid admission to hospital.

• The service collected data in all its specialisms on patient outcome measures. Results showed that the majority of patients achieved positive outcomes from the care and treatment provided to them.

• Staff were kind and compassionate in the care and treatment provided to their patients. Staff involved people in decisions and ensured people understood the care and treatment provided to them, and supported people emotionally when appropriate.

• The service worked with local commissioners, GP and other stakeholders in planning the services offered to people, and also took into account individuals’ needs. People were able to access the service when they needed to and waiting times were within local and nationally agreed targets.

• The service’s leaders understood the challenges the service faced, and had a vision and plans for the future development of the service to integrate further with primary and secondary medical services in the area.

• The culture within the service and engagement with staff and the public had improved since our last inspection. Innovation, improvement and learning was supported by the trust.

However:

• Patient treatment plans developed in the electronic ‘paper light’ working environment were not of sufficient detail or quality to enable staff to adequately plan individualised patient treatment and care goals, to assess progress against these, or to reasonably mitigate the risks to the health and safety of patients receiving care and treatment. This meant there was an over-reliance on staff knowledge of individual patients to mitigate any ongoing or developing risks to patients.

Updated 4 October 2019

Our rating of community health services for children and young people stayed the same. We rated it as requires improvement because:

Some groups of staff were unaware of the systems in place to respond to the potential risks of patients with sepsis.

Not all records were up to date and easily available to all staff providing care.

The arrangements for monitoring patient outcomes were not consistent. Staff appraisal rates in some teams did not meet trust targets. Arrangements to make sure that some children, young people could make legally informed decisions about their care and treatment were not effective. Transition arrangements of children and young people were not suitably planned or monitored to meet individual need.

Information was not always in formats that met individual needs.

There was a lack of a clear vision and strategy to ensure that all staff felt connected with the trust and ensure that the service was monitored. Leaders were not consistently visible in the service.

There was limited engagement with patients, staff, equality groups, the public and local organisations to plan and manage services.

However;

Managers and staff understood how to protect patients from harm and abuse and how to report any safety incidents. Environments and equipment were clean and well maintained. Staffing levels were monitored and adjusted to meet patient’s needs. Medicines were managed safely.

Managers held meetings with staff to provide support and development. There was good team working both within the service and externally with partners.

Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Emotional support was provided as needed.

Leaders supported staff to develop their personal skills and take on more senior roles. Staff were focused on the needs of patients receiving care. Staff within local teams were clear about their roles and accountabilities and had regular opportunities to meet.

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.