Cheshire and Wirral Partnership NHS Foundation Trust

Updated 14 January 2025

Cheshire and Wirral Partnership NHS Foundation Trust (CWP) is a combined NHS provider of mental health services, learning disability services, community mental and physical health services and primary medical services. The trust has services across Wirral and Cheshire, as well as Trafford, Warrington, Bolton, Halton and Liverpool. It also commissions specialist eating disorder services for the North West. The trust was formed in 2002. In June 2007, the trust became the first mental health trust in the North of England to become a foundation trust. The trust has over 14,700 members and employs more than 4,500 staff across 73 sites, serving a population of over 1 million people and highly specialist services for 2 million. We undertook a trust-level assessment (well-led review) of the trust which included an on-site visit on 2-4 July 2024. We undertook further visits to observe the trust’s board and committee meetings on 31 July, 2 September, 11 September and 17 September 2024. We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust in the Single Assessment Framework. We found areas for improvement within three of the eight quality statements and positive findings within five of the eight quality statements. We have asked the trust for an action plan in response to the concerns found at this assessment. The well-led review followed several assessments of the trust’s frontline services (assessment service groups). The initial assessment of the trust’s services was triggered following two serious incidents (inpatient deaths) in Bowmere Hospital. This resulted in an assessment of the trust’s acute mental health wards at Bowmere Hospital, and the psychiatric intensive care units at Bowmere Hospital and Springview Hospital. The assessment found significant concerns regarding the staffing levels across Bowmere Hospital and a letter of intent was served on the trust requiring them to take immediate action to ensure a reduction of the risk of harm to people who used services. The trust responded to the letter of intent and addressed our concerns through an action plan detailing how the issues would be resolved. Further assessments included wards for older people; community mental health services for working age adults; mental health crisis services and health-based places of safety; community end of life care and Willaston Surgery. We undertook these assessments to ensure we had a thorough understanding of the full range of services provided by the trust ahead of our well-led review. We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust in the Single Assessment Framework. We found areas for improvement within three of the eight quality statements. The trust had a strategy however it was not supporting a shared direction within the trust. There was work in-progress to reframe and reset the trust’s strategy to focus on the highest priority objectives. Governance systems, particularly the systems in place to identify and manage risk, quality and performance, did not always operate effectively to sight leaders on all emerging risks within services. Information systems were in development which meant the board did not always have consistent systems in place to capture, analyse and present information. There was work in-progress to strengthen freedom to speak up processes. However, the trust had a clear statement of vision and values. These were well-embedded within the trust. Leaders consistently demonstrated their commitment to compassionate and inclusive leadership. Leaders were visible within the trust and there was strong evidence of the commitment of the board to the equality, diversity and inclusion agenda. The trust’s commitment to learning, innovation and research was clear, particularly the focus on patient outcomes. There was strong evidence of both the commitment and passion within the provider collaboratives led by the trust. There were examples of partnership working and innovation in relation to involving communities and co-production.

Updated 7 March 2024

The Trust failed to ensure the service consistently had enough staff to keep patients safe, to support patients to access all aspects of their care created unnecessary restriction on 'quality of life of patients and placed them at risk of avoidable harm. The service's culture was not consistently centred on the needs and experiences of patients, and staff told us they found difficulty forming relationships with patients due to staffing pressures. Patients were complimentary about the care and compassion provided by staff toward them and we observed staff caring for patients with kindness and compassion. Following our last inspection the Trust provided an updated action plan to manage staffing pressures and had a workforce plan in place aimed at growing their own staff and the retention of existing staff. Staff told us they consistently raised concerns with senior managers about safe staffing levels on the wards and they did not see significant improvements despite the Trust action plan. The Trust was experiencing staffing pressures across most services as a result of high levels of absence and vacancies. This impacted on patient’s access to therapeutic activities and on staff wellbeing. Care plans were not always individual to the needs of the patient. Systems and processes were in place so staff could report incidents and receive information about serious incident outcomes and learning from these. Ward managers had set up local communication processes to check staff were receiving important information, but told us they did not have sufficient time to read this due to staffing pressures.

Updated 17 April 2024

We assessed Cheshire and Wirral Partnership NHS Foundation Trust's mental health crisis services. During this assessment we visited services in Cheshire East, Cheshire West and the Wirral. We assessed 18 quality statements across the safe, effective, caring, responsive, and well led key questions and have combined the scores for these areas with scores from the last inspection.

Updated 24 April 2024

Date of assessment 04 June 2024 to 11 June 2024. We assessed 16 quality statements across safe, effective, caring, responsive, and well-led key questions and have combined the scores for these areas with scores from the last inspection. Staff showed good understanding of the Mental Health Act and Mental Capacity Act and this was integrated in to their every day practices. Staff had a clear understanding of patients' risks and care requirements. The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. The service treated people with kindness, empathy and compassion and respected their privacy and dignity. They promoted people’s independence, so they knew their rights and have choice and control over their own care, treatment and wellbeing. Staff felt well supported by managers and felt confident approaching them. However, we found issues around the administration and management of medication on Cherry ward. We interviewed 26 staff across 3 wards and observed MDT meetings and the care and treatment of patients. We spoke with 9 patients and 10 carers.

Updated 8 July 2024

Cheshire and Wirral Partnership provides community mental health services across Cheshire and Wirral. We carried out assessments at 4 community teams across this footprint. We assessed 20 quality statements across safe, effective, caring, responsive, and well-led key questions. We interviewed 22 staff across the sites and observed meetings and care onsite at community locations as well as out on home visits. We spoke to 20 patients on and off site and 7 carers remotely. We found patients were treated with kindness and compassion across all sites. Key workers knew patients well and continuity of care was maintained. The creation of a high-risk board and morning handover meeting was supporting good oversight and management of current and emerging risk within teams. These meetings also promoted shared risk management within teams. There was a focus on safety and concerns or incidents were managed and investigated appropriately. Learning from incidents was regularly shared. Staff teams were also happy and well supported and workloads were generally manageable. However, we noted some inconsistencies in case note documentation across all sites in risk and safety plans. This was of particular note in consultant led caseloads, which were large across all sites. It was also clear within key worker caseloads that the level of care being provided was not always accurately reflected in the case notes. There had also been notable difficulties across sites in recruiting psychologists, leading to a marked reduction in or absence of psychology provision within teams. Teams also raised concerns about increasing acuity in their caseload and an increased need to provide crisis support for their patients.

Updated 15 May 2024

Community End of Life Care services for Cheshire and Wirral Partnership NHS Foundation Trust are based at The Hospice of the Good Shepherd in Backford, Cheshire. The trust is registered CQC to deliver the regulated activities: Treatment of disease, disorder or injury. This assessment was prompted due to the time since the last inspection of the service (2015). At the time of this assessment a wider review of services was also undertaken. We carried out this assessment on 11, 12 and 13 June 2024. We looked at quality statements in key questions safe, effective, responsive and well-led. The service remains re good in all these areas and we have rated the service good overall. During our assessment we found systems and processes were in place to ensure safe care and treatment was provided to end of life care patients. However, for well-led there was not fully effective oversight of risk. Action was being taken to address this at the time of the assessment.

Updated 18 June 2020

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. 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.
• Staff provided good care and treatment, checked that patients ate and drank enough, 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 from community mental health teams were regularly visiting community health teams to provide advice and support for patients presenting with co-morbid mental health issues.
• 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.
• Staff understood the service’s vision and values, and how to apply them in their work. Staff were focused on the needs of patients receiving care. Staff were committed to improving services continually.

However

• The trust’s governance systems were not fully effective. We found some minor shortfalls that had not been fully identified or addressed by the trust’s own governance systems. These included cleanliness in one clinic, lone working arrangements, supervision uptake rates, clinical photographs, consent and capacity recording and deferment of appointments.

Updated 4 December 2018

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

• The trust had addressed the recommendations identified by the CQC at the last inspection and made significant improvements across the service.
• The trust electronic patient record system was shared across all services and anyone with access to the system could see the full patient history.
• Staff were aware of the importance of raising incidents and there was a positive culture of incident reporting.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• The service made sure staff were competent for their roles and there were excellent professional relationships across all services.
• There was an exceptional family focused approach to care delivery and staff had extensive knowledge about their patients.
• Caseloads across all services we visited were very well managed and care was tailored to meet individual needs.
• The trust planned and provided services in a way that met the needs of local people and worked well with external organisations.
• There was a diverse knowledge base among managers that was utilised across the services.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• There was an improvement in the way services were delivered and staff felt this was due to the new ways in which the teams worked.

Updated 18 June 2020

We last inspected Cheshire and Wirral Partnership NHS Foundation Trust’s child and adolescent mental health wards in August 2018. On that inspection, we rated this core service as good overall with ratings effective, responsive and well led domains rated as good, safe as requires improvement and caring as outstanding. An action plan was developed by the provider to address the issues raised in the safe domain.

We visited both wards in this core service.  

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.  

Before the inspection visit, we reviewed information that we held about the service and asked a range of other organisations for information.  

During the inspection visit, the inspection team:  

• visited both wards, looked at the quality of the ward environment and observed how staff were caring for patients; 
• spoke with patients who were using the service; 
• spoke with carers; 
• spoke with the acting ward manager of Indigo and Coral wards;
• spoke with other staff members; including support workers, doctors, nurses, occupational therapy staff, psychologists, participation worker and nurse consultant; 
• attended and observed one listen up group; 
• attended and observed one multi-disciplinary meeting; 
• looked at 12 care and treatment records of patients; 
• attended and observed ward based activities;
• carried out a specific check of the medication management on both wards;  
• reviewed 15 prescription charts and 
• looked at a range of policies, procedures and other documents relating to the running of the service. 

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

• The service provided safe care. The ward environments were safe, clean and specifically designed with the patient group in mind. This had considered the risks this group may pose. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• The service had their own website which was developed in collaboration with patients and carers. This allowed them quick access to help and information using information technology.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They involved patients and families and carers in every care decision. Patients and carers were involved in every change that was due to take place on the wards and changes were led by patients. For example, patient panel at interviews, questions devised by patients, new forms and leaflets were designed by patients and there were numerous groups where patients could give their ideas for ways to improve the service. There were monthly carer meetings where carers could raise any concerns or ideas about the service and feedback was always given at the following meeting. We saw evidence of how changes were made to the service following engagement with patients and carers.
• Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason. The service had worked hard to ensure that the wards were part of the local community. There were lots of ways this was done including involvement in the local nature reserve, members of the community coming in regularly to speak to patients such as the police, local MPs and even a Paralympian. The building had been designed with the help of patients. The bedrooms had mood lighting which patients could use to signal to staff how they were feeling. For example, using the red light if they were struggling. The wards had access to a large outdoor space with room for growing fruit and vegetables which were later used in cooking groups. There was a gym and staff had been trained as instructors.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly. Many of the senior leadership team had worked in child and adolescent services for several years. Ward managers had access to a wide range of information about their service monthly which allowed them to pick out themes and trends. The senior leadership team in conjunction with ward-based staff had a clear vision for the future of the service. This had allowed them to plan by putting extra funding into training for the staff team. The wards were applying for accreditation to be an autism friendly ward and staff were making changes to make the environment and paperwork more autism friendly. The wards had been involved in several quality improvement projects which had featured in the trust quality improvement report. The ward was accredited with the quality network for inpatient child and adolescent mental health services and the team had also won an award for inpatient services at the positive practice awards in 2019.

Updated 3 February 2017

We have rated specialist community mental health services for children and young people as good overall because:

• Following our inspection in June 2015, we rated the service as ‘good’ for effective, caring, responsive and well-led. Since that inspection, we have received no information that would cause us to re-inspect these key questions or change the ratings.

• We re-rated the safe question from requires improvement to good following this inspection. This was because the provider had taken action to make improvements. We found that staff followed the trust and local lone working procedures, that the environment at the team bases were safe and that team managers monitored waiting lists.

• We also found that patients' risk assessment and management plans were up to date and completed to a high standard. Safeguarding procedures were followed. Serious incidents were reported and investigated.

Updated 18 June 2020

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

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access and staff and managers managed waiting lists and caseloads well. The criteria for referral to the service did not exclude patients who would have benefitted from care. Staff assessed and initiated care for patients who required urgent care promptly and those who did not require urgent care did not wait too long to receive help.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However;

• We identified items of equipment that were overdue maintenance checks. However, the trust responded immediately to this.
• Although staff considered patient capacity, we found that staff did not always document assessments of capacity within clinical records.

Updated 3 February 2017

We rated community-based mental health services for older people as good because:

• Following our inspection in June 2015, we rated the services as ‘good’ for safe, caring, responsive and well led. Since that inspection, we have received no information that would cause us to re-inspect these key questions or change the ratings.
• Following this focused inspection, we amended the rating for effective from “requires improvement” to “good”. We found that the provider had taken action with regards to the findings of the previous inspection.

Updated 18 June 2020

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

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
• Staff undertook functional assessments when assessing the needs of patients who would benefit. They worked with patients and with families and carers to develop individual care and support plans and updated them as needed. Care plans reflected the assessed needs, were personalised, holistic and strengths based. There is a truly holistic approach to assessing, planning and delivering care and treatment to all patients who use the services. This includes addressing, where relevant, their nutrition, hydration and pain relief needs. The safe use of innovative and pioneering approaches to care and how it is delivered are actively encouraged. New evidence- based techniques and technologies are used to support the delivery of high-quality care.
• They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Feedback from people who used the service, those close to them was always very positive about the way staff treated people.
• They supported patients to understand and manage their care, treatment or condition. Relationships between people who use the service, those close to them and staff are strong, caring, respectful and supportive. These relationships are highly valued by staff and promoted by leaders. People who use services and those close to them are active partners in their care. Staff are fully committed to working in partnership with people and making this a reality for each person.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. There is a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which is accessible and promotes equality. This includes people with protected characteristics under the Equality Act, and people who are in vulnerable circumstances or who have complex needs. Staff helped patients with communication, advocacy and cultural and spiritual support.
• It was well led, and the governance processes ensured that ward procedures ran smoothly. Carers had been involved in a qualitive study to explore how family members experienced their involvement, with a view to shaping service development. The trust had created a centre for autism, neurodevelopmental disorders and intellectual disability (CANDDID). CANDDID has also worked with families and carers to coproduce the development suite of online training for people who care for people with learning disabilities or autism.

However;

• Figures provided following the inspection indicated that only 77% of staff at Greenways had received training in managing violence and aggression including rapid tranquilisation and immediate life support. On Eastway ward only 68% of staff had received training in fire ward evacuation and on Greenways ward only 74% had receive the same training.
• Not all staff had received management and clinical supervision necessary for their position.
• The trust did not have full oversight of patients who were subject to a Deprivation of Liberty Safeguards authorisation, though the trust responded immediately and put a system in place.

Updated 4 December 2018

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

• Staff knew about any risks to each patient and acted to prevent or reduce risks. Staff and managers worked to keep the use of restrictive interventions to a minimum. The service had low levels of the use of restraint, rapid tranquilisation and seclusion.
• The service had enough staff with the right skills, qualifications and experience for each shift. Patients had regular one to one sessions with their named nurse. Patients rarely had their escorted leave cancelled, even when the wards were short staffed. The service had enough daytime and night time medical cover and a doctor was available to come to the ward in an emergency.
• Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. All patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff developed a comprehensive care plan for each patient that met their mental and physical health needs.
• Staff delivered care in line with best practice and national guidance. Staff used recognised rating scales to assess and record the severity of patient conditions and care and treatment outcomes.
• The Mental Health Act was implemented effectively. Staff received training about the Mental Health Act and knew how to access advice.
• Staff were aware of the Mental Capacity Act, and knew how it worked in relation to best interest decision making.
• Care plans were holistic and recovery orientated. There was a programme of activities for patients, which were based on their individual needs and preferences.
• Staff were respectful and responsive when caring for patients. The patients we spoke with were generally positive about the staff. Patients knew how to raise concerns. Patients gave feedback about the service through a weekly meeting called ‘my service, my say’. Patients had personalised bedrooms, which they could access with an electronic key. There were facilities on the wards such as an activities of daily living kitchen and a gym.
• The trust had clinical governance structures that the secure wards fed into. Information packs were generated for each of the services in the trust, which contained key information such as staffing and incidents.

However:

• Not all care plans were person centred, and some described what the patient would do (“you will”) rather than involving the patient (“I will”).
• Capacity decisions were recorded, but they were not always easy to find in the care record.
• Most patients we spoke with thought the food was of poor quality.

Updated 3 December 2015

We rated long stay rehabilitation mental health wards for working age adults good because:

The wards had systems in place to manage patient safety. The ligature risk management plan identified ligature points and how they might be used by patients who were suicidal. This made sure that staff were fully aware of the risk presented. The suicide prevention environmental risk assessment clearly documented where the risks were, the level of risk and how they were to be mitigated

The service generally had sufficient numbers and the appropriate skill mix of staff on duty to meet patients’ needs. Ward managers could increase staffing levels when appropriate. There was access to a regular cohort of bank staff.

There were clear processes in place for reporting safeguarding concerns. Staff had a good understanding of procedures and were confident in applying trust policy. Safeguarding was a standing item on the team meeting agenda.

Staff delivered care and treatment that was underpinned by best practice and a recovery focused theme was evident across the service.

Supervision and appraisals took place in line with trust policy. This meant that staff were supported by managers and colleagues and received the professional development needed to carry out their duties effectively. Managers were able to assess the quality of staff performance.

Peer support workers helped support patients, carers and staff. A peer support worker is a person with direct experience of mental illness.

The admission process informed and oriented patients to the wards. Each patient received an information pack before admission. Staff organised a series of pre-admission visits that gradually introduced the patient to the ward environment. Both patient and carer were included in these visits. On the day of admission patients were met by a member of staff who was familiar to them.

There was effective management of complaints. Patients discussed informal concerns during community meetings and nursing staff discussed any actions arising from these discussions during hand over. The ward manager investigated formal complaints in line with trust policy.

The service captured the ethos of the trust’s vision and values and this was evident in the care and treatment provided by the staff. Senior management had a visible presence on the wards and supported ward managers and staff.

There were good governance systems at a local level. Ward managers routinely monitored key performance information. Team meetings included governance issues as standing items on the agenda.

However, the service was struggling to enforce the nicotine management policy relating to the restriction of tobacco related products. Staff were aware that patients were bringing tobacco and lighters on to the ward and had been reminded about the trust’s search policy. In spite of this, we found little documented evidence relating to the searching of patients or their rooms for contraband items.

We were concerned about the confidentiality of patient and carers information due to the location of the office whiteboard on Rosewood. Information contained on the board, which included home contact numbers for patients and their relatives/carers was visible to anyone who passed by the office on their way to the dining area.

There was not enough emphasis on adhering to the Mental Health code of practice in respect of section 132 rights and access to an independent mental health advocate (IMHA).