Cheshire and Wirral Partnership NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed a total of 4 quality statements in the responsive key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Our rating for this key question is good. Feedback from patients was positive feedback about service they received. They did not always want a copy of their care plan, but were aware of their plans and goals of care. Staff were positive in how they spoke about patients. They were aware of people’s needs and saw people as individuals, including people who presented regularly. Patients and carers were aware of the opportunities they had to give feedback on care, this included supporting carers and family members, through the provision of accessible information or listening to questions and queries, offering advice, or signposting people to other agencies. Staff we spoke to were positive about caring for patients. Their descriptions and examples of patient care demonstrated individualised care was offered to people to meet their individual needs. This was balanced against practicalities, such as patients having different staff visit them from the home treatment team or accommodate patients' work and childcare arrangements. The trust introduced the first response model aimed at improving access to mental health services to reduce pressure on accident and emergency and mental health services. The model referred or signposted people to more suitable services, third sector organisations (voluntary/charities/private). The Trust was in the early stages of developing urgent assessment centres using first response teams together in a more suitable environment for people to have a mental health assessment as opposed to accident and emergency departments.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care plans reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. Feedback from patients was generally positive feedback about service they received. They did not always want a copy of their care plan, but were aware of their plans and goals of care. Positive feedback from patients showed that the care they had received was person-centred and supported their needs. Positive comments from patients included the team were “amazing” and had “saved my life”; they’d been supported with medicines, filling in forms, and paying bills. People told us “can’t fault them” and they had visited every other day; and that staff were “fantastic, – everyone who came was marvellous”.

People received the most appropriate care and treatment for them as the service made reasonable adjustments where necessary. Staff said the care they provided was person centred. Staff we spoke with were positive and caring about patients, and their descriptions and examples of patient care demonstrated individualised care that met the needs of the individual. This was balanced against practicalities, such as patients having different staff visit them from the home treatment team and not being able to give a fixed time. But staff collaborated with patients on this, negotiating a time slot. Care provided was individualised and in response to the person. Delivery and coordinated services considered the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. Staff collaborated with patients on care and crisis planning. Staff feedback was that patients were empowered through the provision of information, for example, having a long discussion about alternatives to admission, support from a home treatment team or even respite care as options. Other offers to choose from were talking therapies and support groups. Staff followed the principles of the Mental Capacity Act and where aware patients could make unwise decisions, for example about medicines, so the team provided information about side effects, or a pharmacist would also attend a meeting to explain how medicines worked. Liaison psychiatry staff feedback highlighted the side by side process was positive as patients were seen earlier, and if there were no concerns identified, patients could leave the accident and emergency department sooner. Otherwise, they had to have a full assessment by the acute trust staff first.

People received care and treatment from services that understood the diverse health and social care needs of their local communities. We attended multidisciplinary team meetings and observed staff working in offices and on Crisis Line. During observations all the interactions with staff we observed were positive towards patients and appeared person-centred. Staff responded to individual patient, rather than a one-size fits all approach. Language used by staff toward patients was positive and respectful.

People who used services and those close to them (including carers and dependants) were regularly involved in planning and making shared decisions about their care and treatment, so it is centred around them and their needs. The format of care plans were generally generic, but assessments were detailed and care delivered was individualised.

There was continuity in people’s care and treatment because their needs were assessed and referrals to other services made, and services were flexible and joined-up. No information of concern was evidenced about the care provision, integration, and continuity during our calls with patients. The first response model was aimed at improving access to services, and reduce pressure on accident and emergency services generally by referring or signposting people to more suitable services, including contracting with third sector providers. However, one patient who was homeless said they couldn’t get access to suitable accommodation, and another patient said they wanted access to a respite bed, but this was unavailable, when referrals had been made through the assessment process.

Delivering and co-ordinating services considered the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. The population of the local area was generally white British, but services took account of and were building up links with specific populations including asylum seekers, students at the University of Chester and homeless communities. There was a dedicated children and young peoples crisis line for people aged under 16 years.

People received the most appropriate care and treatment for them as the service made reasonable adjustments where necessary or used what services were available to them to reduce the risk to an individual patient. We received limited feedback from partners. Feedback from Cheshire police was that street triage was a good service when there were staff available to carry it out. Otherwise when street triage staff were not available the police could be left with limited options, and had to use health based places of safety which could be more restrictive.

People received care and treatment from services that understand the diverse health and social care needs of their local communities. The first response model was aimed at improving access to services, and reduce pressure on accident and emergency services generally by referring/signposting people to more suitable services, including contracting with third sector providers. The trust were in early stages of developing urgent assessment centres that would bring first response teams together and be a more suitable environment for people who needed a mental health assessment, for example, if they have no physical concerns they do not need to go to the accident and emergency dep0ratment.

People could get information and advice that was accurate, up-to-date and provided in a way that they could understand, and which met their communication needs. Information was provided to patients based on patient's choice and needs. Patients' feedback was information was provided in the form of information leaflets about the service which they had contacted. Some patients said they were offered a crisis or care plan, and other patients took contact details from the crisis line or this was sent to them by email or was available on the Trust’s public website. Information was available in accessible formats. Patients had given feedback via the Trust service user feedback report [published February 2024, survey took place Nov/Dec 2023. These were telephone surveys of people who had used the service. Of the 5 main questions responses were positive in about half (47-54%), and negative responses were low (3-11%). Additional comments were mixed and some very positive, some negative. Trends identified were broadly around improving communication at various levels with patients.

Patients' individual needs to have information in an accessible way were identified, recorded, highlighted and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. Feedback from staff was there was a range of information leaflets available to patients, which could be translated into different languages and formats such as easy-read. This included medication leaflets. Other information was available to patients about other services, for example third sector services, including community and residential substance misuse, respite homes and support groups for addictions.

People could expect information to be tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people whose first language was not English and for deaf people who used British Sign Language. People who had difficulty with reading, writing, or using digital services were supported with accessible information. The trust has an autism strategy and an autism lead. Individualised support plans, including use of the green light tool kit were available as well as feedback mechanisms; and collaboration and co-production to improve access to information. Leaflets had been co-developed with autistic people to support staff in collaborating with them. There was a flowchart for accessing telephone, face to face and British Language Signing (BLS) interpreter services, and translation services. Referrals for interpreter services could be made immediately, though responses depended on the availability of a person. Staff could also indicate if the person wanted a male or female interpreter, or a specific person. Interpreter and translation services were provided and co-ordinated by one external organisation, apart from BLS interpretation services which were provided by local providers in Cheshire and Wirral.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People’s care, treatment and support promoted equality, removed barriers or delays and protected their rights. No information or concerns were indicated about about equity in experiences and outcomes during calls with patients and carers. The first response model was aimed at improving access to services, and reduce pressure on accident and emergency services generally by referring/signposting people to more suitable services, including contracting with third sector providers. However, one patient who was homeless said they couldn’t get access to suitable accommodation, and another patient said they wanted access to a respite bed but this was unavailable, when referrals had been made through the assessment process.

The Trust complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. Staff were not aware of barriers to access services. The crisis line was available to anyone, as was the accident and emergency departments 24 hours a day. The self-defined crisis model meant anyone could present for an assessment. There were links with some specific groups, such as asylum seekers, substance misuse services; and alcohol workers linked into accident and emergency departments. Staff feedback was the crisis cafes were more embedded in Wirral and West Cheshire, and that although there were cafes in East Cheshire they may be harder to get through to from more isolated or rural areas. Attempts were in progress to reduce barriers to care and treatment by developing links in communities and in services there was an access to clinics for homeless people through accident and emergency departments and local authorities. Staff were not aware on any barriers to seldom heard communities, but were aware of asylum seekers through police liaison contacts. Staff feedback was positive about access to language line and translation services, and reasonable adjustments were made for people and this was captured and flagged on the electronic patient records system.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals. They proactively sought ways to address these barriers to improve people’s experience, act on information about people's experiences and outcomes and allocate resources and opportunities to achieve equity. The Trust monitored demographic information and worked with the third sector to improve the Trust understanding of the needs of communities to promote access. The Trust has an autism strategy which aimed to improve the access and experience of services for autistic people. The Trust was monitoring whether people accessing crisis services were already known to other parts of the Trust mental health services with the aim of reducing this. It was 32% at the time of inspection

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.