Cheshire and Wirral Partnership NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed a total of 3 quality statements in the well led 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. There was limited feedback from staff about the freedom to speak up process. Some staff said they had raised concerns but the responses in their experience were not positive, and nothing had changed. Generally staff said they did not feel involved in the change/transformation process, though most were aware of why it was happening due to national guidance. There had been previous consultation on the process and staff described changes being quickl The Trust had policies and procedures for the freedom to speak up process advertised around the trust and the policy was adopted in late 2023. Information on the freedom to speak up process was contained in Trust newsletters. Staff generally felt supported by their managers at a local level and managers were able to demonstrate their systems of oversight. Policies and processes were available for the first response model and standard operating procedures were in development as this model was implemented. Implementation and evaluation of the model sits under the overarching care group, which is part of the Trust’s overarching governance monitoring process.

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.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders at every level were not always visible. Local managers led by example and modelled inclusive behaviours. Staff feedback was they generally were supported by their managers at a local level. Managers were able to demonstrate their systems of oversight. Staff were less positive about senior managers who were described as not visible. Some teams had managers off long term sick or seconded to other roles which led to less local support. Team managers were supported by resource managers, which was a more administrative role, including doing off-duties and monitoring staff training. Feedback from managers was they were aware of how the pace of change had impacted upon staff morale . Feedback included the timing of meetings was not always compatible with working patterns, so important meetings were missed. Feedback included managers feeling change was top down.

Leaders had the experience, capacity and capability to ensure that the organisational vision could be delivered and risks were managed. There was a clear structure in place for management of the services from local level, through care groups. Following change to the first response services managers had oversight and responsibility across wider services for both the home treatment team and liaison psychiatry. The Trust had a leadership training programme available to staff and mangers which consisted of three component courses. The Trust structure chart had names and contact details for the specialist mental health acute care and first response care group, which included all the services within this care group, who the managers were, and their contact details. There was one vacant post (Operational Lead) but a named person was covering that role.

Staff and leaders demonstrated a positive, compassionate, listening culture that promotes trust and understanding between them and people using the service, however staff reported the freedom to speak up and transformation processes did not always focus on learning and improvement. There was limited feedback from staff about the freedom to speak up process. Some staff said they had raised concerns but the responses in their experience were not positive, and nothing had changed. Staff feedback was they had spoken up on calls and emailed the Chief Executive Officer about their concerns in services, but nothing had changed. Generally staff said they did not feel involved in the change/transformation process, though most were aware of why it was happening due to national guidance. There had been previous consultation on the process and staff described changes being quick.

The Trust had policies and procedures for the freedom to speak up process advertised around the trust and the policy was adopted in late 2023. Information on the freedom to speak up process was contained in Trust newsletters. The Trust freedom to speak up policy included relevant and expected information. The current policy was approved and implemented in November 2023 and stated it adopted the National Freedom to Speak Up Policy. The ‘policy’ in use was the NHS policy and was formatted as such. This policy made it clear what staff could do, and what the trust would do to address this, but did not include specific organisational information. This information was available on posters and the trust intranet.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The systems to manage current and future performance and risks to the quality of the service took a proportionate approach to managing risk that allows new and innovative ideas to be tested within the service. The first response service feeds into the overarching care group, which was part of the Trust’s overarching governance process. The implementation of the model has been in consultation and development for some time, but staff feedback was it was implemented very quickly, elements were piloted, rolled out in different parts of the Trust, and continued to be evaluated. There were routine meetings and processes for monitoring and dealing with standard issues such as staffing, day to day, ongoing recruitment, safeguarding and incidents. These included other organisations, and other parts of the Trust. Audits were carried out at a local level to monitor, for example, care plans, risk assessments. The frequency and impact varied from team to team.

Processes were in place to monitor the completion of patient electronic records. if patient records were not completed this was discussed in line management meetings. Each team has a locality data pack (LDP) that included key information about the team, and comparisons on performance with other teams in the first response service. The LDP included charts and information about various staffing metrics, serious incidents, compliments and complaints, staff supervision, staff appraisal and training. Processes were in place for monitoring key performance indicators, where each team within the respective service had set parameters for waiting times from referral to assessment, response times and caseload numbers, as some examples. There was a response to the referrer within an hour, with the type of response and time agreed with the referrer and depending upon the perceived risk, where possible took place within 4 hours. There was a 72-hour follow-up from the acute mental health wards that could be completed by the crisis resolution and home treatment team (CRHTT, in the event a patient was discharged without an alternative secondary care referral. CRHTT was a needs-led service with no cap on the volume of caseloads. It provided short-term interventions to individuals in mental health crisis. The first response service operated on a capacity and demand model, allowing flexible staff allocation to ensure timely emergency assessments. First response was developing the use of a patient safety dashboard, supported as part of a central, evidence-based initiaitive, to monitor the timeliness of assessments and caseloads in each locality, as well as other safety measures.. The psychiatry liaison and accident and emergency assessment target was within 1 hour of referral and ward assessment within 24 hours. Referrals were monitored through Core 24 national service standards.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.