Cheshire and Wirral Partnership NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Patients were well supported and felt safe in the care they were receiving. There was a focus on safety and concerns or incidents were managed and investigated appropriately. Teams showed evidence of good oversight of current and emerging risks. Staff teams were happy and workloads were generally manageable. Staff were qualified, skilled, and experienced with access to support. Safeguarding processes were robust and concerns responsively dealt with, although there were mixed compliance rates for Level 3 training across teams. We also noted inconsistencies in some case note documentation.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found that the majority of patients would feel comfortable complaining, although some were unclear of the process. All carers interviewed knew how to make a complaint and felt comfortable doing so.

Staff had a good understanding of incident reporting and reported learning was shared regularly with them. Staff had a good knowledge of how to process complaints and how they were investigated and supported patients to do this. Managers confidently described the processes through which incidents are reported in their teams and were able to discuss recent examples including learning and how this was shared.

Appropriate systems were in place to manage incidents as well as complaints made to the service. Patient safety events were regularly reviewed individually and collectively and learning was shared locally or across the trust depending upon need.

Patients received continuity of care and felt safe in the care they were receiving. Observations of care showed a strong awareness of patient safety and assessing risk and the morning handover meetings and high risk board helped to provide oversight and management of new and emerging risks within services.

Teams were aware of the risks to people across their care journeys. Managers collaborated with the MDT as well as external services to ensure care remained consistent and transitions were managed well. There was good oversight of care provided within teams to ensure patient safety. Staff showed a solid understanding of the processes surrounding referral and transfer of patients and felt able to support patients through them.

No concerns were raised by partner organisations.

Appropriate systems were in place to allow for safe admissions, discharges and transfers of care. However, we noted large consultant led caseloads noted across all 4 sites. Inconsistent documentation of risk and safety plans were of particular note in the consultant led caseload. This raised concerns about the oversight of risk in this large group of patients. Staff also raised concerns about having to provide cover for intensive home treatment due to capacity in the home treatment team, especially in relation to the impact this had on other patients needing regular care from the community mental health team. The trust told us processes were in place to minimise the impact on regular care in community mental healthcare, including provision of overtime for staff working to support other teams.

Patients had good relationships with their key workers and felt safe in the care they were receiving.

Staff and managers had a good knowledge of the safeguarding process and of the local safeguarding team and structure. There were good relationships with the local safeguarding team and regular meetings to share concerns and learning. Staff showed good understanding of the Mental Health Act and Mental Capacity Act and this was integrated in to their every day practice. They also knew where to seek further support or advice when required.

Observation of care showed robust consideration of risk and potential vulnerabilities that require safeguarding, with appropriate action being taken where necessary. With those under Community Treatment Orders we saw that the Mental Health Act Code of Practice was followed appropriately. Referral and interface meetings showed evidence of a positive approach to ensuring vulnerable patients received the right support.

Appropriate systems and policies were in place to ensure people were safeguarded. Staff received appropriate training in safeguarding, however we noted inconsistent rates of compliance to training at some locations, especially for Level 3 training where the lowest rate seen at one site was 50%. However, overall performance was 79% and had improved each month from November 2023 to that point. The Trust was overseeing progress against set improvement trajectories via reporting in to the Trust's Quality Committee.

Patients built up good relationships with their key workers and key workers knew individuals well. The majority of patients felt they were informed and involved in decisions around their care. Carers were confident key workers knew patients and their needs well and were also involved as part of care planning and risk assessment where appropriate. All observed interactions between staff and patients showed notable evidence of risk assessment including supporting patients to understand and manage their own risk. Staff had good relationships with patients including clear boundaries and had open discussions about care and treatment.

Staff had a good understanding of the process of risk assessment and when/how these should be completed. There was good oversight of current risk within services and risk was shared across the team, especially with complex patients. Patients with high or increasing risk were discussed daily at the morning meeting. This allowed staff to share risks and create robust and responsive management plans for those most in need. Staff across all sites consistently fed back about increasing acuity and risk in their caseloads.

Appropriate systems were in place around care planning and risk assessment. However, we found that risk reviews and safety plans in case notes were inconsistently completed and did not always reflect the level of care that was being provided. Those that had been fully completed did show evidence of patient involvement.

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

Patients and carers reported that appointments were rarely cancelled due to lack of staff. They also reported they were easily able to contact their team or key worker when required. There was also good continuity of care.

Staff all reported happy and supportive teams. Staff were happy with their roles and with the support of their managers. Workloads were manageable and staff were able to seek support when needed. Staff received regular supervision and appraisal. Appropriate mandatory training was provided and this was updated regularly. There were also opportunities for additional training, upskilling and progression. Staff were aware of lone worker policies and how they followed them to keep themselves safe. Performance management and other issues were dealt with promptly.

There were sufficient staff to allow continuity of care and this was evident in care observations where patients were very familiar with staff, allowing for positive relationships to be built. It was evident that safety was not compromised by staffing numbers as appointments went ahead as planned and were rarely delayed. The morning handover meeting made staff aware of any absences and gave the team the opportunity to cover or rearrange appointments as necessary. It also gave staff with a high workload, or those managing high risk, the opportunity to gain support or redistribute appointments within the team to avoid or reduce the impact on patients.

Services had safe levels of staff for the number and acuity of patients. Staff were qualified, skilled, and experienced with access to support. The main staffing deficits across all sites related to psychology support. There was also notable difficulty recruiting consultant psychiatrists on a permanent basis. Total mandatory training completion rates were high across all sites (85-97%). However we did see variable compliance in management and clinical supervision rates.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.