Updated 14 February 2024
The Countess of Chester Hospital NHS Foundation Trust provides acute services for 343,000 people across Chester, West Cheshire and Welsh patients living within the area served by Betsi Cadwaladr University Health Board. The trust employs over 5000 staff.
The trust has over 5000 members and was one of the first ten trusts to achieve foundation status, which was awarded in 2004. The trust has two locations where services are provided:
- The Countess of Chester Hospital, an approximately 600-bedded general hospital providing services from the Countess of Chester Health Park.
- Ellesmere Port Hospital, a 60 bedded rehabilitation and intermediate care service.
The trust was also providing services from Tarporley War Memorial Hospital although this was not a location included within the trust’s registration at the time of our inspection.
We undertook this unannounced inspection because we had concerns about the quality of services. We inspected the trust’s services for children and young people to specifically to provide an up-to-date assessment of the quality and safety of this service for patients, the public and stakeholders.
We inspected four acute core services across two locations provided by this trust on 17-19 October 2023. We inspected urgent and emergency care services, medical wards, maternity services and services for children and young people at The Countess of Chester Hospital. We also inspected medical wards at Ellesmere Port Hospital. We also inspected the well-led key question for the trust overall on 14-16 November 2023.
During our inspection we identified significant risks to quality and safety in several services, particularly in the trust’s urgent and emergency care services. We considered using our urgent enforcement powers. We decided to provide detailed feedback to the trust about our findings, requiring the trust to take urgent action. The trust provided an action plan detailing the immediate action taken in response to our concerns and the longer-term actions required to ensure the improvements would become sustained and embedded. The action taken by the trust mitigated the immediate risks to patient safety sufficiently to mean CQC did not need to use urgent enforcement powers.
We undertook a follow-up visit to the trust’s urgent and emergency care services during our inspection of the trust’s governance and leadership. Our follow-up visit found some improvements although some concerns remained. Our service-level ratings therefore reflect our findings during our inspection of core services during October 2023.
Our rating of the trust stayed the same. We rated the trust as requires improvement because:
- We rated safe, effective, responsive, and well-led as requires improvement, and caring as good. The overall rating for well-led had improved from inadequate to requires improvement.
- The trust provides 12 core services in total from the two locations which we inspect and rate. We rated one of the trust’s 12 services as inadequate, five as requires improvement and six as good. In rating the trust, we considered the current ratings of the services we did not inspect this time and aggregated the ratings for outpatients and diagnostic imaging together as they were inspected jointly in 2016.
- We use ratings characteristics to determine our ratings for each question and for the trust overall. We assessed that the trust met the rating characteristics of requires improvement overall.
- People could not always access services when they needed it or receive the right care promptly. The demand on services had frustrated access and flow through the trust and left services gridlocked. Urgent and emergency care services were providing care for too many patients without enough staff and without enough space. This had resulted in corridor care becoming normalised which compromised patient safety, privacy and dignity. The trust had too many patients waiting to be discharged with a third of beds occupied by people who did not need hospital care. There was more that the trust needed to do, and more that system partners needed to contribute to alleviate the pressures on services.
- In multiple services the trust did not always have enough staff with the right skills, training and regular appraisal to provide safe and effective care. Mandatory training rates were low in several areas and for specific courses including resuscitation and safeguarding training. Appraisal rates were lower than the trust’s target.
- The trust did not manage infection prevention and control well. Clinical environments and equipment were not always clean and fit for purpose. Equipment and medicines including resuscitation trolleys were not always stored or checked appropriately to ensure they were fit for purpose.
- The trust did not consistently operate effective governance processes to ensure all patients received high-quality care which met their needs. The trust did not always have effective oversight of the quality and safety of care provided to patients. There were examples where failures in governance systems had resulted in unmitigated risks.
- The trust’s systems for identifying, escalating and managing risks, issues and performance were not always effective and had resulted in significant unmitigated risks developing in frontline services. The trust's internal audits showed significant improvements were still required to many aspects of how care was being delivered.
However:
- The trust had prioritised diagnostic activity and self-assessment since the last inspection to enable it to act to improve care and treatment. The trust welcomed external reviews in several key areas to stress test internal systems, identify weaknesses and formulate improvement plans. Leaders understood the priorities and issues the trust faced and needed to turn plans into action to embed and sustain improvements.
- Staff in most services and leaders at all levels told us that the trust was a better place to work than it was a year ago. The trust had relaunched Freedom to Speak Up processes with a refreshed policy and new champion roles to ensure all staff felt able to raise concerns. Leaders told us they were committed to acting the concerns raised by staff.
- The trust was due to launch a new strategy shortly after our inspection. The new strategy committed the trust to making significant improvements in the quality and safety, as well as rebuilding public trust and confidence in the trust’s services.
- Staff consistently demonstrated resilience in the context of significant internal and external pressures on services. Staff continued to treat patients with compassion and kindness, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
How we carried out the inspection
The inspections of the trust’s core services were led by a CQC operations manager and supported by ten CQC inspectors, one CQC regulatory coordinator, a CQC inspection planner and 9 specialist professional advisors.
The inspection of the well-led key question (the trust’s senior leadership and governance) was led by a CQC Deputy Director of Operations and supported by an operations manager, one CQC inspector, one CQC regulatory coordinator and an inspection planner. The team also received support from four specialist professional advisors and executive reviewers with a background and experience in NHS senior management.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.