The Care Quality Commission
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  • SERVICE PROVIDER

Countess of Chester Hospital NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

17 October - 16 November 2023

During a routine inspection

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.

26 to 27 July 2022

During a routine inspection

We carried out this focused inspection of services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We inspected Maternity services, we also inspected the well-led key question for the trust overall.

The Countess of Chester Hospital NHS Foundation Trust consists of a 600 bedded large district General Hospital, which provides its services on the Countess of Chester Health Park and a 64 bedded Intermediate Care Service at Ellesmere Port Hospital. It also hosts and delivers an integrated care partnership. The Trust has over 5,100 staff and provides a range of health services to more than 445,000 people per year from an area covering Western Cheshire, Ellesmere Port, Neston and North Wales.

The Trust is the main trust serving Western Cheshire and also provides services to approximately 30% of the population covered by Betsi Cadwaladr University Local Health Board in Wales. Welsh patients represent one fifth of the workload of the trust. At the time of the inspection the trust was arranged into three clinical divisions: urgent care, planned care and diagnostics and pharmacy division, plus support services.

We carried out this unannounced focused inspection because at our last inspection we rated the Well Led question overall as inadequate. Concerns were found in relation to maternity and trust-wide governance processes, which meant we served the trust with two warning notices under Section 29A of the Health and Social Care Act 2008. The warning notices told the trust that they needed to make significant improvements in the quality and safety of governance and safety process across trust services and significant improvements in governance systems relating to referral to treatment processes, implementation of the electronic patient record system and around the management of incidents, learning from deaths and complaints.

Please refer to our February 2022 inspection report for our findings about this service and the actions we have taken.

We did not inspect all the core services provided by the trust as this was a follow up inspection. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.

We did not rate this inspection. We found:

Mortality reviews were not completed in a timely manner. There was limited overview and scrutiny of mortality reviews; this had resulted in reviews not been completed in a timely manner leading to delays in learning.

There were some systems in place for both strategic and operational governance, however these were not always operated effectively or completed in a timely manner, and there was a lack of support and overview at a higher level.

Whilst there were some systems in place to manage risks, there was an inconsistent.

application of risk management strategies and of operational oversight at board and senior level.

Clinical and internal audit processes were inconsistent in their implementation and impact.

The complaints system was not yet managed consistently and there was limited evidence of the learning applied to practice within the service.

The Electronic Patient Record system implementation had encountered a number of difficulties, which the trust was still working through regarding training, hardware and immediate functionality issues.

However:

Performance in relation to cancer care between March and May 2022 had improved the trust was in the middle when compared with other trust in the area for cancer treatment waits of less than 62 days at 67.9% of patients treated within the appropriate times.

Risks relating to medicines management through the EPR system, which were identified at the last inspection had been addressed by the trust, we noted that the system had been amended to ensure only those staff who were suitably qualified could prescribe and dispense medications.

There were significant plans in place to increase governance support across the trust and to improve risk management.

How we carried out the inspection

We carried out this unannounced follow up inspection of maternity services and elements of how well the trust was well led as part of our continual checks on the safety and quality of healthcare services. At our last inspection we rated the trust overall as requires improvement, we also inspected the well-led key question for the trust overall which we rated as inadequate.

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.

15 February 2022 to 17 March 2022

During a routine inspection

We carried out an unannounced inspection of acute services provided by Countess of Chester NHS Trust as part of our continual checks on the safety and quality of healthcare services.

The Countess of Chester Hospital NHS Foundation Trust consists of a 600 bedded large district General Hospital, which provides its services on the Countess of Chester Health Park and a 64 bedded Intermediate Care Service at Ellesmere Port Hospital. It also hosts and delivers an integrated care partnership. The Trust has over 5,100 staff and provides a range of health services to more than 445,000 people per year from an area covering Western Cheshire, Ellesmere Port, Neston and North Wales.

The Trust is the main trust serving Western Cheshire and also provides services to approximately 30% of the population covered by Betsi Cadwaladr University Local Health Board in Wales. Welsh patients represent one fifth of the workload of the trust. At the time of the inspection the trust was arranged into three clinical divisions: urgent care, planned care and diagnostics and pharmacy division, plus support services.

The Countess of Chester Hospital provides a full range of acute and a number of specialist services including urgent and emergency care, general and specialist medicine, general and specialist vascular surgery and full consultant led obstetric and paediatric services for women, children and babies. At Ellesmere Port Hospital the trust provides medical care services, outpatients, rehabilitation and intermediate care to patients over 65 years age. It has 64 beds over three wards.

At our last inspection we rated the trust overall requires improvement because we had concerns about the quality of services. Prior to our 2022 inspection we received information giving us concerns about the safety and quality of the services.

We visited the Countess of Chester Hospital as part of our inspection during 15 to 18 February 2022. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. We visited urgent and emergency care services, surgical services, maternity and medicines core services as part of the inspection. We also looked at those parts of these services that did not meet regulatory requirements following the 2018 inspection.

In addition, we inspected the well-led key question for the trust overall. The Well Led inspection took place on the 15, 16, 17 March 2022.

We did not inspect all the core services provided by the trust as this was a risk-based inspection. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.

Our rating of services stayed the same. We rated them as requires improvement because:

  • We rated the trust as requires improvement overall. We rated safe effective, responsive and well-led as requires improvement and caring as good. In rating the trust, we took into account the current ratings of critical care, services for children and young people, end of life care and outpatient services which were not inspected this time.
  • The well led provider rating for the trust was inadequate.
  • During our inspection of the trust’s leadership and governance in December 2019, we asked the trust to ensure that action was taken to improve the quality and safety of care patients were receiving on the inpatient wards. Our return visit found that the trust had not made significant improvement in some of the areas of concern identified in our 2019 inspection which resulted in continued breaches of several regulations.
  • The trust did not have suitable governance systems and processes to effectively manage patient referral to treatment waiting times performance. We were not assured that senior leaders had ensured a sufficient pace of change or timely implementation of an effective recovery plan for planned care and treatment.
  • Due to the implementation of the new Electronic Patient Record system, staff were not always able to assess risks to patients. Care records were not always up to date, contemporaneous or easily accessible.
  • The trust did not always manage safety incidents well, actions and learning following incidents was not always robust.
  • Senior and executive leaders did not always operate effective governance systems to manage risks and issues within the service. Not all staff felt respected, supported and valued.
  • The trust did not always engage well with staff, patients and the community to plan and manage services effectively.

However:

  • Staff understood how to protect patients from abuse.
  • Staff treated patients with compassion and kindness.

How we carried out the inspection

We carried out this unannounced inspection of some of the acute services at Countess of Chester Hospitals NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services. At our last inspection we rated the trust overall as requires improvement. Our inspection was prompted by concerns about the quality and safety of some services. We also inspected the well-led key question for the trust overall.

We inspected urgent and emergency care, medicine, surgery and maternity services at the Countess of Chester Hospital. At this inspection we found the core service ratings for urgent and emergency care, medicine, surgery had stayed the same and maternity services had deteriorated since our previous inspection in 2018.

As part of the inspection, we spoke with 142 staff across all disciplines, looked at 69 patient records and spoke with 41 patients.

Further concerns were found in maternity services and trust-wide governance processes, which meant we served the trust with two warning notices under Section 29A of the Health and Social Care Act 2008. The warning notices told the trust that they needed to make significant improvements in the quality and safety of healthcare provided in maternity services and significant improvements in governance systems relating to referral to treatment processes, implementation of the electronic patient record system and around the management of incidents, complaints and patient deaths.

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.

13 Nov to 13 Dec 2018

During a routine inspection

Our rating of the trust went down. We rated it as requires improvement because:

  • We rated safe, effective, responsive and well led as requires improvement. We rated caring as good.
  • At this inspection, we inspected three core services and rated all of them as requires improvement. All three services had previously been rated as good.
  • In rating the trust, we took into account the current ratings of the services not inspected this time.
  • We rated well-led for the trust overall as requires improvement.
  • The trust was rated as requires improvement for Use of resources.
  • Overall this gives a combined rating of requires improvement.

February 2016

During a routine inspection

The Countess of Chester NHS Foundation Trust serves a population of approximately 445,000 people in and around Western Cheshire, Ellesmere Port, Neston and North Wales.

The Trust was one of the first 10 in the country to gain foundation status in 2004. In 2010, Ellesmere Port Hospital came under the management of the Countess of Chester Hospital NHS Foundation Trust.

Over 425,000 patients attend the Trust for treatment every year.

The Trust provides a full range of acute and a number of specialist services including an urgent and emergency care, general and specialist medicine, general and specialist vascular surgery and full consultant led obstetric and paediatric hospital service for women, children and babies at the Countess of Chester Hospital. In Ellesmere Port Hospital the trust provides medical care services, rehabilitation and intermediate care to patients over 65 years age. It has 56 beds over three wards.

We carried out this inspection as part of our scheduled program of announced inspections.

We visited the hospital on the 16, 17, 18, 19 February 2016. We also carried out an out-of-hours unannounced visit on 26 February 2016. As part of this inspection, the team inspected the following core services:

• Urgent and emergency services

• Medical care services (including older people’s care)

• Surgery

• Critical care

• Maternity and gynaecology

• Children and young people

• End of life

• Outpatients and diagnostic services

Overall, we rated the trust as good.

We have rated the Countess of Chester Hospital as ‘good’ for effective, caring and well led. However, improvements were needed to ensure that services were safe and responsive to people’s needs.

We rated Ellesmere Port Hospital as good for all key questions safe, effective, caring, responsive and well-led.

Our key findings were as follows:

Leadership

The Trust was led and managed by an accessible and visible executive team. The team were well known to staff and were regular visitors to wards and departments through the monthly executive walkabouts. Staff were also invited to attend a monthly open forum where they were able to meet with the Executive Team to ask questions, raise issues and discuss the trusts plans for the future.

It was evident that the executive and non-executive directors had taken steps to improve communication with staff using a variety of communication methods including the above and the use of newsletters and good use of social media. However some staff working in surgical services felt that their engagement with Board members could be improved and felt disconnected from the senior team.

There was good leadership and communication in services at a local level; senior managers were visible and approachable. Staff felt well supported and were positive about managers who were seen as knowledgeable and supportive.

The trust had introduced a series of ‘masterclasses’ to support leadership development. In addition there were plans in place to provide coaching and mentoring opportunities as well as support for front line, middle managers and team leaders through leadership development programmes.

Culture

There was a very positive culture throughout the trust. Staff felt well supported, able to raise concerns and develop professionally. Staff were proud of their services and proud of the trust.

There were improving levels of staff engagement. Staff were well motivated and committed to providing high quality services and experiences for patients.

There was a range of reward and recognition schemes that were valued by staff. Staff were encouraged to be proud of their service and their achievements. The trust had recently expanded the ‘celebration of achievement awards’ so that they were more wide ranging and inclusive.

Strategy

The trust had a vision and strategy with clear aims and objectives. The vision was underpinned by the trust core values, Safe, Kind, and Effective.

The trusts long term strategy was based on three key programmes:

  • The ‘West Cheshire Way’ included working with local healthcare and other related partners to drive service re-design and integrate care for the residents of Western Cheshire. The trust was adopting the approach of an Accountable Care Provider organisation.

  • Integrated Specialist Services providing the right services to meet the needs of patients, either as part of clinical network or as a specialist centre in its own right.

  • The’ Countess 20:20’ programme that was aimed at reviewing the core services provided to ensure the delivery of good outcomes and high quality services for patients.

Work was in progress to implement the programmes based the ‘Model Hospital’ initiative. Staff were sighted on the strategy and plans and there were regular communications with staff to keep them informed of progress in this regard.

Equality and diversity

The Trust had a very positive and inclusive approach to equality and diversity and we found the leadership in this important area of organisational culture to be committed and proactive in relation to providing an inclusive workplace.

Equality and diversity training was part of the mandatory training programme and over 95% of staff had received E&D training.

There was a range of diversity awareness raising events coupled with celebratory events. Staff were positive about the trusts approach and felt that the trust was a good place to work where diversity was encouraged and supported appropriately.

We analysed data from the NHS Staff survey regarding questions relating to the Workforce Race Equality Standard (WRES). The results for the trust were positive results across all indicators.

The trust also undertakes a “full census” approach to its staff survey which is the preferred approach rather than using a basic sample group. We considered this to be an example of good practice.

Governance and risk management

The trust had a well-developed approach to governance and risk management.

Governance was well managed and board assurance sought through a divisional governance structure that was well embedded and understood.

There was a robust committee structure in place that supported challenge and review of performance, risk and quality.

The Board Assurance Framework was aligned to trust priorities and linked appropriately to risk registers that were regularly reviewed.

There were divisional and service specific monthly governance meetings were performance, risks and learning was discussed and shared. Quality and performance were monitored through service specific and divisional dashboards.

Mortality rates

Mortality and morbidity reviews were held in accordance with trust policies and were underpinned by policies and procedures. All cases were reviewed and appropriate changes made to help to promote the safety of patients. Key learning Information was cascaded to staff appropriately.

The Summary Hospital-level Mortality Indicator (SHMI) is a set of data indicators, which is used to measure mortality outcomes at trust level across the NHS in England using a standard and transparent methodology. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average England figures, given the characteristics of the patients treated at the hospital. Between August 2014 and July 2015 the trust score was 103, which was within the national average.

Nurse and Midwifery Staffing

The trust had established process in place to assess nurse staffing levels that included the use of an evidence based tool.

The trust undertook biannual nurse staffing establishment reviews as part of mandatory requirements and set key objectives though this work to support safer staffing. Data provided as part of this review in January 2016 identified that over-all the trust had maintained over 95% of staffing levels planned against actual levels for nine months. However the trust recognised that there had been a reliance on bank and agency staff to achieve this and that this was not a sustainable position for the future.

Consequently, the trust continued to actively recruit nurses both locally and from overseas. At the time of our inspection the trust has successfully recruited 20 – 30 registered nurses from Spain.

The trust was also in the early stages of using a workload management tool (NHPPD) from the recently published Lord Carter model hospital review. The trust was also piloting a national activity monitoring tool, to gain robust data on required nurse staffing levels going forward.

However, nurse and midwifery staffing levels, although improved, remained a challenge for the trust and there were times when wards and departments were not fully staffed to meet the needs of patients. This was a particular issue in surgical services at Countess Of Chester Hospital.

Medical Staffing

At the time of our inspection there were sufficient numbers of consultants and medical staff to provide patients with appropriate care and treatment.

Locum doctors were used to cover existing vacancies and for staff during leave. Where locum doctors were used, they were subject to recruitment checks and induction training to ensure they understood the trusts policies and procedures.

Trust data at the time of inspection showed a turnover rate of 17.7% and a sickness rate of 0.41% for medical staff.

A shortage of a paediatric consultant was recorded on the divisional risk register on 21/10/15 however; approval had been obtained to increase medical staffing in this area and work was underway to address the shortfall.

The number of palliative care consultants was below the recommended staffing levels outlined by the Association for Palliative Medicine of Great Britain and Ireland, and the National Council for Palliative Care guidance, which states there should be a minimum of one WTE consultant per 250 beds.

The trusts medical staffing information confirmed 60 hours consultant cover for the delivery suite. This meant the service met the recommendation in the safer childbirth best practice guidelines.

Interventional radiologists worked on a rota system. There were seven consultants covering 24 hours per day, seven days a week. The trust had recently recruited three interventional radiologists to manage the increasing workload.

Safeguarding

Staff in all service areas were able to identify and escalate issues of abuse and neglect. Practice was supported by regular and ongoing staff training. However there were service areas where we found that the numbers of staff attending safeguarding training was below the trusts set target of 80%.

Staff had access to advice and guidance so that safeguarding issues were escalated and managed appropriately and promptly.

The trust had in place a safeguarding strategy board who met to discuss safeguarding issues, reports and incidents. This group had the responsibility to develop strategies and ensure action plans were implemented to improve safeguarding practice across the trust. The work of the safeguarding board was over seen by the trust board.

At the time of our inspection there was not a safeguarding adult and learning disability coordinator in place to take the strategic and operational lead for Safeguarding Adults, however an appointment had been made and the trust were being supported by the lead from the local clinical commissioning group in the interim.

Staff had access to a named doctor and named nurse along with five other staff who acted as points of contacts for advice and guidance in relation to safeguarding.

In children’s services there was a multi- agency approach with links to local authority Child Protection Teams.

Access and Flow

The trust had established policies and both internal and external escalation procedures in place to support patient access and flow across the trust. This included a designated hospital team based at Countess of Chester Hospital who were responsible for patient flow and provided senior nurse presence and clinical leadership across the trust out of hours.

Access and flow remained a significant challenge in the emergency department. Waiting times in the ED Department regularly breached the 95% target for admitting, transferring or discharging patients within four hours of their arrival in ED. Between April 2015 and January 2016 performance varied from 76-93%, except for July and August 2105 when the 95% target was reached

There were also significant issues with access and flow across the medical and surgical wards with high bed occupancy rates and substantial numbers of delayed discharges.

A number of extra beds had been provided to help support flow though the hospital at both Countess of Chester Hospital and Ellesmere Port Hospital. Discharge planning was well understood and supported by a trust wide discharge team.

However, at the time of our inspection, there were approximately 100 patients who remained in hospital due to delays in transfers of care. These were due to a variety of reasons, predominantly the availability of packages of care and decisions and delays in relation to community living arrangements.

The trust was very aware of its challenges in this regard and was working closely with other strategic leaders to plan system delivery, strategy and plans in order to support elective and emergency admissions, attendances and discharges to and from the hospitals.

The trust had introduced a number of initiatives including a general practitioner admissions unit (GPAU) that had recently opened. By the time of our unannounced inspection in March 2016 we found that that the general practitioner admissions unit (GPAU) was already having a positive impact on flow though the hospital and there had been a reduction in patients who were delayed in being suitably transferred.

Medical services met the national 18-week referral to treatment time targets in all specialities from September 2014 to September 2015.

In January 2016, the trust achieved the referral to treatment (RTT) targets, of 95%, in all areas and specialities with the exception of ear, nose and throat at 94%.

All three cancer wait measures (patients seen within two weeks, 31 day wait and 62 day wait) were generally better than the England average from 2013/14 to 2015/16, although October and November 2015 were below the target of 85% for 62-day wait at 77% and 79.8% for the planned care division.

Cleanliness and Infection control

Clinical areas at the point of care were visibly clean; however, we did identify some cleanliness issues in none-clinical areas in urgent and emergency services, outpatients and in none clinical areas specifically related to an area within maternity services.

The trust had infection prevention and control policies in place that were accessible to staff and staff were knowledgeable in respect of good practice to prevent and control infection. Staff followed good practice guidance appropriately.

Between April 2015 to December 2015, there were two cases of MRSA bacteraemia reported across the trust. Lessons learnt from these cases were disseminated to staff across all divisions.

The trust also carried out early screening for infections including MRSA during patient admissions and preoperative assessments. This meant that staff could identify and isolate patients early to help prevent the spread of infection.

Infection rates were in line with national averages.

However, there were also areas where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure that adequate numbers of suitably qualified staff are deployed to all areas within the surgical services to ensure safe patient care.
  • The trust must ensure that patients place in areas outside their speciality meet the trusts criteria and ensure that there is suitably qualified staff to meet their needs.
  • The trust must ensure that patients nutritional and hydration needs are met at all times.
  • The trust must ensure that all staff are able to understand and apply the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
  • The trust must ensure that there are sufficient staff trained in adult and children’s safeguarding procedures in the emergency department.
  • The trust must ensure there are sufficient numbers of suitably qualified and skilled staff on medical wards.
  • The trust should ensure that all medications are stored in a secure environment at all times.
  • The service must ensure staffing levels are maintained in accordance with national professional standards on the neonatal unit and children's ward.
  • The service must ensure that there is one nurse on duty on the children’s ward trained in Advanced Paediatric Life Support on each shift.
  • The trust must improve the waiting times for reporting of radiology investigations.
  • Undertake robust risk-assessment for the women and children’s building so that the risks associated with baby abduction are minimised.
  • Must deploy sufficient clinical and midwifery staff with the appropriate skills at all times of the day and night to meet the needs of patients using the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.