The Countess of Chester Hospital

Updated 31 July 2026

The Countess of Chester Hospital is registered with CQC to deliver the regulation activities: Maternity and midwifery services, Termination of pregnancies, Family planning, Treatment of disease, disorder or injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983, Surgical procedures and Diagnostic and screening procedures.

We assessed 3 assessment service groups at this location. We conducted an on-site, comprehensive assessment visit of urgent and emergency care services, medical care (including older people’s care) and end of life care services on 27 to 29 October 2025. We assessed 33 quality statements for each of the 3 services.

The assessment of urgent and emergency care was to review the progress made against a warning notice that was served on the provider following an inspection in February 2025.

We visited the following areas as part of the assessment:

• Accident and emergency department
• Urgent treatment centre
• Same day emergency care unit
• Medical wards
• Wards where patients were receiving end-of-life care including surgical and chemotherapy wards.

At this assessment we identified breaches of regulations person-centred care, safe care and treatment, premises and equipment, good governance and staffing.

Updated 26 August 2025

We carried out an unannounced on-site comprehensive assessment of end-of-life care services at The Countess of Chester Hospital on 27 to 29 October 2025.

This assessment was prompted due to the time since the last inspection of the service (2016) under a different assessment framework.

The trust provided a consultant led specialist palliative care team [SPCT]. The SPCT team supported all clinical areas across the Countess of Chester Hospital and Ellesmere Port Hospital, providing specialist palliative care, advice and support for adult inpatients who were affected by cancer and other life limiting illnesses.

The SPCT provided an advisory and supportive service, whilst the medical and nursing management of the patient remained the responsibility of the ward teams. The SPCT provided trust staff with the support and guidance to facilitate the transfer of the patient from the curative to the palliative approach for their incurable illness. The trust had a bereavement team who provided support to relatives following the death of those close to them.

The team had established links with charitable and voluntary organisations providing hospice care, counselling and bereavement support across the local area.

During the assessment we spoke with staff, leaders and people who used the service. We looked at care records, policies and procedures, complaints and incidents and we observed patient care.

We reviewed 16 patient clinical records, spoke with 21 members of staff and 6 patients and family members.

The rating for this assessment reflects the end-of-life care delivered to inpatients across the trust as a whole.

We rated the service as good. We found the service was in breach of the legal regulation person-centred care. Evidence showed there were no advanced care plans for end of life care patients. This meant patients preferred care and place of death were not taken into consideration.

We requested an action plan following publication of the final report.

Updated 26 August 2025

We carried out an unannounced on-site comprehensive assessment of medical care (including older people’s care) at The Countess of Chester Hospital on 27 to 29 October 2025.

We carried out this assessment to follow up on the findings of our previous assessment.

The medical care services at the hospital provided care and treatment for a wide range of medical conditions, including general medicine, cardiology, respiratory, gastroenterology, stroke services and same day emergency care (SDEC). The stroke service was part of the Greater Manchester regional thrombolysis service. There were 563 beds at the hospital and 4428.70 WTE members of staff employed at the trust. The hospital provides medical care services to a population of 445,000 people.

We looked at 5 sets of patient clinical records; we spoke with 12 patients; we spoke with 6 family members or friends; and we spoke with 40 members of staff.

The service was in breach of the legal regulations in related to safe care and treatment, premises and equipment and staffing.

We rated medical care (including older people's care) as good.

We have requested an action plan, this will be requested upon publication of the final report.

Updated 26 August 2025

We carried out an unannounced on-site, comprehensive assessment of urgent and emergency care services at The Countess of Chester Hospital on 27 to 29 October 2025.

We carried out this assessment to review the progress made against a Warning Notice that was served to the trust following the inspection in February 2025.

We visited the following areas as part of this assessment:

• The Countess of Chester Hospital Emergency Department
• The Countess of Chester Hospital Urgent Treatment Centre

The service was previously in breach of the legal regulations in relation to dignity and respect, safeguarding from abuse and improper treatment, premises and equipment, governance and staffing.

We looked at 13 sets of patient clinical records; we spoke with 10 patients and their family members or friends; and we spoke with 43 members of staff.

We found the service had made improvements and had met some of the actions of the warning notices.

However, the service remained in breach of 5 regulations related to good governance, staffing, safe care and treatment, premises and equipment and person-centred care.

We rated the services as requires improvement.

Key issues included insufficient staffing in the paediatric emergency department, the completion of risk assessments and streaming processes from the Emergency Department (ED) were not always safe. Staff did not consistently follow best practices for infection prevention. Governance and leadership were not always effective, with repeated failures to address known risks, including some issues which had not been addressed after multiple inspections.

However, the service demonstrated a strong commitment to learning and staff wellbeing. There was a notable change in the culture of the department with staff interactions being kind and compassionate. Safeguarding systems were effective, and staff showed professional curiosity in identifying risks. The service also engaged in regional partnerships showing a willingness to innovate and improve patient flow and care delivery.

We requested an action plan following publication of the final report.

Updated 14 February 2024

Updated 29 June 2016

We have rated critical care services as good because:

• Incidents were reported and acted upon and used continuously as a service improvement tool

• Safety thermometer data was collected and displayed in public areas for patients and relatives to view.

• Performance results were also shared with staff in critical care in a monthly unit newsletter, together with results from relative’s surveys.

• There were sufficient numbers of suitably skilled nursing and medical staff to care for the patients.

• The service took part in the intensive care national audit and research (ICNARC) data so we were able to bench mark its performance and effectiveness alongside other similar specialist trusts.

• The trust performed well, however data indicated some concerns regarding delayed discharges.

• The trust had an outreach team with five critical care trained, dedicated members of staff who supported wards in the early detection and treatment of acutely unwell patients.

• There was evidence if a multidisciplinary approach to caring for the patients. Ward rounds included consultants, a physiotherapist, a pharmacist, a junior doctor, a nurse, SHO and a member of the outreach team.

• There was adequate number of nursing and medical staff to provide a seven-day service.

• Staff were aware of the vision for the service and had strategies in place for innovation and improvement.

However,

• We did find that that the unit fell below the intensive care society’s recommended level of staff who held a post registration award in critical care nursing.

Updated 14 February 2024

Updated 29 June 2016

Overall we found the outpatient and diagnostic service as good because:

• There was strong reporting culture with staff reporting incidents via the trusts electronic system. There was some learning from incidents, although similar incidents continued to be reported in radiology areas.

• Systems were in place for the maintenance of equipment. Processes were in place for daily checking of resuscitation equipment.

• Any prescribed medications were stored in locked cupboards and there was no controlled drugs or intravenous fluids stored in outpatients at COCH. Patients’ records were maintained on paper and via electronic systems, although; plans for changes in electronic systems were in place.

• Staff had received mandatory training, although some groups were not up-to-date with safeguarding requirements. There was some staff shortages identified, although recruitment processes were in progress.

• There was a caring culture embedded in all areas visited and from all members of staff we met. We observed good, compassionate care being delivered.

• Reception staff were polite and helpful. Patients and their relatives were very positive about the staff in outpatients and radiology. They said they were supportive and communicated well. We observed respectful interactions between staff and patients.

• Staff actively involved those close to patients with initiatives in place to support relatives of patients who attended regularly.

• There was specialist staff in clinics with good multidisciplinary working, although not all had been appraised annually.

• Services were available seven days a week.

• Consent for procedures was obtained although by different clinicians.

• There were audit plans in place and good use of the WHO safety checklist, for radiological interventions, was observed.

• The outpatient and diagnostic services were available at both Countess of Chester Hospital (COCH) and Ellesmere Port Hospital (EPH). The main activity was at COCH with a small department at EPH for routine care of patients in the local area.

• Targets of referral to treatment targets were within national guidelines, however; there was a wide variation in waiting times for individual consultants. Extra clinics were arranged, out of hours and at weekends to manage the demands of the local population.

• There was support for patients with individual needs including visually impaired, hearing impaired, learning disability or dementia.

• There was evidence of learning from complaints and how changes had been implemented.

• There was a clear vision and strategy for the future.

• The management teams were stable and committed to patient well-being in both out patients and diagnostics despite challenges.

• There were governance processes embedded with action plans in progress to improve services. Waiting list initiatives took place to meet demands of the local population.

• There were regular meetings, at all levels. Staff felt supported by their line managers and there was good team working in the departments.

• There were several innovations taking place with plans to increase services.

• Radiology trust guidelines and standard operating procedures were in place although not always clear and robust. There had been recent reviews of procedures.

• There were delays in reporting in radiology, which meant there could be delays in treatment. The trust had responded to increased demand by outsourcing x-ray reporting.

However,

• There was dust found on some medical equipment.

• In the nuclear medicine department of radiology, we observed that a prescribed medication was not always signed as administered.

• There were delays in reporting in radiology, which meant there could be delays in treatment. The trust had responded to increased demand by outsourcing x-ray reporting.

Updated 15 June 2022