The Countess of Chester Hospital

Updated 8 August 2025

Date of assessment 6 January to 29 May 2025. We conducted an on-site, comprehensive assessment visit of urgent and emergency care services on 24 to 26 February 2025 in response to concerns around access and flow and care of mental health patients and patients in non-clinical areas.

Following the assessment, we issued the trust a warning notice under Section 29A of the Health and Social Care Act 2008 on 4 April 2025. The warning notice was issued due to breaches of 5 of the legal regulations in relation to dignity and respect, safeguarding from abuse and improper treatment, premises and equipment, governance and staffing. The warning notice told the trust it must make significant improvements to the quality of healthcare provided by the trust’s urgent and emergency care services. 

Therefore, our overall rating for urgent and emergency care remains inadequate and the overall location remains requires improvement.

Updated 6 January 2025

Date of assessment 6 January to 29 May 2025. We conducted an on-site, comprehensive assessment visit of urgent and emergency care services on 24 to 26 February 2025 in response to concerns around access and flow and care of mental health patients and patients in non-clinical areas.

Following the assessment, we issued the trust a warning notice under Section 29a of the Health and Social Care Act 2008 on 4 April 2025. The warning notice was issued due to breaches of 5 of the legal regulations in relation to dignity and respect, safeguarding from abuse and improper treatment, premises and equipment, governance and staffing. The warning notice told the trust it must make significant improvements to the quality of healthcare provided by the trust's urgent and emergency care services.

Therefore, our overall rating for urgent and emergency care remains inadequate.

We rated urgent and emergency care inadequate in 2 key questions, with repeated breaches of the legal regulations. Concerns included unsafe patient care environments, prolonged ambulance handovers, overcrowding, and corridor-based care that compromised dignity and safety. Infection prevention and control were poor, with visibly dirty equipment and low audit compliance. Staffing levels, training, and medicine management were inconsistent, with critical gaps in sepsis treatment and mental health risk assessments. Governance and leadership were not effective, with repeated failures to address known risks such as outdated equipment, and poor audit outcomes. The culture was task-focused and lacking compassion and at times unprofessional, with managers telling us addressing culture in the service was one of their top priorities.

However, the service demonstrated a strong commitment to learning, improvement, and staff wellbeing. Staff were encouraged to report incidents. There was visible executive leadership support, and staff development was promoted through training and mentorship. The service was expanding its mental health facilities and planned to increase resuscitation capacity in the future. Safeguarding systems were generally effective, and staff showed professional curiosity in identifying risks. Patient confidence in staff remained high, and there were improvements in staffing allocation and agency usage. The service also engaged in regional partnerships and audits, showing a willingness to innovate and improve patient flow and care delivery.

Updated 14 February 2024

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 29 June 2016

We rated end of life services as requires improvement over-all because :

• There was an insufficient number of general nursing staff who had received appropriate training regarding end of life care and the replacement for the withdrawn Liverpool Care Pathway [LCP] the care and communication record [CCR].

• The trust performed worse than the England average in five of the seven organisational key performance indicators for the National Care of the Dying Audit 2014. However an action plan is currently in place to address the issues identified in the 2014 audit.

However,

• There was a three-year vision developed by the trust's end of life committee. We found this had been communicated to most general ward teams. We found evidence of an overarching monitoring of the quality of the service across the trust. Complaints were responded to appropriately.

• Specialist palliative care nurses we spoke with were able to describe safeguarding procedures and provided us with examples of how these would be used.

• All of the general nursing staff we spoke with were aware of how to report an incident or raise a concern.

• Appropriate equipment was available to patients at the end of their life; the equipment at the hospital was adequately maintained.

• Medicines were managed appropriately.

• Patients were involved in care planning and decision making. Staff were respectful and treated patients with compassion.

• Specialist nurses were visible, competent, and knowledgeable.

• The trust had a dedicated specialist palliative care team [SPCT] who provided good support to patients at the end of life. Care and support was given in a sensitive and compassionate way.

• On the wards staff worked hard to meet and plan for patient’s individual needs and wishes.

• Staff within the [SPCT] team were very motivated and committed to meeting patients’ different needs at the end of life and were actively developing their own systems and projects to help achieve this.

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