The Countess of Chester Hospital

Ratings - Urgent and emergency services

• Overall

  Inadequate

• Safe

  Inadequate

• Effective

  Inadequate

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

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 Governance and leadership were not effective, with repeated failures to address known risks such as outdated equipment, and poor audit outcomes.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.

People's experience of this service

Patients and their families shared mixed experiences of care. While many described staff as kind, competent, and doing their best under pressure, others reported feeling neglected or undignified, particularly when cared for in corridors. People said they often waited long periods without updates and felt staff were too busy to respond to their needs promptly. Despite this, most patients expressed confidence in staff’s clinical abilities and appreciated the support they received once attended to.

Healthwatch and other feedback sources highlighted concerns about long waiting times, lack of privacy, and inconsistent communication.