The Countess of Chester Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff did not consistently assess or discuss patients' health and wellbeing needs. Team collaboration was inconsistent, particularly between the Emergency Department and Urgent Treatment Centre, and reliance on a third-party provider for mental health observations posed ongoing risks. Patients were left on trolleys or in chairs for extended periods, leading to deconditioning and unmet basic needs. Monitoring of clinical outcomes was inconsistent, with fluctuating compliance in key indicators and delays in sepsis treatment. Sepsis management fell short of national standards. Consent was not always obtained or respected, causing distress among patients. However, we saw examples of good multi-disciplinary team working and responsive specialist teams.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We observed 2 patients with potential fractured hips that had been sat in wheelchairs and taken for x-ray where they had confirmed fractures. Patients with a suspected neck of femur fracture should be assessed and cared for on a trolley for comfort and to prevent further displacement of the fracture and further complications. Staff then had to find 2 trolley spaces for these patients to be cared for in an already gridlocked department.

Mandatory training in learning disabilities and autism was below the trust target of 90% at 79%.

Audit data for falls assessments were below target between September 2024 and January 2025 ranging from 50% to 83.3%. The audits also demonstrated mixed compliance with venous thrombo-embolism (VTE) assessments ranging from 30%-100%.

We observed patients being asked about their allergies and these being recorded in their medical notes.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Audit data showed average compliance with monthly audits between March 2024 and February 2025 for Braden Scores, nutrition and falls was 49%, 50% and 6% respectively.

The service did not assess patient’s nutritional needs effectively, with a range of 1.3% to 12.3% of patients having a nutrition assessment completed within 6 hours of the decision to admit between March 2024 and February 2025.

The service did not manage sepsis in line with evidence-based care and treatment.

We reviewed a selection of clinical policies. Out of 16 policies reviewed 3 did not have dates of implementation or next review date however, all were in line with current guidelines.

The trust took part in national audits such as the emergency medicine audits of care of older people and mental health (self-harm).

Patient records were clear and contemporaneous.

We observed posters in the department referencing evidence-based guidance.

The service did not always work well across teams and services to support people. Staff did not always share their assessment of people’s needs when people moved between different services.

The trust relied on a third-party independent provider to support observations of patients with mental health risks. Patient records and staff feedback supported that the third-party provider was routinely unavailable to support observations within the department or was required to urgently discontinue observations. Leaders told us that they were working on their relationship with the provider’s lead commissioner to improve reliability, however this was difficult and so the risk to patients remained.

Staff told us that the teams in the ED and UTC did not always work well together as patients that were acutely unwell would be sent to the UTC where staff were not trained to deal with this level of acuity and did not have the staffing numbers to manage it. Leaders told us that UTC had only recently moved to the division and this divide was observed during our inspection.

Staff and partners told us that the relationship between the department and the mental health services was challenging with lack of confidence from both sides in how the department managed mental health, including which side had lead responsibility, and how pressures caused by demand on both sides was leading to conflict.

Feedback from partners was mixed, saying that staff and leaders collaborated and worked well together, and any negative instances were from when the service was under extreme pressure. For example, partners said that sometimes the reviewing of electric patient records, before or during patients’ admission to ED wasn’t always done to its best due to the demand in the ED.

We observed that the pain team and safeguarding teams were responsive to the department’s referrals and Palliative care, safeguarding and complex care team and the tissue viability nurses attended the department each morning to check if any patients required their specialist input.

The trust had made improvements to responding to emergency situations with the introduction of a hyper acute team, which clearly identified the staff needed to respond to an emergency.

There was now more pharmacy input in the department which had improved efficiency of discharges when patients required medications to take home.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

We observed people deconditioning whilst being bedded on corridors for excessive periods of time.

People told us that they had been on trolleys on the corridor for long periods of time or sat in chairs overnight when prone to pressure sores and were unable to go to the toilet as staff were not available to assist them due to how busy the department was.

The department had posters with digital codes on for people to scan with their phones to access information on infection prevention and control and common causes for attendance such as head and limb injuries.

The service did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

National guidance requires staff to respond to patients with possible sepsis within specific times including treatment within an hour for patients presenting with highest risks. The most recent data from June 2024 showed that sepsis screening and treatment performance were both below target with screening for sepsis at 79.5% with a target of 84% and treatment significantly lower at 59.3% with a target of 84%.

Leaders told us however that in their own sepsis audit, 86% of patients with confirmed sepsis received treatment within national guidance. However, the overall performance in sepsis which includes patients who should receive treatment according to their sepsis screening results continued to fall below national standards and the trust's targets.

The incident data for the emergency department from March 2024 to March 2025 highlighted multiple cases where sepsis treatment had been delayed as there was no capacity to offload potential sepsis patients from ambulances to the department for treatment. The trust undertook a retrospective audit of incidents in response to our findings, identifying 59 incidents of delays in sepsis treatment, with 44 due to ambulance delays. Of the 44 incidents, 42 were categorised as no harm and 2 were categorised as low harm.

We found 1 patient in the emergency department during our assessment who presented with suspected sepsis and who had not received treatment within the requirements of national guidance.

The service audited NEWS compliance which fluctuated significantly between September 2024 and February 2025 ranging from 48% to 90%, only meeting the target 1 month out of the 6 at 90% in October 2024 and then declining to 57%.

The paediatric ED used a different Paediatric Early Warning Score (PEWS) to the paediatric ward, which meant that ED staff had to ring the paediatric ward to reconcile the patients PEWS scores before they could be admitted. Whilst staff raised this with us as a concern, the trust clarified that this was the result of plans to implement a national pilot within the trust and mitigations were in place.

The service also conducted their own audits on specific areas of clinical care in ED such as the procedural sedation within the ED against guidelines and how well assessment tools for pneumonia patients were used. This audit had been completed in January 2025 and had shown a result of "very limited assurance".

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We utilised the Short Observational Framework for Inspection (SOFI) conducted by a trained and experienced SOFI inspector. During a SOFI, inspectors observe the mood and engagement of people using services and the quality of staff interactions. They also make notes on other aspects of care practice during their observations. Our SOFI observations showed that due to the pressures on the department, staff conducted observations without asking their consent and moved patients without telling them what was happening which caused them to be distressed and confused.

However, we saw good practice of consent taking for an invasive procedure using the appropriate record.