The Countess of Chester Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

The service was in breach of legal regulation in relation to timely care and treatment.

Evidence showed significant delays in emergency care and prolonged corridor stays in the service. Patients with complex needs, such as those with learning disabilities or mental health conditions, often experienced longer wait times and longer stays in ED resulting in an overall poorer experience.

However, the service showed commitment to future planning, including policies for resuscitation and organ donation, and efforts to improve patient flow and complaint handling.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people to decide how to respond to any relevant changes in people’s needs.

Feedback collected by the trust and other agencies was however mixed with some people saying that they had not been kept informed of what was happening or about they were waiting on. However, during our inspection people told us that staff involved them and their loved ones in planning and making decisions about their care.

We observed a patient with a learning disability waiting to be seen in the main ED waiting room becoming more agitated by their surroundings with no sign of consideration for this person’s needs or if any adaptations could be made for them. This was an issue that had also been raised by Healthwatch in their visit in December where another patient with a learning disability had been cared for on the corridor overnight with no assessment of individual needs.

We observed an “escalation bed” in use in the corridor outside of resuscitation that was being used for a patient who had been stepped down from resus. This patient spent the full day of our inspection in this area. We used SOFI to measure the interactions, and the quality of care received in this area and found that whilst the corridor was busy with people walking past through the department, into resus and into the relative’s room this patient was not interacted with for the half an hour we observed her. Due to the location of the bed the patient was underneath a glove dispenser meaning staff were regularly reaching over her to get gloves and reaching over her to press the door release button. The doors were noisy, opening and closing frequently and in that time, we did not see anyone interact with her whilst leaning over her for gloves or walking past her. There was a trolley table on the patient’s feet, and we had to ask staff to remove this to make the patient more comfortable and prevent pressure sores. This was raised with leaders at the time of our inspection and this trolley was taken out of use immediately.

We observed a patient’s confidential data that had been left in a cubicle, when we escalated this to staff, they told us the patient had been discharged 16 hours previously, meaning these details had been on display in the bay for the entire day.

We saw patients deconditioning whilst spending long periods of time being nursed on the corridor. Patients became confused and no longer orientated to date, time or location, referring to their stay in the corridor at the Countess of Chester Hospital in the past tense. The corridor being used for patient care was noisy and dark. When we approached a nurse to raise concerns about a patient’s deterioration, we were told that due to the lack of light, clocks and routine in this area, elderly patients would become confused with “corridor induced delirium”. This demonstrated that long stays on the corridor and the deterioration from it had become normalised.

Partners said that leaders understood the diverse needs of the community of the area and worked with partners to ensure that health and care needs were understood and met. For example, the extension of UTC and SDEC services to better meet patients’ needs and minimise reliance on hospital admissions.

Partners said that the service had specific tailored services such as the High Intensity User worker, the dementia discharge nurse and the community frailty team, amongst others, to support patients with the diversity of their health and care needs once their urgent care need had been resolved.

Further work was underway to develop homeless and alcohol dependent pathways.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Feedback from people collected by us, the service and partners showed that often people felt they had not been given updates or information on waiting times, their condition or what was next for them. This was also a common theme in complaints.

We observed that staff made daily announcements, in the morning and evening to inform patients of what the waiting times were and gave them the names of staff managing the shift should they need to raise any concerns.

There was information available on what to expect and the process within the emergency department. There were posters and leaflets written to advise patients in ED and parents in paediatric ED for common reasons of attendance such as head injuries and various infections.

Leaders had written an information sheet to advise those patients were residing in temporary escalation areas to apologise that a room was not available on a ward, why this happened and how patients should expect to be treated.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

We saw 1 information poster in the department on how to raise a concern or complaint at the front desk of ED but none in any other areas such as the corridor.

Some patients told us they knew how to make a complaint whilst others didn’t as there was no information on this where they were in the department.

Leaders told us that all complaints concerns had been acknowledged on time, however not all complaints were responded to or closed within the recommended time frame. Where there was a delay to a complaint response leaders would regularly update the person. Leaders told us there was improvement work ongoing for time taken to respond and close complaints.

Leaders analysed complaints for themes and trends and were aware of what the main themes of complaints were and had action plans for improving these. Leaders gave examples of where complaints had been used to improve the service.

The service also collected feedback through the friends and family test and all patients received a text message to provide feedback and comments or concerns.

People could not always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital.

Since July 2023, a larger percentage of patients at Countess of Chester Hospital NHS Foundation Trust have consistently been spending longer in AE compared to the region and England. Waits at the trust worsened over time with a smaller percentage of patients spending less than 4 hours in AE in December 2024 (42.4%) compared to December 2022 (46.8%) and December 2023 (47%).

Data for February 2025 showed 38% of patients waited more than 4 hours in the department before a decision to admit, transfer or discharge.

Improvements to the trust’s four-hour performance were noted by NHS England who identified the trust as one of the top 10 most improved trusts. This compared four-hour performance in March 2024 and March 2025. In March 2024 the trust’s performance was below 50%. In March 2025 it had increased to 60.1%. Despite the improvements to four-hour performance, the trust still had one of the lowest percentage of people seen within four hours compared to trusts in the Northwest region.

Triage times showed inequity between how the service provided physical and mental healthcare. The average time to triage for mental health attendances was longer than the NHS England target time of 15 minutes and longer than those attending with physical health needs, with the average over 12 months for adults at 18 minutes and for children and young people 19.5 minutes, with the highest monthly average of 36 minutes in July 2024. This correlated with an increase in the proportion of patients attending ED with a mental health condition from January 2024 to May 2024, remaining higher until the most recent month of data (November 2024), where the proportion was higher compared to other hospitals.

Most patients we spoke with told us about long wait times they had experienced. In the last 12 months the service had higher than the NHS England target percentage of 5% maximum, ranging from 5.66% to 9%. However, this was similar to the England average. Of the patients that left before being seen for this period, there was an average reattendance rate of 8.4%, which is also above the target range of 5%.

Leaders and staff acknowledged that people could not always access support and treatment in a timely manner due to patient flow and capacity issues. Delayed discharges on wards were partly responsible for this.

Bed occupancy was slightly higher at the Countess of Chester Hospital than the trust, ICS, region and England between November 2024 and February 2025. There was a high rate of patients with no criteria to reside remaining in hospital for more than 21 days. The trust had a larger percentage of longer waiters compared to the region and England since April 2023. This peaked to 68% of patients remaining in hospital longer than 21 days or with no criteria to reside in June 2024.

Lack of beds available to admit patients into impacted on ambulance handover times as additional patients were in the department. Staff followed the streaming pathways to manage patient flow pressures.

In the main waiting area, there was a phone for direct 111 calls that patients could use for advice.

The quality of care provided by the service resulted in poor patient experience including long delays through urgent and emergency pathways within the department, and poor-quality interactions between patients and staff.

Data for December 2024 showed the trust had the highest percentage of patients waiting more than 12 hours in the ICS and in February 2025 showed 1 in 10 patients waited more than 12 hours from decision to admit to admission.

During the 3-month period prior to our inspection people had spent long periods of time being cared for on the corridor of ED, with 1,984 patients spending under 12 hours on the corridor, 386 spending between 12 and 24 hours and 157 patients spending over 24 hours on the corridor. Leaders told us that the longest length of stays in ED had reduced from over 70 hours to 48 hours. Leaders attended bed management meetings every 2 hours to address issues with flow through the hospital.

Patients with mental health conditions had longer stays in ED compared to all ED attendances. From May 2023 to November 2024, the service consistently had higher proportions of these patients spending more than 12 hours in the ED compared to the England average. In November 2024 these patients who spent more than 12 hours in this hospital’s ED experienced the highest delays with patients spending on average, a further 31.2 hours over the initial 12 hours (43.2 hours) compared to the England average of 13.6 hours (25.6 hour wait in total).

The paediatric department was working to improve health outcomes for people with different skin tones. For example, posters from the NHS race and health observatory were displayed for patients on identifying cyanosis and jaundice in babies with darker skin and of different ethnicities.

Staff told us that DNACPR orders from the community were not always reviewed in a timely manner to ensure they were valid in line with the service’s policy. The trust had acted to address this concern ahead of our assessment and had updated the DNACPR policy. An audit in November 2024 confirmed 98% of patient records had an appropriate paper DNACPR form. The trust confirmed there were no reported incidents in this service in relation to DNACPR forms.

The service had a resuscitation policy that stated that all patients admitted with a DNACPR decision in place must be reviewed; ensuring the original rationale, communication process and written documentation remained valid. This also gave clear guidance to staff on following DNACPR alongside staff training.

The service also had a policy for the donation of organs and tissues after death.