The Countess of Chester Hospital

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We saw improvement in the National Care of the Dying Audit 2024 since our last inspection 2016.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. 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.

End-of-life care needs of patients in the trust were not reviewed or documented in the form of an advanced care plan. Data showed that 60% of end-of-life care patients who died at the trust had no specialist input from the palliative care team.

Patients in the last days of life were not always identified in a timely way and appropriate action taken for patients on surgical wards. We reviewed incidents and found delays in prescribing syringe drivers for patients on end-of-life care. This was raised with the provider for review.

There was no oversight or single point of contact for end-of-life care of patients in the trust. Individual consultants oversaw their patients, and the palliative care team reviewed patients based on clinical need.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service had completed a gap analysis to review compliance with legislation and best practice including the ambitions for palliative and end-of-life care.

This included referral, assessment and care, coordination and partnership working, leadership and governance and workforce. Where gaps were identified a tracking system was in place to monitor progress. Some actions were behind the planned target date due to capacity.

The trust care of the dying policy did not support staff to recognise the dying patient and escalate deterioration to senior staff. Staff told us they did miss changes in patient deterioration, and this was an issue in recognising the dying patient.

A ward accreditation programme was in place to assess compliance to the expected standards for care of the dying person in wards and departments across the trust. programme found staff were able to describe excellent care but could not always list the actual 5 priorities of care. Full end-of-life care plans were not recorded as the electronic patient record system did not support this at the time of this assessment. In the interim a standardised text note was used and added to the electronic patient record.

The SPCT shared best practice guidance with medical and clinical staff for patient symptom and pain control. Syringe driver prescription was completed by medical staff as the band 7 palliative care nurses had not completed the prescribing qualification. Specialist pain management advice for end-of-life care was not available across the trust. However, the SPCT would provide advice and guidance reflecting national best practice guidance.

Nutrition and hydration needs were assessed and supported by the speech and language team (SALT) initially. When a patient deteriorated this was reviewed by medical staff who determined if care and treatment was withdrawn.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The SPCT had met daily to review new patient referrals, specialist advice and prioritise patient’s for review. They attended specialist multidisciplinary meetings across the trust for patient’s with heart failure, lung cancer, liver, breast cancer and gynaecology to review patients progress and advise teams for end-of-life care patients. These meetings included community services to support the continuity of care for patients on discharge from the trust.

The consultants held clinics to review patients who were able to attend in person.

The SPCT at the trust linked into the Cheshire and Merseyside Palliative and End-of-life care network. This included hospices and community end-of-life services.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The trust provided patients with information to support their health and wellbeing, helping them maximise independence, choice and control. Resources were made available in a variety of formats via the trust website, apps and leaflets, covering areas such as weight management, alcohol reduction, physical activity and smoking cessation.

The consultant-led hospital Specialist Palliative Care Team provided an advisory and supportive service whilst the medical and nursing management of the patient remained the responsibility of the ward teams. Access to the Specialist Palliative Care service depended on need and not diagnosis. The service supported patients with cancer and life-limiting non-malignant diseases.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Trust staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Patients preferred care and place of death were monitored if seen by the specialist palliative care team. The trust did not routinely collect preferred place of death data across the trust patients with end-of-life care needs.

From June 2024 to September 2025 the preferred place of death for patients seen by the SPCT was recorded as 74%. The reasons for not achieving the preferred place of death for the patient were due to sudden deterioration, availability of hospice beds, too unwell to transfer and transport delays.

The National Audit of Care at the End-of-Life audit (NACEL) in 2024 identified where death was expected; over 90% of patients had appropriate anticipatory medicines prescribed. Anticipatory medicines are prescribed ahead of patient need. The audit identified areas for improvement which included assessment of spiritual, religious, hydration, psychological and emotional needs, education and training for staff, patient participation in individualised care planning and provision of and signposting to bereavement care.

Actions for improvement from the audit listed oversight of hospital improvement plan, access to Specialist Palliative Care services, improved personalised care and support planning, equitable care being delivered to all dying patients and training and support. Actions were planned for completion by December 2026.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

We saw capacity assessments had taken place to support do not attempt cardiopulmonary resuscitation (DNACPR) decision making process. Where patients did not have capacity best interest decisions were made with discussion with a family member or a representative.

We saw capacity assessments for other decisions and treatment were completed in line with legislation.