The Countess of Chester Hospital

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• 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

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained the same. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care. Evidence showed there were no advanced care plans for end of life care patients. This meant patients preferred care and place of death were not taken into consideration.

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.

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

Care and treatment were not always tailored to the patient’s individual needs. The trust did not approach patients as equal partners with end-of-life care by focusing on their specific needs, values and preferences. We found there were no advanced care plans in place for patients. Relatives told us discussions were held with staff during the last days or hours of patient’s dying did not always take place in a timely manner.

The trust did not prioritise and monitor the individual’s personal preferences for place of care and death at a trust level. This meant data was not collected to inform review of services for future patient need.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

End-of-life care services were delivered across the trust on all wards. However, the trust did not have oversight of all end-of-life patients care needs as they only collected data for those patients reviewed by the SPCT.

The trust did not routinely review the care and treatment provided to all patients with end-of-life care needs who died in hospital, and therefore did not consistently assess whether care was delivered in line with patients' wishes. For example, information about patient’s preferences and choice for preferred place and care and death was not monitored. This meant the trust did not always understand the needs of the people and their local communities to support choice and continuity.

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service did not have an end-of-life care information in a leaflet form for patient’s relatives to inform them about what to expect during the last days of life. One was in draft and had not been discussed with a patient group to gather feedback.

Feedback from relatives we spoke with was mixed. Most relatives told us they found it difficult to find out information about their loved one’s end-of-life care needs in a timely manner and specialist advice was not always available.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

The trust received 5 complaints relating to end-of-life care in the preceding 12 months. Of the 5 complaints 2 were not upheld. Information provided by the trust did not demonstrate what learning had been identified and if any changes had been made following the complaint investigation.

The main theme of complaints for end-of-life care was communication. We received feedback from relatives that they had not been informed about their loved ones end-of-life care and treatment in a timely manner and this was also a theme identified in the complaints received.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The end-of-life care service was provided throughout the trust wards. Access to specialist support was not equitable. There was no 7-day service for Specialist Palliative Care nursing team. There was no Specialist Palliative Care consultant cover Monday to Thursday from 4:30pm to 8am.

Following our assessment the trust worked collaboratively with a local trust and hospice to set up a telephone support line for specialist palliative care.

We found clinical staff were not always confident in assessing and prescribing anticipatory medicine for end-of-life care patients. We saw reported delays in pain relief for some patients where the SPCT provided advice and this had not been followed by trust staff.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff were trained in equality, diversity, inclusion and human rights.

Outcomes for patient’s with end-of-life needs sometimes varied due to lack of specialist advice.

We scored the service as 2. The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The trust had a clear policy for managing resuscitation risks, including “DNACPR decisions. The policy outlined how the resuscitation service operated and ensured that staff received appropriate training and updates for their roles. It also addressed the provision of necessary equipment, managerial and administrative support, financial planning, and regular monitoring of standards and outcomes. Staff could access emotional and psychological support through the trust’s occupational health service.

We reviewed four DNACPR patient records. We found there were four different places where the DNACPR record could be stored on the electronic patient record system. This meant staff had to look in different places to check for the documentation, especially if a patient had moved ward.

Patients who were approaching end of life were not routinely offered and given the opportunity to create an advanced care plan.