The Countess of Chester Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

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

People were safe and protected and safeguarded. Where people raised concerns about safety, the primary response was to learn and improve.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The trust had established arrangements for managing patient safety incidents. Each morning senior leaders met with the Director of Nursing to review harms, moderate incidents and discuss cases. Matrons reviewed incident forms and SWARMS (Structured Walk-Around-Risks Meetings) were conducted by the teams. Patient safety surveillance meetings and weekly patient safety oversight meetings ensured all required actions, such as PSII (patient safety incident investigation) were completed and outcomes signed off. Harm levels, including low and no-harm incidents, were discussed at senior-level weekly meetings, with the risk team preparing reports for review. Broader checks and challenges on action plans and learning took place at the monthly safety surveillance group, addressing trust-wide issues.

Some staff told us they could raise safety concerns and knew how to report incidents using the trust’s electronic reporting system. However, some staff told us they did not know the trust had implemented the Learning from Patient Safety Events (LFPSE) system in February 2024 which provided different methods to investigate incidents. Staff did not always feel listened to when they raised safety concerns and were not confident that action had been taken to prevent a re-occurrence.

We reviewed incidents relating to end-of-life care and found the advice provided by the specialist palliative care team had not been followed by medical staff out of hours. We raised this with the divisional leaders to review the roles and responsibilities of medical staff in prescribing syringe drivers out of hours.

The trust completed an incident review for syringe drivers, palliative care medications, anticipatory medications and end of life as no audits had been completed within the last 12 months for end-of-life care. There were 85 incidents from 10 November 2024 to 10 November 2025 within the four categories. 94% were no or low harm and related to discharge, prescribing and staffing.

We scored the service as 3. The service worked well with people and healthcare partners to establish and maintain safe systems of care. Staff managed or monitor people’s safety. They made sure there was continuity of care, including when people moved between different services.

The specialist palliative care team (SPCT) supported clinical staff across the trust with specialist end-of-care advice and guidance and recommended symptom management.

End-of-life care and sharing of information was documented in the patient electronic record system.

Trust staff referred patients to the SPCT via a referral form in the trust’s electronic patient record system. Patient information and reason for referral were then kept on a separate log for the SPCT to access.

The SPCT did not have capacity to review every patient referred to the service. Patient need was based on the clinical information presented in the referral rather than using an assessment tool. This meant that some patients who were referred to the service were not always reviewed by the team and specialist advice provided.

The number of referrals to the Palliative care team from June 2024 to September 2025 was 764 cancer patients and 525 non-cancer patients.

Trust staff told us specialist palliative care was not always available due to the service operating on weekdays only from 9am to 5pm.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The Safeguarding and Complex Care team supported trust staff to prevent harm, abuse and neglect and to protect people at risk. This was completed through the delivery of training, the provision of safeguarding supervision and advise, partnership working and support to trust divisions. The team worked closely with internal and external partners, including Local Authority Social Care and local safeguarding boards in Cheshire West, Chester and North Wales.

The trust had a Safeguarding Adults at risk policy which staff were required to follow. The trust advised that staff were expected to prevent and respond to safeguarding concerns, adhere to professional and trust standards and completed mandatory safeguarding training. Clinical staff were also required to follow the local multi-agency safeguarding adult policies and procedures.

Staff in the end-of-life team had completed mandatory training for adults and children safeguarding levels 1, 2 and 3.

Some staff we spoke with gave good examples of how to protect patients from harassment and discrimination, including those with protected characteristic under the Equality Act.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered.

Risks relating to people were not always assessed and managed appropriately with the involvement of the patient, so they understood decisions about their care and treatment relating to end-of-life care. Advanced care plans to record the patient’s end of life care wishes were not completed. The service planned to create an electronic advanced care plan and this was in development.

We saw patients who had repeated hospital admissions with no care plan agreed to support their preferences of remaining at home. Not having a care plan increases the risk of neglected health needs and patients may experience emotional distress and reduced dignity.

The service had implemented an alert system to allow the palliative care team to review patient’s that were known to them in real time when a patient arrived in the emergency department. This initiative supported patients to access planned care and treatment and in some cases reduced admission to hospital unnecessarily.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We found the surgical and medical care ward environments visited as part of the assessment to be generally clean and tidy. Patients on end-of-life care were given a side room where possible.

Seven resuscitation emergency trolleys across medical care were checked at random and were found to be in good working order and appropriately stocked.

We found syringe drivers were maintained and used in accordance with professional recommendation.

Trust staff had access to specialist equipment to provide care to patients. This included specialist mattresses and mobility aides.

We reviewed 4 patient transportations and found 3 out of the 4 patients were prepared as per trust policy and documentation was completed. The other had missing documentation for risk of infection and pacemaker information which is important safety information for the medical examiner and funeral director.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff in end-of-life care to provide advice and guidance to staff caring for patients across the trust.

The SPCT consisted of a nurse leader, 5 specialist palliative care nurses who were supported by two consultants with a specialist interest in end-of-life care.

The team provided specialist support and guidance to trust staff who deliver care and treatment to patients.

Due to the availability of the service, Specialist Palliative Consultant advice was not available to staff from Monday to Thursday from 4:30pm to 8am.

Not all trust staff received advanced care planning training to support patients in making decisions about their future care and treatment as their health deteriorated. Training was planned to be completed for staff over the next few months.

Staff training compliance for syringe drivers was 100% for Ward 51 and the acute medical unit. For all other wards compliance was 32% or below. Syringe driver training is an expected skill for registered nurses on core wards and departments in the trust. We were told the syringe driver training records had not been accurately recorded and immediate action would be taken to address this.

Following our assessment, the trust implemented a Specialist Palliative Care out of hours advice line in collaboration with another local hospital, hospice and private company to address the shortfall identified.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We found ward clinical areas visited as part of this assessment were generally clean. Housekeepers were responsible for stores and conducted monthly stock checks. Domestic staff were supervised by the estates team.

End-of-life care patients were supported where it was possible to have a side room.

The trust had a standard operating procedure for the transfer of the deceased patient from the ward to the mortuary to manage the risk of infection.

There were clear roles, responsibilities and procedures around infection prevention and control across the SPCT to meet current and relevant national guidance.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff told us medicines used in end-of-life care were available on some wards, and if the medicines were not available staff knew how to access the medicines. Staff told us to support the mixing of medicines within a syringe driver and doses of medicines were available from the pharmacy team.

Staff told us the pharmacy team would prioritise discharge prescriptions to support the discharge from hospital of service users who were near the end of their life.

The trust provided an audit that showed staff did not always complete checks of the syringe driver when scheduled to do so. Information provided by the trust showed staff training in the use of syringe drivers, was very low for some wards. The trust identified this and have developed a plan to ensure staff complete the required training.