The Countess of Chester Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant the service was consistently managed and well-led.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy, and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Over the past year, the trust refreshed its strategy and approach to working with partners and other organisations. Each division assessed its strengths, weaknesses, opportunities, and risks considering what it aimed to achieve over the next year and the following 5 years.

While the overall business plan was developed separately, divisions had focused on addressing immediate challenges. Staff across services collaborated, shared their expertise, prepared strategy documents, and presented them to teams throughout the trust. THE SPCT aligned with the trust’s overarching goals and often partnered with external organisations to deliver projects.

At the time of this assessment the trust End-of-Life Care strategy was in development.

Within teams, staff worked well together and showed mutual respect. This contributed to an environment focused on delivering high quality care. We observed positive, compassionate interactions between the SPCT, trust staff, patients and their relatives. However, trust staff told us they did not always receive specialist end-of-life advice for patients in their care. Whilst trust staff told us they were confident in caring for patient’s with end-of-life needs, additional specialist guidance could be beneficial.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness, and honesty.

The specialist palliative care team were part of the urgent care division at the trust. This included urgent and emergency care services and inpatient medical wards. There was a leadership team for the urgent care division that included nursing, operational and medical leaders.

The leadership team had changed since our last inspection. The leadership team were working to improve end-of-life care services in the Specialist Palliative Care Team who supported staff on the wards.

SPCT staff reported that while morale within the team was generally good, overall morale towards was lower due to capacity issues and limited time specialist advice was available to the wider trust.

Trust staff valued the support and guidance of the SPCT, however due to availability of the team commented that they sometimes waited longer for a response and on some occasions did not receive one.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The Freedom to Speak Up (FTSU) process was embedded within the organisation, with quarterly pulse surveys and annual staff survey checkpoints used to monitor staff confidence and engagement. The NHS 2024 staff survey results for raising concerns was 5.93 out of 10. The FTSU policy was last reviewed in October 2023 and was considered appropriate. It outlined how staff could raise concerns, who to approach, and the actions taken following escalation. FTSU Champions were in place across medical care services to provide and available to provide specialist palliative care team support.

Staff were aware of the whistleblowing process and the role of the Freedom to Speak Up Guardian. However, 2 members of staff reported that, after raising concerns through the Freedom to Speak Up process, they felt limited action had been taken.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service valued diversity within its workforce and staff described working towards an inclusive and fair culture, with a focus on improving equality and equity for colleagues. The trust had an Equality, Diversity and Inclusion (EDI) Strategy in place for 2023–2026, which set out its organisational commitments and priorities.

Feedback from education partners was positive about the experience and support provided to learners, including those requiring reasonable adjustments. Partners also highlighted the department’s commitment to supporting a diverse student population

In the division’s most recent staff survey results from 2024 the result for ‘we work flexibly’ was 5.33 out of 10, this was below both the organisation wide result and the national average. The score for ‘we are compassionate and inclusive’ was 6.69 out of 10, this was slightly below the organisation wide result and national average.

Staff had access to a range of relevant training and toolkits including defeating barriers training, unconscious bias training, fair and inclusive recruitment training and active bystander training and a neurodiversity toolkit.

There were 6 staff networks within the trust. These included Black and Asian Minority Ethnic (BAME) Lesbian, Gay, Bisexual, Trans, Questioning/Queer Plus (LGBTQ+) and Enhancing Abilities and Leveraging Disabilities (ENABLED). Staff networks provide protected spaces where people can be open, supported and inclusive. The ‘NHS People Plan’ requires boards of local NHS institutions to recognise the expertise of staff networks. The trust had established the Staff Networks Working Group (SNWG) to improve planning and coordination of network events and activities.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The preferred place of death was not monitored for all patients across the trust. There was no trust wide oversight of end of life care.

The trust had established governance arrangements to provide clinical, operational, and quality oversight while reducing the risk of siloed working.

The risk register was actively used to identify, monitor, and mitigate risks. All staff could submit risks via the risk management reporting system, promoting real time reporting. Risks were reviewed by the triumvirate and specialty leads, with further information requested where required. Risks were discussed routinely at daily operational meetings, on the shop floor, and at quarterly risk meetings. Executive oversight was maintained through consistent feedback and a robust check-and-challenge process, providing assurance.

The top three risks for end-of-life care include how the service managed out of hours, how the service worked with the wider patient care system and supporting staff to deliver end-of-life care. The service had a business case in progress to address the shortfalls identified.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders – such as local hospices, commissioners and community services.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Following our assessment local hospices and community services set up a collective hot line for palliative care support.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The Specialist Palliative Care Team were innovative in utilising the resources available to support end-of-life care service in the hospital.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. For example, end-of-life care support in Accident and Emergency. A dedicated specialist palliative care nurse reviewed patients on end-of-life care coming into Accident and Emergency to reduce wait times and unnecessary admissions.