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 changed to good. 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.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

We reviewed a selection of patient records from each ward and confirmed that MUST (Malnutrition Universal Screening Tool) screenings, Speech and Language Therapy (SALT) referrals, and dietitian assessments had been completed appropriately and as required.

Pressure ulcer prevention was supported through weekly tissue viability reviews, improved compliance with Braden and MUST assessments, enhanced admission documentation, and the replacement of over 250 mattresses. Both falls and skin integrity remained strategic priorities for the trust.

Across medical wards, the number of falls decreased by 3%, and falls resulting in harm remained low. Most falls caused no harm, with only a small proportion resulting in low or moderate harm. Falls prevention was overseen by the Safer Mobility Steering Group, which implemented enhanced measures including improved compliance with six hour risk assessments, strengthened incident reviews, and broader prevention strategies.

We observed that the timing of NEWS2 observations for patients on the wards aligned with trust policy and standard guidance. In addition, during the onsite records review, we saw that all patients records we looked at included a VTE assessment.

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 Sentinel Stroke National Audit Programme (SSNAP) overall audit compliance band for the trust was A with a compliance score of 98.2% for July to September 2025.

The trust had identified learning from deaths as an area requiring improvement. At the time of our assessment, actions were being taken to improve awareness of escalations from the Medical Examiner, strengthen learning from deaths and mortality review oversight.

The trust had a range of policies, clinical leads and oversight groups for specific areas including SSNAP, NIV (Non-Invasive Ventilation), Heart Failure, and thrombolysis pathways.

A review of sepsis management between August 2024 and August 2025 showed in a pilot (snapshot) audit of inpatients audited with a diagnosis of sepsis, that 73 -93% had a sepsis screen completed and 70 – 86% received antibiotics within an hour.

The trust had complied with requirements to submit data to national audits. Data showed variable compliance with national audit standards. Audits identified gaps in timely assessment, documentation and completion of recommended care processes although there was evidence to show areas for improvement and remedial actions had been identified.

Local audits were completed in July and September 2025 to monitor compliance. Composite process scores were 69% in July 2025 and 70% in September 2025. Pneumonia outcomes were also reviewed at the monthly mortality surveillance meeting, which demonstrated a slightly improving trend.

The endoscopy service achieved JAG (Joint Advisory Group on Gastrointestinal Endoscopy) accreditation in April 2025.

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.

A trust led audit assessed how promptly patients received key multidisciplinary assessments following admission. The trust reviewed a random sample of 60 adult medical patients admitted between August and October 2025. Timings were measured from the point at which the decision to admit had been made.

The audit found that all patients had been seen by a consultant during their hospital stay, with 83% reviewed within 14 hours of admission. All patients received timely nursing observations and checks.

Physiotherapy and occupational therapy assessments were provided for all patients during their hospital stay, although commencement of therapies were frequently delayed beyond 14 hours due to patients’ clinical condition or ongoing investigations.

Staff held regular and effective multidisciplinary meetings to discuss patients and support improvements in care. Teams worked collaboratively across healthcare disciplines and with external agencies when required, including mental health liaison services and community stakeholders.

The trust had an AKI group that met monthly and was led by an Acute Medicine Consultant. Representation at the group included nursing, medical, critical care outreach and pharmacy staff.

Patients’ care pathways were reviewed by either specialty or general consultants, depending on the reason for admission. Ward rounds were multidisciplinary and included doctors, advanced nurse practitioners, dietitians, occupational therapists, physiotherapists, discharge to assess staff, and rapid response teams.

Staff reported an improved culture across the medical wards, describing strong teamwork and effective collaboration among all clinical staff.

A stakeholder told us that strong working relationships have been established to build and strengthen interprofessional relationships between services. Another stated they had a good level of communication and collaboration with colleagues within the hospital setting.

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. These covered areas such as weight management, alcohol reduction, physical activity, and smoking cessation.

Patients had access to a wide range of free tools and support to help them make healthier choices. The Healthy Choices Quiz offered NHS advice, tools, and apps to help patients make changes where they mattered most. Every Mind Matters provided expert guidance and practical tips to support mental wellbeing, including simple ways to lift mood.

The trust promoted a variety of NHS apps, located on their website and available to assist patients, including the BMI Calculator, Healthy Choices App, Couch to 5K, Drink Free Days, Food Scanner, and Quit Smoking. Patients could also take a short test to discover their heart age and learn how lifestyle choices, such as diet and exercise, could reduce their risk of cardiovascular disease.

The trust also reached beyond its usual work by running quarterly cardiovascular disease (CVD) education sessions for primary care teams. Around 40–50 teams attended each session, covering CVD, related risks, metabolic disorders, and diabetes. A mental health education session was planned for the new year.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The National Heart Failure Audit 2025 showed that the trust was compliant with national standards for heart failure care.

The National Audit of Cardiac Rhythm Management (NACRM) showed that the trust’s pacing performance was above the national average.

The National Diabetes Audit 2022–2023 showed that the demographics of patients at the trust were comparable with Integrated Care Board (ICB) and national data. However, the trust underperformed in several care plan process measures including some clinical parameters, which included body mass index and blood pressure recording.

The time of decision to admit was clearly documented in patient records.

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.

Between July and September 2025, the Safeguarding Complex Care Team reviewed 10 urgent DoLS cases. All cases met the statutory requirements of the Mental Capacity Act 2005, including decision and time specific capacity assessments and documented best interest decisions. All patients received first and second reviews; only 40% required a third review, primarily due to discharge or transfer.

Data showed that between Q1 and Q4 of the 2025/26 period, there were 1,277 urgent Deprivation of Liberty Safeguards (DoLS) authorisations. National data indicated that the trust’s activity was within the expected national pattern.

A further review of 10 inpatients with learning disabilities and/or autism found all patients were correctly identified and received reasonable adjustments such as carer access, low stimulation environments, and communication support, and 95% received pharmacy psychotropic medication reviews. However, not all patients who would have benefitted from a hospital passport had one.