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 requires improvement. At this assessment the rating has changed to good. This meant people’s needs were mostly met. However, the service was in breach of safe care and treatment regulation due to delays with hospital discharges.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

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 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Reasonable adjustments were made to accommodate additional visiting for certain patients, such as those in the last hours of life or those requiring a carer due to their condition. Signage was used to indicate patients at the end of life, and staff aimed to provide side rooms where possible.

Information leaflets were readily accessible on all wards visited. On the stroke unit, patients received information packs from the external agencies to support recovery.

Patients were offered a choice of food and drink tailored to their cultural and religious preferences. In the discharge lounge, hot and cold drinks were provided, and when there were delays in transport, food was also offered.

Staff demonstrated a clear understanding of, and adherence to, the policy for meeting the information and communication needs of patients with disabilities or sensory impairments.

The trust undertook quarterly audits against the NHSI Learning Disability Improvement Standard (2018), reviewing how patients with learning disabilities and/or autism were identified and supported. The Quarter 2 (Q2) audit indicated that patients were consistently identified through system generated alerts, enabling staff awareness from admission. Medication checks were undertaken to support appropriate prescribing practices.

Where reasonable adjustments were identified, the Safeguarding and Complex Care Team was notified, and personalised care plans were developed. Hospital Passports were used to support communication and individualised care although a review identified these were not used consistently for all patients who would benefit from having one.

Patient and carer feedback was collected and was largely positive. The audit identified opportunities to continue volunteer support for Hospital Passport completion and to expand their involvement in feedback collection.

The audit indicated that systems were in place to support compliance with the NHSI standard and the delivery of person-centred care.

We scored the service as 3. We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Leaders emphasised that continuity of care began at admission. In the Emergency Department, escalation areas were closely monitored, with daily reports identifying patients needing urgent review to ensure they were seen by the right consultant in the appropriate ward. Although patients were not always managed by the same consultant throughout their stay, structured handovers helped maintain continuity in their care.

Patients were admitted under specialist teams who continued their care and treatment management. Rotas were planned 2–3 weeks in advance to support continuity, and discharge under the same consultant was often possible. Departments used bed allocation risk registers to adjust staffing and placement safely.

Daily board rounds and MDT discussions aligned teams on patient pathways. Handover processes included detailed care information and highlighted risks. Huddles and escalation meetings addressed patient flow, while incident reporting and patient stories supported learning.

The trust had an electronic system which showed a single live patient list, their location, NEWS2 scores, diagnostics, and delays.

Leaders regularly reviewed patients who were cared for on a different ward than the one that normally looked after their condition.

Medical patient outlier numbers on the surgical wards reduced from 99 in August to 19 in September, before rising again to 38 in October. Between April and October 2025, 419 medical patients were managed as outliers. In October, 158 overnight ward moves occurred, mostly from AMU.

During our assessment, we saw patients had long periods of inactivity whilst being cared for in the emergency department. Prolonged inactivity can lead to further issues for the patient including decreased stamina, balance changes and cognitive changes. Patients were spending extended periods in escalation areas due to no beds being available on the wards.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The trust maintained a Translation and Interpretation Policy, accessible to all staff. Services were delivered through three external specialist providers, including British Sign Language (BSL) interpretation, available either on demand or via pre-booking.

During 2024/25, the trust facilitated 263 BSL interpretation sessions and nearly 2,600 Language Line interactions, providing a total of 48,962 minutes of interpretation across 47 languages.

An electronic system supported the consent process, embedding patient information within consent forms in multiple languages and formats. In 2024/25, approximately 3,500 patient information leaflets were downloaded, predominantly in English, with some use in Arabic, Polish, and Ukrainian.

A six month incident review identified five translation or interpretation related incidents, all of which resulted in no harm. One concern regarding BSL provision was raised in September 2025 and was promptly addressed with an apology and assurance of improved interpreter bookings in the future.

Oversight of translation and interpretation services was provided through the Quality Governance Group. During our visits, we observed that information leaflets were readily accessible on all wards. On the stroke unit, patients received information packs from the Stroke Association to support their recovery.

We scored the service as 2. The evidence showed some shortfalls. The service did not always respond to complaints in line with the trust policy. However, there was evidence to show people were involved in decisions about their care and improvements had been made in response to complaints.

In the first three months of 2025/26, the trust received 31 formal complaints, one of which was later withdrawn. The majority related to communication, staff attitude, and treatment. One complaint was reopened during this period.

A total of 24 complaints were closed, including the two that had been withdrawn. Most cases were expected to be resolved within 40 or 65 days; however, some took longer, averaging 60 days for 40-day cases and 109 days for 65-day cases. Delays were primarily due to slow initial responses, staff absences, or the need for additional investigation.

In the following three months, 44 new complaints were received, again predominantly concerning communication, treatment, and general patient care. Three complaints were reopened. Thirty cases were closed, though 15 exceeded the planned resolution timeframe for the same reasons as before.

The trust demonstrated that they had implemented changes in response to complaints. Catheter plans were now included in discharge checklists, a project had been introduced to improve SDEC patient booking accuracy, and staff videos had been created to share lessons learned across the trust.

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 SDEC environment was larger than required for its core function and, during periods of sustained operational pressure, part of the area was used to accommodate escalation patients overnight, with up to 16 patients in Acute SDEC and 6 in Frailty SDEC. The trust maintained dedicated SDEC capacity throughout, and there was no evidence that access to SDEC pathways was reduced, referrals delayed, or the service unable to fulfil its intended purpose. The area remained appropriately staffed, clinically supervised, and supported by established governance and risk management processes.

The trust's model differed from RCEM guidance, which states SDEC areas should not be used as bedded capacity during operational pressure. Escalation activity increased during the review period, with escalated stays rising from 26 hours in August to 45 hours in October, while Frailty SDEC escalation activity increased from 2 patients in August to 44 in September and 38 in October. However, trust risk assessments concluded the arrangement could be delivered safely, supported by sufficient physical capacity and protected patient flow.

Review of operational policies, escalation procedures, risk assessments, and activity data demonstrated appropriate inclusion and exclusion criteria for safe patient streaming. During the 12-month period reviewed, 28,023 patients accessed UTC services and 3,833 accessed SDEC, diverting 31,856 patients from the Emergency Department. SDEC activity in 2025 was significantly higher than in 2024, indicating improved access and utilisation.

Patients were protected through appropriate assessment, triage, consultant oversight, dedicated medical cover, established nursing models, and clear escalation processes. The trust had implemented risk controls including escalation limits, daily capacity reviews, escalation and de-escalation pathways, governance oversight, and quality monitoring. There was no evidence that escalation activity adversely affected access, safety, or the effectiveness of SDEC services.

Patients who no longer met the No Criteria to Reside (NCTR) represented between 21.5% and 22.9% of the acute bed base, slightly above the Cheshire and Merseyside average. In response, the trust implemented a range of initiatives across discharge processes, community services, Hospital at Home, Rapid Response, pathway redesign, and system-wide partnership working to reduce delays and support earlier discharge.

NCTR performance was subject to daily operational review, executive oversight, discharge planning meetings, long length of stay reviews, twice-daily discharge reviews, OPEL monitoring, and formal escalation processes. The trust also worked closely with Local Authorities and system partners through multi-agency discharge events, Community Response Hubs, executive summits, and the digital discharge tracking system.

Many delays were attributable to constraints within partner organisations, particularly social care assessments, brokerage services, and community placement availability. Additional delays affected patients resident in Wales due to cross-border discharge arrangements. While the trust appropriately identified and escalated discharge barriers, resolution of some delays depended on wider system capacity.

The trust strengthened community provision through a joint leadership model with the local community trust. Hospital at Home expanded to 70 virtual beds, maintained occupancy above 90%, accepted referrals from ED, SDEC, and wards, and consistently exceeded the national two-hour Urgent Community Response standard. The Rapid Response Team operated seven days a week, managed approximately 70 patients at any one time, and supported same-day discharge assessments, rehabilitation, and Home First principles.

An up to date Patient Access Policy, aligned to the trust's Inequalities Framework, demonstrated a commitment to reducing health inequalities through partnership working with voluntary and charitable organisations.

Despite these initiatives, patient flow pressures remained evident. Average medical length of stay was 10 days in August, 12 days in September, and 11 days in October 2025. Up to five beds were occupied by patients with delirium whose stays ranged from 23 to 28 days. Between 27 and 29 October 2025, 165 to 181 patients each day no longer met the criteria to reside, while only 57 to 68 patients were discharged. The trust continued to experience major delays in discharging medically optimised patients, with a significant number of patients per day remaining in hospital despite no longer meeting criteria to reside, leading to prolonged lengths of stay, constrained bed flow, and sustained Emergency Department pressures. This is a breach of safe care and treatment.

The trust's RTT (referral to treatment) performance was strongest in Diabetic Medicine (90%), Acute Internal Medicine (89%), and Hepatology (84%). The number of patients waiting over 52 weeks had reduced, although Cardiology and Nephrology remained outliers, with approximately 10% of patients waiting more than one year.

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.

Social workers joined ward teams to help plan discharges and find the right care placements. Brokerage services worked with the teams to arrange care home placements following local rules, and a process was set up for situations where a patient was turned down by more than two homes. A new tool was also developed to make discharge planning and community care coordination easier.

Post diagnosis information packs were provided for patients recently diagnosed with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

Integrated community teams, including rapid response, early intervention, and virtual wards used population health data to spot people most at risk of going into hospital and focused resources where they were needed most.

We scored the service as 3. The evidence showed a good standard. People were 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 “Do Not Attempt Cardiopulmonary Resuscitation” (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.

The trust implemented processes to plan and prepare for future service delivery and patient needs. This included reviewing care pathways, workforce requirements, and available resources to identify areas for improvement. Risks and challenges were monitored through established governance systems, with action plans developed to address any issues.

Services were regularly reviewed to ensure responsiveness to changes in patient demand, clinical standards, and regulatory requirements. Planning was informed by staff, patient, and stakeholder feedback, and training and resources were continually updated to support safe and effective care.

Long term planning considered both operational and strategic priorities, including patient experience, service accessibility, and integration with community and partner organisations.

The trust patient portal allowed secure access to health information, appointment management, and relevant resources, supporting patients in managing their care and accessing treatment when needed.