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 remained requires improvement. 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 significant delays in emergency care and long waits within the service as well as poor compliance with complaints processes. Care was not equitable for people with mental health conditions. However, staff provided person-centred care and provided tailored information. The service showed commitment to future planning and had made significant improvements in ambulance handover times.

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.

We spoke to people using the service, most people told us staff had asked whether they required any reasonable adjustments.

People using the service told us they were consulted about their treatment plan and care in general. They told us their tests had been completed and treatment plan explained to them, and they were satisfied with the standard of care they received. One relative told us the views and priorities of their family member had been considered, and they had been given additional time and information to support decision making.

Staff considered patients' individuals needs and preferences. Risk assessments were in place to identify specific needs, including nutrition, hydration, and pressure ulcer prevention.

Leaders told us a screening tool was completed for patients who were being admitted to wards. This documented reasonable adjustments, safeguarding concerns and information about carers or dependents. There were plans in place to introduce this in ED, however, it was not in place at the time of our assessment.

We saw positive interactions between staff and patients with complex needs.

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.

During our assessment, we observed patients becoming deconditioned whilst spending extended periods of time being nursed in the ED. Patients were spending more than 12 hours in the department once a decision to admit had been made due to no beds being available on the wards.

Staff engaged with other healthcare providers both within and external to the hospital to ensure patients received appropriate follow-up care. However, patients waited many hours to be reviewed and transferred to the appropriate wards. During our inspection we observed some patients who had been waiting over 20 hours for a medical bed.

External partners, such as GPs, community nurses, and social workers were involved to enable continuity of care and support for discharge planning. The department had formal arrangements with other NHS Trusts and tertiary centres to facilitate seamless transfers of care where required.

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.

Staff had access to both pre-bookable and on demand translation and interpretation services. Staff could also access a patient information library containing information leaflets for people using the service. We saw evidence that leaflets had been downloaded in multiple languages.

Posters within the service displayed QR codes for people to scan for information about common medical conditions and guidelines for patients and visitors. A Tannoy system had recently been introduced, regular announcements were used to provide information about waiting times and how to escalate any concerns. A report on translation and interpretation data was submitted to the trust board through the services governance processes.

Staff had information governance training, compliance in September 2025 was 86.1%.

People using the service told us they had been updated regularly, and their relatives had also been included when appropriate.

Staff were allocated to waiting areas to monitor patients. We observed staff engaging with patients to give them regular updates such as expected wait times. We observed appropriate conversations between medical staff, patients and family members about treatment plans and available options. A private family room was available where staff could take families and carers, when delivering bad news.

We reviewed the ‘Interpreting and translation policy’ which outlined staff roles and responsibilities in line with The Equality Act 2010. The policy also included processes for emergency situations. The service evidenced oversight of incidents, complaints or concerns relating to translation or interpretation services. There we no incidents reported that resulted in harm. We saw evidence of improvement following a concern raised through the services’ Deaf Sensory Network.

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. They did not respond to complaints in a timely manner. We reviewed information relating to complaints provided by the service. For complaints relating to ED, we found delays in resolving cases within the trust’s expected timescales. The average time to close complaints on the trust’s 40-day pathway was 80 days. The main themes identified in these complaints were communication, treatment and general patient care. The urgent care division received the second highest number of complaints in the trust during June to September of 2025/26. Leaders told us this was proportionate given the size and the nature of the service.

Leaders told us communication and waiting times were the most common themes for complaints within the service. Complaints were investigated by senior leaders, and managers met regularly to review concerns. Learning from complaints was shared with staff through emails, team meetings and information displayed on staff noticeboards. We saw evidence that actions had been taken in response to patient feedback, including the introduction of staff working in the waiting room to improve oversight and patient experience, and the use of mobile medication carts to support the timely administration of medicines.

Staff worked collaboratively with people who had provided feedback about their care. Patients had been invited to revisit the service to contribute to improvement work, including initiatives aimed at enhancing the experience and safety of people attending ED who were immunosuppressed.

People using the service told us they knew how to raise a concern or make a complaint. The service also collected feedback through the Friends and Family Test; in October 2025, 75.7% of feedback collected from 540 surveys in ED was positive. Results for the UTC were not provided.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure that people could access the care, support and treatment they needed when they needed it.

People could not always access care, treatment, and support promptly due to capacity constraints and patient flow challenges across the hospital. Patients described long waits in the department, especially when awaiting admission to a ward. At the time of our assessment, the longest wait we observed was over 20 hours, excluding patients with mental health needs who waited significantly longer. In July 2025, the service had the highest proportion of patients spending over 12 hours in ED nationally.

The ED had not been meeting the national 4‑hour performance target, meaning patients were not always able to access emergency services when needed or receive treatment within agreed timeframes. Over the previous 6 months, only 24% of admitted patients were seen, treated, or admitted within 4 hours. During the same period, 38.6% of admitted patients waited between 4–12 hours from a Decision to Admit (DTA) to admission. In addition, 31.8% of admissions from the ED waited over 12 hours from DTA to admission

The trust did not meet and respond to the needs of all people using the service because key performance targets in urgent and emergency care were not met. This was a breach of person-centred care.

NHS England’s UEC Care Plan 2025/26 sets a maximum of 45 minutes for ambulance handovers to ED. The service averaged 27 minutes based on ambulance service data between 1st August and 16th October 2025. This was an improvement from 67 minutes during the same period in 2024. Leaders had worked closely with ambulance providers to improve ways of working including implementing “call before convey” which utilised alternative pathways for patients who did not require care in the ED. Despite triage and ambulance handover times significantly improving since 2024, the proportion of patients admitted, transferred or discharged within 4 hours of arrival remained below the national average.

From October 2023 to July 2025, Countess of Chester Hospital NHS Foundation Trust consistently had a higher proportion of patients leaving ED before being seen compared to the England average. The service recognised this and had taken steps to improve the communication of waiting times.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The average time to triage for adults presenting with acute physical health issues for the last 6 months was 13 minutes. During the same period, it was 13.6 minutes for adults presenting with acute mental health issues. This was within the national target of 15 minutes and had significantly improved since our last inspection.

Triage times showed inequity between how the service provided physical and mental healthcare, though this had improved since our last inspection. Children attending with mental health needs continued to wait longer for initial assessment than those attending with physical health needs. In the 6 months prior to our assessment, children attending for mental health needs waited on average 4 minutes longer than those attending for physical health needs. In July 2025, this disparity increased, with children attending with mental health needs waiting on average 10 minutes longer than those attending for physical health needs.

The long delays within the department impacted patient experience but staff worked hard to remove any barriers to access for patients. Staff listened to people who had raised concerns or complaints and sought ways to improve the service.

Patients had access to digital information with QR codes displayed throughout the service providing easy access to advice leaflets. For those unable to access digital resources, leaflets could be printed upon request. Staff actively signposted patients and carers to additional services, including community pharmacies and dental services.

Staff had training in equality, diversity and human rights with a compliance rate of 92.29% trust wide. This was a mandatory requirement for all staff across non-clinical, clinical, medical, and dental roles across the Trust.

We reviewed policies relevant to the service. Not all policies had equality impact assessments undertaken to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

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.

Staff had access to the trust wide policy for managing resuscitation, including “Do Not Attempt Cardiopulmonary Resuscitation” (DNACPR) decisions. The policy outlined how the resuscitation service operated and ensured staff received appropriate training and update relevant to their roles. We observed staff from the resuscitation team attend an emergency during our assessment.

Patient care records we reviewed took account of people’s needs and preferences.

Information to support staff caring for patients requiring palliative and end of life care was displayed clearly in the department. This included guidance on how to contact the hospital specialist palliative care team and information promoting awareness of Advanced Care Planning (ACP). ACP is a voluntary process that gives people the opportunity to discuss and document their wishes and preferences for their future care and support.