The Care Quality Commission (CQC) has published a report following an inspection at the Countess of Chester Hospital NHS Foundation Trust, to look at maternity services and how well-led the trust was overall.
This focused inspection was carried out in July to follow up on concerns found at the last inspection in February, with trust-wide issues around systems and processes, as well as maternity services. This resulted in the trust being served two warning notices.
The warning notices told the trust they needed to make significant improvements in the quality and safety of healthcare provided in maternity services, and with systems relating to referral to treatment processes, implementation of the electronic patient record system, and around the management of incidents, complaints and learning from deaths and complaints.
Services were not rated following this inspection, therefore maternity services and how well-led the trust is remain rated as inadequate. The trust’s overall rating remains rated as requires improvement.
This latest inspection did not include all the core services provided by the trust as this was a follow up inspection. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.
Karen Knapton, CQC head of hospital inspections, said:
“We saw some improvements had been made at Countess of Chester NHS Foundation Trust since our last inspection in February, including starting to reduce the number of people waiting for treatment from referral, however more work needs to be done to improve people’s care and experiences.
“We found senior leaders had the necessary knowledge and skills to lead, however they weren’t applying this to have enough oversight of the trust, to ensure it was effective and met people’s needs. It was encouraging to see there had been several new appointments to the board, but there hadn’t been enough time for their plans to be fully embedded in order for us to see their impact or sustainability.
“Included in the new appointments were a director of maternity and a head of maternity, who we were told, would attend board meetings to provide a stronger voice for maternity services. Also, the trust had recruited more staff who were due to start soon. Additionally, processes in maternity services had been put in place to review incidents in a timely manner so staff could learn from them, to prevent them from happening again.
“It was disappointing there were still significant issues with the new electronic patient record system. The trust must ensure staff are appropriately trained to use this system so that risk assessments and other patient information can be easily accessed. Also, some staff continued to access data on multiple systems which wasn’t effective and could put people at risk.
“We will continue to monitor the trust and return to check on progress. If we are not assured people are receiving safe care, we will not hesitate to take action in line with our regulatory powers.”
Inspectors found:
- Mortality reviews were not completed in a timely manner. There was limited overview and scrutiny of mortality reviews, this had resulted in reviews not been completed in a timely manner leading to delays in learning
- There were some systems in place for both strategic and operational governance, however these were not always operated effectively or completed in a timely manner. There was a lack of support and overview at a senior leader level
- Whilst there were some systems in place to manage risks, and provide oversight at board and senior level, these were inconsistent
- Clinical and internal audit processes were also inconsistent in their implementation and impact, which puts people at risk
- The complaints system was not yet managed consistently and CQC saw limited evidence of staff being enabled to learn from these and apply them to practice within the service.
However:
- Performance in relation to cancer care between March and May 2022 had improved
- Risks relating to medicines management through the electronic patient record system, which were identified at the last inspection, had been addressed by the trust
- There were significant plans in place to increase governance support across the trust and to improve risk management.