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Provider: Mid Cheshire Hospitals NHS Foundation Trust Good

On 15 January 2015, we published our inspection reports for Mid Cheshire Hospitals NHS Foundation Trust.

Read the full service report below.

Inspection Summary


Overall summary & rating

Good

Updated 14 April 2020

Our rating of the trust stayed the same. We rated it as good because:

We rated safe as requires improvement.

We rated effective, caring, responsive and well led as good at acute and community service level.

We rated well led for the trust as good.

The use of resources was rated as good.

This gave a combined quality and resource rating of good.

Inspection areas

Safe

Requires improvement

Updated 14 April 2020

Effective

Good

Updated 14 April 2020

Our rating of effective stayed the same. We rated it as good because:

The effective domain was rated overall as good for Leighton Hospital.

The effective domain in medicine improved to good. This was because audit findings showed the services had improved outcomes for chronic obstructive pulmonary disease, stroke and inpatient falls pathways.

However;

The effective domain in urgent and emergency care at Leighton Hospital went down to requires improvement. The audit data regarding outcomes for patients was poor in a number of areas. There had been no clear leadership of the audit processes or clear action to improve, although a consultant lead had recently been identified.

The effective domain in urgent and emergency care at Victoria Infirmary remained at requires improvement. There was limited local audit and limited evidence of its use for improvement. This had been identified at the last inspection.

Caring

Good

Updated 14 April 2020

Our rating of caring stayed the same. We rated it as good because:

The caring domain ratings were good in all services.

We saw that the trust had a patient centred approach to care.

Patient feedback was positive and response rates were good.

All staff demonstrated a caring and respectful manner when caring for patients and relatives.

Staff included patients and relatives in the decision making processes of their care.

Responsive

Good

Updated 14 April 2020

Our rating of responsive stayed the same. We rated it as good because:

The responsive domain rating for urgent and emergency care at Leighton went down to requires improvement. We found that patients did not always receive care in a timely way in the urgent and emergency department at Leighton hospital with regards to performance against national standards such as the time from arrival to treatment and median total time in the department

The responsive domain rating stayed the same at Victoria Hospital as good.

The responsive domain rating for medicine improved to good although it was noted that complaint response times were not always within trust targets.

The responsive domain rating of requires improvement in outpatients in 2015 remained as we did not inspect this core service. However, we had information that the concern regarding clinics over running had been resolved and the referral to treatment times were good.

The team used their professional judgement to depart from the ratings principles to ensure a proportionate rating.

Well-led

Good

Updated 14 April 2020

Assessment of the use of resources

Use of resources summary

Good

Updated 14 April 2020

Our rating of use of resources stayed the same. We rated it as good because:

The trust is in surplus and has a track record of managing spending within available resources and in line with plans. In October 2016 the trust took on community services which has impacted a number of metrics considered within this assessment. However, the trust highlighted this has led to an increase in collaborative working across the local health economy and has allowed for new models of working to be introduced such as single points of access for specialities.

Since the previous Use of Resources Assessment in March 2018, the trust has demonstrated an improvement across a range of metrics in addition to areas which in the previous assessment were recognised as challenged, for instance e-rostering which has now been rolled out across the organisation. Despite challenges across the workforce, including high pay costs, high sickness absence rates and an increasing agency spend, the trust demonstrated they are using alternative workforce models and recruitment strategies to mitigate these issues where possible.

Please see the separate use of resources report for details of the assessment. The report is published on our website at

Combined rating

Combined rating summary

Good

Updated 14 April 2020

Our rating of combined quality and resources stayed the same. We rated it as good because:

The trust was rated as good for use of resources and for well led at trust level.

However, there were some areas for improvement.

There were significant indicators within the audit results for the urgent and emergency care unit at Leighton Hospital to show a declining picture of effectiveness which did not have embedded ownership or leadership.

They did not meet national standards for responsiveness within urgent and emergency care although there was significant environmental improvement work underway at the time of our inspection aimed at improving the capacity and flow within the department.

The trust faced significant challenges with staff recruitment and although international recruitment had been successful there remained challenges to the levels of registration in order to meet staffing standards in the urgent and emergency department.

Checks on specific services

Community health services for adults

Good

Updated 19 September 2018

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • There were good examples across all services where integrated care was provided.
  • The trust used a capacity and demand tool to monitor caseloads and manage staffing across the community teams. Managers assessed and prioritised their caseloads daily and where teams were understaffed, staff were reallocated to meet demand.
  • Patients were supported to live healthier lives and good health promotion activities were demonstrated across the communities.
  • Staff cared for patients with compassion and respect.
  • All patients we spoke with confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The trust planned and provided services in a way that met the needs of local people.
  • The trust monitored the changing needs of the community and used feedback from patients and stakeholders to monitor their services.
  • The service took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • There was a clear strategy which was embedded throughout the services we visited and staff were all aware of the plans for transformation of the community services.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However:

  • The service needed to make improvements to ensure services were safe. Not all staff had completed mandatory training, including safeguarding training. Equipment was not always maintained appropriately and medicines were not administered and stored well. Staff recognised incidents but did not always report them. Records were not up-to-date or easy to follow and could not be accessed by all staff.
  • Not all staff received clinical supervision and staff found it difficult to access appropriate training to maintain their competencies.
  • The service did not always investigate and respond to complaints in a timely manner in line with trust policy.

Community health services for children, young people and families

Good

Updated 14 April 2020

Our rating of this service improved. We rated it as good because:

  • The service provided mandatory training in key skills to all staff. The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, regularly checked if children and young people were eating and drinking enough and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children, young people and their families, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, their families and carers.
  • The service planned care to meet the needs of local people, took account of children, young people and families’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people, their families and the community to plan and manage services and all staff were committed to improving services continually.

However

  • The service did not always make sure all staff completed mandatory training. There were not always enough occupational therapy staff to provide the right care and treatment for children and young people. Some medicines charts had incomplete photographic identification records, and access to electronic records in some community locations was more limited. Key services were not available seven days a week and waiting times for some community services in paediatric occupational therapy and speech therapy did not meet targets.