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Provider: Mid Cheshire Hospitals NHS Foundation Trust Good

On 19 September 2018 , we published a report on how well Mid Cheshire Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings


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 19 September 2018

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

  • We rated one of the three services we inspected at Leighton Hospital as requires improvement and the other two as good. Combined with the ratings from the previous inspection Leighton Hospital had an aggregated rating of requires improvement overall. However, it was agreed that the responsive rating of requires improvement in medicine should not be aggregated as it referred to a small area within the service. This location was rated as good overall.
  • Urgent care services at Victoria Hospital were rated as requires improvement. However, we did not inspect the outpatients service at this location and at the last inspection the service was not rated separately. Therefore, it was agreed that this location rating would not be aggregated into the trust overall rating.
  • We inspected both community adults’ services, rated good overall and community services for children and young people, rated requires improvement overall. We did not inspect Elmhurst Intermediate Care Centre at this inspection so it remains good from the last inspection. However, as these services have been delivered by this trust for less than two years it was agreed that these ratings would not be aggregated into the trust overall ratings.
  • Therefore, overall, we rated effective, caring, responsive and well led within the trust as good. We rated safe as requires improvement. In rating the trust, we took into account the current ratings of the six services not inspected this time.

  • We rated well-led for the trust overall as good.
  • The use of resources assessment was rated as good with a combined rating for quality and use of resources of good.
Inspection areas

Safe

Requires improvement

Updated 19 September 2018

Our rating of safe went down. We rated it as requires improvement because:

  • We observed failure to follow infection prevention and control procedures on a number of occasions. These failings were observed across wards and areas within urgent and emergency care, maternity care and medicine services. This meant that not all was being done to protect patients from avoidable harm. We also found that there was a lack of adequate assurance that there was an effective process for overseeing and monitoring compliance with infection prevention and control procedures.
  • Some services did not always have enough staff with the right qualifications, skills, training and experience to provide care and treatment. Urgent and emergency care services did not comply with the Royal College of Paediatrics and Child Health guidelines as there was only one registered children’s nurse for the department. Nursing vacancy, turnover and sickness rates were all above the trust targets in medical care services, as was the use of bank staff. There were medical vacancies but the skill mix was in line with the England average. Maternity service had enough staff. However, there was limited flexibility in numbers to cope with increased capacity and demand, or short notice sickness and absence.
  • In all the services we inspected, we found that completion levels of mandatory training for some subjects, particularly level 3 safeguarding children were variable.
  • Due to lack of storage space in medical care services, equipment was not always stored safely. We saw sluice rooms unlocked in several wards, with cleaning solutions left out accessible to patients and visitors.
  • Staff in the community services did not always recognise incidents and report them appropriately.
  • There was inconsistent use of risk assessments in medical care services and a lack of risk assessments relating to patients’ mental health needs or behaviour. The World Health Organisations five steps to safer surgery maternity safety checklist was not completed fully in theatre. Patients attending the emergency department were not routinely assessed for venous thromboembolism and as such were not always offered appropriate preventative treatment in line with best practice guidance.
  • We were not assured that urgent care services at Victoria Hospital had appropriate adjustments in place for the care of children.
  • The community service did not always ensure that staff completed mandatory training, including safeguarding training. Records showed that only 45% of eligible staff had completed level 3 children’s safeguarding training.
  • We found that staff did not always have access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Not all community staff had access to the trust electronic records system.
  • In community services staff did not always keep appropriate records of patients’ care and treatment. Records were not clear, up-to-date and available to all staff providing care. Risk assessments were not completed and care records were completed differently across community services.
  • Patients in community services did not always receive the right medication at the right dose at the right time. The community service did not always administer and record medicines well. There were also limitations to medicine availability at the Minor Injuries unit due to staffing constraints.
  • Not all equipment used by community services was well maintained. We found equipment used to deliver medicines that were overdue for maintenance checks. We found there were no formal systems for monitoring stock use-by dates. We found consumables in stock that were past the use-by date.
  • Not all services displayed safety monitoring information or evidence of how it was used to improve the care.

However:

  • Staff in the hospitals kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff in the hospitals recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The maternity service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
  • Following the inspection, we raised the concerns we had identified regarding infection control procedures with the trust and requested assurance that improvements would be made. The trust provided us with evidence that action had been taken and was being monitored to ensure sustained improvement and adherence to standards.

Effective

Good

Updated 19 September 2018

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

  • Staff worked in a multidisciplinary way to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Most services monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • There were a number of initiatives to reduce hospital admissions.
  • The services provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Information about the outcomes of patients’ care and treatment was routinely collected and compared against national data in most areas. Information was monitored in different meetings to identify areas for improvement.
  • Staff appraisal rates had improved since the last inspection but not to the expected levels in all areas we inspected.
  • Staff were aware of the role of the dignity matron, dementia lead and mental health liaison team. They reported they were approachable and supportive for patients with additional needs.
  • Staff gave patients enough food and drink to meet their needs and improve their health.

However;

  • The Urgent and Emergency Care Service at Victoria Infirmary, did not undertake audits to monitor and benchmark performance or review patient outcomes to monitor effectiveness of care at the time of inspection.
  • We found variable knowledge of staff in relation to the implementation of the Mental Capacity Act 2005. Staff did not consider the smaller decisions that may require capacity to be assessed and not all staff reported that they had received training in the Mental Capacity Act 2005.
  • Patients could not always access pain relief medication if they visited the Urgent and Emergency care unit after 6:30 pm this was due to a lack of trained staff to check and administer medication in line with best practice guidance.
  • Managers did not appraise staff’s work performance to provide support and monitor the effectiveness of the service.

Caring

Good

Updated 19 September 2018

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

  • Staff provided emotional support to patients to minimise their distress. We saw staff reassuring patients who were anxious or upset, with specialist support available if this was needed.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • 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. We observed nurses offering patients and relatives the opportunity to ask questions and to clarify anything they were unsure of. Patients and relatives told us staff had explained things in a way they could understand.
  • The service had a dedicated dignity matron who could support patients’ transition through the healthcare services where required.
  • We noted that staff had a good rapport with their patients and those close to them.

Responsive

Good

Updated 19 September 2018

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

  • The trust had undertaken a gap analysis and produced a number of options for the future of its services.
  • People could access the service when they needed it. Waiting times from treatment were in line with good practice in most speciality areas.
  • Women could access the maternity service when they needed it with no closures to the unit in 2017. There was a process for busier periods, where community midwives supported the midwifery-led unit while those midwives supported the labour ward suite.
  • The percentage of patients waiting in urgent care between four and 12 hours from the decision to admit until being admitted was consistently better than the national average.
  • From February 2017 and January 2018, no patients waited more than 12 hours from the decision to admit until being admitted.
  • Re-attendance rates in urgent care were better than the England averages and the number of patients leaving without being seen was better that the national figures.

However;

  • There was a lack of x-ray facilities at weekends at Victoria Infirmary.
  • At the last inspection the trust did not always meet the national standards for access to services. At this inspection we found the service did not always meet national standards to admit, transfer or discharge patients within four hours.
  • There were limited facilities to support the care and treatment of people living with dementia and there was no evidence of easy read documents or leaflets.
  • Referral to treatment time (RTT) information was not currently collected for paediatric therapies but would be collected routinely from the electronic management system from September 2018.
  • Neurology services were not meeting the 18 week referral to treatment standard.
  • Complaints were not consistently responded to in a timely manner.

Well-led

Good

Updated 19 September 2018

Our rating of well-led stayed the same. We rated it as good because:

  • The trust had a vision for what it wanted to achieve and plans to turn it into action had been developed with involvement from staff, patients, and key groups representing the local community.
  • The services had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • There was evidence of collaborative working with other NHS organisations and stakeholders and there was recognition that there was a need to work in a more integrated way for the benefit of patients.

However;

  • The community service for Children and Young People did not have an effective, comprehensive and embedded process to identify, understand, monitor and address risks. Risks were not monitored and reviewed consistently, in order to maintain quality of care to patients and feedback to staff. Monitoring varied across the teams we visited. Not all risk matrix and GAS assessment tools were completed in records we reviewed.
  • There was limited use of information technology systems within community services. Staff did not always access mobile working devices. Staff documented records on pieces of paper and returned to their base to update electronic records. These records were not always contemporaneous records and the quality of documentation was poor.
  • The trust did not always plan and provide services in a way that met the needs of local people. Within the urgent and emergency care service, we found that there were limited facilities to support the care and treatment of people living with dementia and there was no evidence of easy read documents or leaflets. The children’s waiting area lacked facilities for older children.
  • In some services there was no clear evidence of a strategy and workable plans to make improvements. There was no effective approach to monitoring or providing evidence of progress against delivery of the strategy or plans on a regular basis.

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

Requires improvement

Updated 19 September 2018

We had not previously inspected this service. We rated it as requires improvement because:

  • Not all safety incidents were appropriately recognised, recorded, monitored and investigated in order to maintain the safety of patients.
  • There was no flexibility in staff numbers to cope with increased capacity and demand, short notice sickness and absence, or developing professional development.
  • Hand written patient records were not clear, up-to-date and available to all staff providing care.
  • Risk assessments were not always completed and there was inconsistency in the accurate recording of care plans and care records across the services.
  • Staff did not use integrated patient records, therefore, multidisciplinary (MDT) reviews across different specialities were written in separate records, which did not assure us that integrated care and treatment was robust or fully effective.
  • Some medication prescription charts we reviewed were out of date.
  • Not all staff were up to date with mandatory training, including safeguarding.
  • There were not always clear pathways for reporting and dealing with child protection and safeguarding concerns.
  • Not all equipment used was well maintained or serviced regularly.
  • The service did not have a robust community annual audit or benchmarking system to monitor the effectiveness of care and treatment and improve clinical services.
  • There service did not monitor the outcomes of the care they provided in order to understand their performance or know if they could do things better.
  • There was a poor culture of incident reporting and low level of complaints received within the service.
  • There was a lack of care provision from the homecare team after 4:30pm on a weekday and at weekends.
  • The friends and family test response rate was low.
  • The service did not have a robust, effective, comprehensive, embedded process to identify, understand, monitor and address risks.
  • There was limited use of information technology systems in the community.
  • There was some inconsistency and variability in communication, availability of equipment and service development, with staff, which meant some staff did not feel well engaged. This was evident between staff that were directly managed by CCICP and staff directly managed by MCHFT.

However:

  • CCICP services had introduced a dedicated community pharmacist to review, monitor and audit medicines management within the community setting.
  • We observed numerous examples of multi-disciplinary working with clinicians co-operating and collaborating around the needs of children, young people and their families.
  • Patients were supported to live healthier lives and good health promotion activities were demonstrated across the communities.
  • The service supported patients’ transition through the healthcare services where required.
  • Staff cared for patients with compassion treating them with kindness and respect.
  • Specialist teams and practitioners provided training to staff, patients and families across the communities, to support care and treatment.