Countess of Chester Hospital told it must make improvements

The Care Quality Commission has rated the Countess of Chester Hospital NHS Foundation Trust requires improvement and taken enforcement action, following an inspection in February and March.

CQC carried out an unannounced inspection of four core services at the trust’s Countess of Chester Hospital site: medical care, surgery, maternity, and urgent and emergency services. Inspectors also looked at how well-led the trust was.

This inspection was carried out in response to concerns about the quality of care in certain areas, therefore not all services were assessed.

CQC found standards of patient care continue to be below those people have a right to expect, as was the case at the previous inspection.

It also found the effectiveness of the trust’s leadership and the safety of its maternity service had worsened. CQC served the trust with two warning notices requiring it to make urgent improvements in these areas.

Following this inspection, the trust remains rated requires improvement overall. How well-led the trust is moves down from requires improvement to inadequate. It remains rated requires improvement for being safe, effective and responsive, and good for being caring.

Regarding the individual service ratings, maternity services have deteriorated from good to inadequate. Medical care, surgery and urgent and emergency services remain rated requires improvement.

Karen Knapton, CQC’s head of hospital inspection, said, “While we found kind and caring interactions from staff to patients across the services we inspected, the trust has work to do to ensure people consistently receive the safe and effective care they have a right to expect.

“This was particularly evident in its maternity service, which we rated inadequate due to issues including a lack of staff and suitable equipment to keep women and babies safe. The trust didn’t learn from safety incidents to avoid them happening again and while some reviews were taking place, they weren’t effective in ensuring safe care and treatment in this service.

“Medical care, surgery and urgent and emergency care had enough staff, but some lacked the training for their roles, and poor management of patient records increased the risk of people coming to harm.

“We recognise NHS services are under enormous pressure. However, senior leaders must be visible and have good oversight to manage and mitigate challenges and risks – and we found this was lacking at this trust.

“Although they had the necessary skills and abilities, leaders hadn’t successfully captured key information regarding the quality of patient care and emerging risks across the trust. This hindered their ability to develop and implement solutions, as well as target resources to where they were needed.

“Since the inspection, the trust has started to address the issues we raised. It’s also receiving additional support from NHS England and NHS Improvement to make improvements.

“We will continue to monitor the trust closely and will inspect it again. If improvements are not made, or if patients are at immediate risk of harm, we will take further action to hold the trust’s leaders to account and ensure people’s safety.”

The inspection also found:

• The trust did not have suitable governance systems and processes to effectively manage patient referral to treatment waiting times performance.
• Due to the implementation of the new electronic patient record system, staff were not always able to assess risks to patients. Care records were not always up to date, or easily accessible.
• Safety incidents were not always well managed. Actions and learning following incidents did not always happen.
• Not all staff felt respected, supported and valued.
• The trust did not always engage well with staff, patients and the community to plan and manage services effectively.

However:

• Staff understood how to protect patients from abuse and treated patients with compassion and kindness.
• The trust must make several improvements to comply with the warning notices and to meet its legal obligations, including:
• Ensuring it has effective systems and processes to manage referral-to-treatment times, identify and respond to risks to patient safety, and to capture and embed learning following patient safety incidents.
• Implementing quality improvement systems and processes, including regular assessments of the quality and safety of its services.
• Ensuring patient assessments are completed effectively and safely.
• Appropriately training staff to use the electronic patient record system and ensuring only those with the necessary permissions are able to use its prescribing functions.

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