- NHS hospital
County Hospital
Important:
This service was previously managed by a different provider - see old profile
All Inspections
During an assessment of the hospital overall
4 October 2022
During an inspection looking at part of the service
We inspected the medicine core service on the 4 October 2022. This was a follow-up focused inspection in response to a warning notice issued in 2021 whereby we notified the trust that the Care Quality Commission had formed the view that the quality of health care provided in relation to medical staffing in urgent and emergency care at the Royal Stoke University Hospital and the risk management of patients with mental health needs medicine at County Hospital required significant improvement.
24 August 2021
During a routine inspection
The trust provides a full range of hospital services including urgent and emergency care, critical care, medical care, surgery, end of life care, maternity and gynaecology, and outpatients services at both hospitals. Services for children and young people are provided at the Royal Stoke University Hospital and County Hospital. In addition to these services, the trust is also a tertiary centre on the Royal Stoke site for trauma, cardiology and spinal care.
County Hospital: The County Hospital is a smaller hospital site in Stafford. This hospital provides services including medical care, elective surgery, outpatients and diagnostics, and a paediatric minor injuries unit.
We carried out a focused inspections of surgical and medicine core service at County hospital. Focussed inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of regulation and issued a requirement notice, or taken action under our enforcement powers. In these cases, the ratings will be limited to requires improvement or inadequate.
Surgery services at County Hospital were last inspected in 2015 where it was rated as requires improvement overall. We did not inspect effective, caring and responsive. We are monitoring the progress of improvements to services and will re-inspect them as appropriate.
We also carried out a focused inspection of medicine at County Hospital because several serious incidents relating to falls and pressure ulcers had been reported to us. Medical services at County Hospital were last inspected in 2017 where it was rated as requires improvement overall.
05 Jun to 01 Aug 2019
During a routine inspection
Our rating of services stayed the same. We rated it them as Requires improvement because:
Our rating of safe was Requires Improvement overall. Risks within the emergency department were not always identified and escalated appropriately. Not all staff had completed all of the required mandatory training. Not all staff had training on how to recognise and report abuse. Both nursing and medical staff throughout the core service did not meet the trusts targets for safeguarding training. Staff did not update all risk assessment documentation completely and consistently. There was not enough of all suitable equipment for resuscitation of children and did not have effective systems for identifying risks associated with out of date equipment. In outpatients the service did not always manage patient safety incidents well. Staff did not recognise incidents and report them appropriately. When things went wrong, staff apologised and gave patients honest information and suitable support. However, feedback to staff from managers was inconsistent and lessons learnt were not always shared with the whole team.
Our rating of effective was Requires Improvement overall. There was a lack of effective monitoring of patient outcomes and did not always provide care and treatment based on national guidance and evidence of its effectiveness. Staff did not always assess and monitored patients regularly to see if they were in pain. Staff did not always understand their roles and responsibilities under the Mental Capacity Act 2005. They did not always know how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
Our rating of caring was good overall. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment. Staff cared for patients with compassion however, patient dignity was sometimes compromised.
Our rating of responsive was requires improvement overall. In outpatients people could not always access services when they needed it and receive the right care promptly. Waiting times from referral to treatment were not always in line with good practice for some clinics. There were issues with the ‘choose and book’ system as it was not always reliable. Call centre staff booked patients first appointments and sometimes used incorrect codes. This meant there was a risk of patients not being identified on clinic lists, resulting in them being delayed in clinic or having to rebook their appointment. However, the service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
Our rating of well led was requires improvement overall. In outpatients' systems to manage performance and risk were not always effective in identifying and escalating relevant risks and performance issues or in identifying actions to reduce their impact. The service did not always have a systematic or consistent approach to improving the quality of its services. The governance structure for outpatients services at the fracture clinic was not always clear and consistent which meant that lines of accountability and management were not always clear. However, most managers had the right skills and abilities to run services providing high-quality sustainable care. Departments had effective systems for identifying risks.
3 October to 16 November
During a routine inspection
23 April 2015
During an inspection of this service
April 2015
During a routine inspection
The County Hospital is part of The University Hospitals of North Midlands NHS Trust. It was known as Stafford Hospital until 31 October 2014, when it was part of Mid Staffordshire NHS Foundation Trust. In 2013, the foundation trust was put into administration by Monitor. The new trust was created on 1 November 2014, following integration with University Hospital of North Staffordshire NHS Trust.
We inspected this hospital in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided.
We visited the hospital on 23 April 2015 as part of our announced inspection. We also visited unannounced on the trust on Friday 1 May and Tuesday 5 May 2015. Our unannounced visit included A&E and Medical Care Services.
Overall we have rated this hospital as requiring improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services at the trust also required improvement at both a local and an executive level.
Our key findings were as follows:
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Staff were caring and compassionate towards patients and their relatives; we saw a number of outstanding examples of good care right across the trust.
- There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.
- Achieving safe staffing levels was a constant challenge in medical services and there was a heavy reliance on agency and locum staff to support this.
- Systems and processes did not support patients flow through the organisation.
We saw outstanding work being done on the Specialised Neurological Unit at the County Hospital to improve the outcomes for patients
However, there were also areas of poor practice where the trust needs to make improvements.
Importantly, the trust must:
- Review systems and processes to ensure patients flow through the organisation in a timely manner
- Implement the end of life individualised care plan as soon as possible so that patients who are actively dying are supported holistically. This would also support the nursing staff to meet all the needs of the patients.
- Review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.
- Review pathways between County Hospital and Royal Stoke to ensure patients transferred from the emergency department are kept safe and patients who transferred for treatments and procedures are done so efficiently and effectively.
- The trust must review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.
- Arrangements regarding DNACPR and mental capacity assessments must be improved so that people are safeguarded against decisions being made without their input.
- Improve the training opportunities for clinical staff with regard to Dying Matters
- The discharge process for patients who wish to go home so that fast track discharges can be completed within 48hrs.
Professor Sir Mike Richards
Chief Inspector of Hospitals