The Care Quality Commission has rated Countess of Chester Hospital NHS Foundation Trust as Requires Improvement overall, following an inspection.
CQC carried out its latest inspection in November and December 2018 and found a number of improvements were needed. Overall the trust has been rated, Requires Improvement, falling from Good.
The trust is rated Requires Improvement for safe, effective, responsive and well-led, and rated Good for caring.
Professor Ted Baker, CQC Chief Inspector of Hospitals, said:
“Inspectors found that the ratings for safety, effectiveness and well-led went down from Good to Requires Improvement. Responsiveness remained the same at Requires Improvement and caring remained the same at Good.
“It was disappointing to note that there had been a deterioration overall. At their last inspection, they had been rated as Good for well-led. I recognise that changes in senior leadership such as the appointment of the interim chief executive and interim medical director, both have been made substantive, had led to recognition that improvements were required.
"Following the inspection CQC reported its findings to the trust. The trust board knows what it must now do to ensure all the necessary improvements are made. We will continue to monitor the trust and we will return to carry out further inspections to check on any progress with improvements.”
Some of the key findings in the report are identified:
In respect of safety, the trust did not effectively demonstrate a consistent approach to sepsis identification and treatment. We found that not all staff had not received sepsis training and processes for the rapid identification and treatment of sepsis were not embedded. The trust had developed an action plan to improve this. In addition, the urgent and emergency care department did not have sufficient paediatric nurses to meet the Royal College of Paediatric Child Health standard of two children’s nurses per shift in an emergency department treating children.
With regards to effectiveness, the trust did not always ensure that care and treatment followed national guidance and evidence in order to achieve positive outcomes for patients. The outcomes of people’s care and treatment were not always monitored regularly because participation in external audits and benchmarking was limited.
In the well-led category, there was no clear strategic objective in place to lead the organisation. This meant that there was no robust and realistic strategy for achieving trust priorities and developing good quality, sustainable care - there was no clear strategic objective in place to lead the organisation.
Inspectors rated caring as Good, identifying some areas of good practice. There was a strong, person-centred culture, the staff inspectors met were highly motivated and driven. The relationships between people who used the service, their families and staff was valued and promoted by leaders.
The trust has been told it must make several improvements, including:
Ensure that all patients’ have their privacy and dignity maintained at all times. Patients should not receive treatment, be reviewed, or handed over directly in front of, or next to other patients, or their relatives.
The trust should ensure all wards have enough nursing staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.
Inspectors witnessed some areas of outstanding practice across the trust, including:
Within the urgent and emergency the department had introduced a bereavement re-call service, which was for any relative or carer to be invited to the department to speak with senior staff, if their loved one had died within the department.
The trust board knows what it must now do to ensure all the necessary improvements are made.
Prof Ted Baker, Chief Inspector of Hospitals