Mid Cheshire Hospitals NHS Foundation Trust rated as Good overall by Chief Inspector of Hospitals

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by Mid Cheshire Hospitals NHS Foundation Trust.

Overall Mid Cheshire Hospitals NHS Foundation Trust has been rated as Good. The Care Quality Commission (CQC) has found that the trust provided services that were safe, effective, caring and well led, however improvements were needed in the responsiveness of some services.

The trust runs two hospitals; Leighton Hospital, and the Victoria Infirmary, and provides intermediate services at the Elmhurst Intermediate Care Centre. The full reports on the trust and on each site can be found here.

The trust was inspected by CQC in October 2014 under its new inspection regime. The inspection team, which included doctors, nurses, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the trust. The team also returned unannounced at a later date to the Leighton Hospital to review the management of medical admissions out of hours.

CQC found that the trust had an established and stable senior leadership team, that staff said was visible and approachable. The majority of staff felt engaged and were keen to learn and continually improve the services they offered. The trust had a clear vision and strategy for the future delivery of services.

All areas of the trust were clean and robust infection control practices were adhered to by staff. Staff communicated with and supported people in a compassionate way, and patients and their families spoke positively of the care they had received.

Inspectors noted that there was effective communication and collaboration between multidisciplinary teams. Doctors, nurses and allied health professionals worked well together to provide a holistic approach to patients’ care and treatment

However, pressures on bed capacity within the hospital were affecting patient care and experience. The pressures on the number of available beds, particularly in the medical care wards, meant that once assessed patients could wait for extended periods of time to be seen by a specialist doctor. In addition, the lack of available beds meant that patients were often placed on wards that were not specific to their condition, or best suited to their needs.

Surgical patients were also affected because operations were cancelled if inpatient beds were not available.

Patients were often in hospital longer than they needed to be. Discharge processes required improvement. The trust was taking action to improve discharge processes and was working with commissioners and the local authority to improve discharge support in the community.

Inspectors also identified staffing issues. There were a number of consultant vacancies and this meant there was not always enough medical staff to provide timely treatment and review of patients, particularly out of hours. The trust was working hard to recruit and retain consultants. It had a number of initiatives in place including cross-working with neighbouring trusts and recruiting medical staff from overseas.

CQC also rated acute services at Leighton Hospital individually. The hospital was rated as Good for accident and emergency (A&E), surgery, critical care, maternity and gynaecology, services for children and young people, end of life care, and outpatient services. Medical care was rated as Requires Improvement. The hospital was rated as Good overall.

Inspectors identified a number of areas of outstanding practice, including:

• In medical care, the trust had introduced an electronic handover tool (e-handover) for which they had received a Health Service Journal Award.
• The new critical care unit had been designed in accordance with the latest best practice guidance with the aim of reducing delirium and the problems associated with sensory deprivation. For example the rooms on one side of the unit benefitted from full length windows incorporating an electronic blind so that natural light was visible.
• The end of life care service had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medication.
• The hospital had a rapid discharge pathway to enable patients to be discharged from the acute hospital to home in the last hours/days of their lives.

CQC also identified a number of areas where the trust had to make improvements, including ensuring that:

• Medical staffing is sufficient to provide appropriate and timely treatment and review of patients at all times including and out of hours.
• Improvements are made to patient flow throughout the hospital to reduce the number of patient bed moves and patients’ length of stay – particularly in the medical division.
• Action is taken to clear the backlog of discharge letters and implement an effective system for managing discharge letters so that GPs receive accurate and robust information about their patients in a timely way.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“When we inspected the services run by Mid Cheshire Hospitals NHS Foundation Trust, much of what we saw was good.

“We found that – across the board – staff were working hard to deliver compassionate care to patients. Teams communicated well with each other, and we saw some good examples of collaborative working to improve the treatment and care people received.

“However, we also found that improvements were required in some areas. Pressures on bed capacity within the hospital meant that some patients were being cared for on wards that were not suited to meeting their needs. This issue must be addressed to ensure that patients’ needs are met at all times.

“The trust must also continue the work to improve discharge processes and tackle staff shortages. I know that the senior managers have acknowledged the importance of these challenges. I believe that trust has considerable potential to improve their services along these lines, and I will watch their progress with interest.”

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