The Care Quality Commission (CQC) has published a report following inspections at the Countess of Chester Hospital NHS Foundation Trust between October and November last year.
Unannounced inspections were carried out as CQC had concerns about the quality of services being provided to people, mainly with regards to the urgent and emergency care pathway.
Services for children and young people were inspected to specifically provide an up-to-date assessment of the quality and safety of care for people using the service, the public and stakeholders.
Inspections took place at urgent and emergency care, services for children and young people, medical care and maternity at the Countess of Chester Hospital. CQC also inspected medical care at Ellesmere Port Hospital, and inspectors looked at how well-led the trust was overall.
Following these inspections, the overall trust rating, as well as being safe, effective and responsive, have again been rated requires improvement. Being well-led has improved from inadequate to requires improvement, and caring has been re-rated as good.
The following services were rated:
Urgent and emergency care at The Countess of Chester Hospital – the overall ratings has declined from requires improvement to inadequate overall and for being safe and responsive. Being effective has dropped from good to inadequate. Well-led has been re-rated as requires improvement and caring has been re-rated as good.
Services for children and young people at The Countess of Chester Hospital – the overall rating and being responsive has declined from good to requires improvement, safe has again been re-rated as requires improvement. Effective, caring and well-led have again been re-rated as good.
Medical care at The Countess of Chester Hospital – the overall rating as well as being safe, effective, responsive and well-led have been re-rated as requires improvement. Caring has been re-rated good.
Maternity at The Countess of Chester Hospital – this has improved from inadequate to requires improvement overall and for being safe and well-led. Being responsive has improved from requires improvement to good. Effective has been re-rated as requires improvement and caring has again been rated as good.
Medical care at Ellesmere Port Hospital – this has declined from good to requires improvement overall and for being safe, effective, responsive and well-led. Caring has been re-rated as good.
Ann Ford, CQC director of operations in the north, said:
"When we visited Countess of Chester Hospital NHS Foundation, there had been a significant change in the senior leadership team. This included three new chief executives and three new chairs in the three-year period leading up to the inspection. This meant the trust board had lacked stability and there was a continued reliance on changing senior leaders covering these posts on an interim basis.
“The recently appointed chief executive, who had been carrying out the role on an interim basis was committed to making improvements to the quality and safety of services, as well as rebuilding public trust and confidence in the organisation, with support from the trust board.
“We identified significant risk in urgent and emergency care. There weren’t enough staff to provide safe care and people were being cared for in inappropriate settings without mitigations in place to manage these risks. People receiving care in corridors had become normalised - this compromised people’s safety, privacy and dignity.
“Due to our concerns in urgent and emergency care, we considered using our urgent enforcement powers. However, following feedback to the trust, they took immediate action to reduce risks to people which meant we didn’t need to use our enforcement powers. We also carried out a follow up visit where we found further improvements, although some concerns remained. These issues were system wide and the trust is working closely with partner organisations to make improvements to keep people safe.
“However, there were improvements in maternity services at Countess of Chester Hospital, where some processes had been improved to increase the safety for women, people using the service and their babies. This was encouraging, although more work was needed in this service.
“Following the inspection, we fed back our findings to the trust leaders and have told them to make improvements in all five areas we looked at. We want to see leaders embed and build on the improvements they’ve already started in maternity, and channel their commitment into replicating this in the other areas we inspected. We want to see rapid widespread improvements and we’ll continue to monitor the trust to make sure people are safe while that’s happening and return to check on their progress.”
Inspectors found:
- People could not always access services when they needed it or receive the right care promptly
- In multiple services the trust did not always have enough staff with the right skills, training and regular appraisal to provide safe and effective care
- Mandatory training rates were low in several areas and for specific courses including resuscitation and safeguarding training
- The trust did not manage infection prevention and control well. Clinical environments and equipment were not always clean and fit for purpose
- The trust did not consistently operate effective governance processes to ensure people received high-quality care which met their needs
- The trust did not always have effective oversight of the quality and safety of care provided to people. There were examples where failures in governance systems had resulted in unmitigated risks.
However:
- Staff continued to treat people with compassion and kindness, took account of their individual needs, and helped them understand their conditions. They provided emotional support to people, families and carers
- The trust welcomed external reviews in several key areas to test internal systems, identify weaknesses and make improvement plans
- Leaders understood the priorities and issues the trust faced and needed to turn plans into action to embed and sustain improvements
- When inspectors visited the neonatal department in the trust’s services for children and young people, they found staff were committed to providing excellent care under difficult circumstances.