Inspection reveals serious concerns at Countess of Chester Hospital

Maternity services were rated ‘inadequate’ while the hospital was told it must improve in several other core servcies

Maternity services at the Countess of Chester Hospital Trust have been rated ‘inadequate’ and other core services requiring improvement, according to a report released by the Care Quality Commission. The CQC conducted an unannounced inspection in response to concerns expressed about some of its core services.

The trust’s leadership was also rated ‘inadequate’ in the inspection, after concerns were raised about the quality of care being delivered in four core areas, those being maternity, urgent and emergency services, surgery and medical care.

The inspection took place between February 15 and March 17 this year, with CQC saying that they found standards of patient care continued to be below those which people had a right to expect, as was the case at the previous inspection carried out in 2018. They found that the quality of maternity services and the effective leadership of the trust had worsened and so two warning notices have been served, requiring it to make urgent improvements in these areas.

In maternity services, a shortage of staff and suitable equipment were flagged up as being causes for concern when it came to keeping women and babies safe.

The trust, which runs the 600-bed Countess of Chester Hospital and the 64-bed Ellesmere Port Hospital, was given an overall rating of ‘requires improvement’ overall, just as it was following the previous inspection. It remains rated ‘requires improvement’ for being safe, effective and responsive, and is rated good for being caring.

In terms of individual service ratings, maternity services have deteriorated from good to inadequate. Medical care, surgery and urgent and emergency services remain rated ‘requires improvement’. Staff also hadn’t learned from previous safety incidents to prevent them from happening again. Security was also mentioned, with CQC saying all clinical areas including the central labour suite needing to be secured to stop anyone leaving the area unsupervised.

In terms of emergency care, the trust needed to review arrangements in the waiting area to minimise the length of stay of patients without access to a bed.

A lack of staff training in the other core service areas inspected was also flagged up as an issue, along with poor management of patient records.

The trust, which employs over 5100 staff, was praised by the CQC for its kind and caring interactions between staff and patients across these core services, but work needed to be done to address concerns. The CQC said it would be monitoring the situation and would, if necessary, take further action to hold the trust to account.

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, which involved speaking to 142 staff and 41 patients across the trust, also found:

• The trust didn’t have suitable governance systems and processes in place to effectively manage patient referral to treatment waiting times performance.

• Staff weren’t always able to assess risks to patients due to the implementation of the new electronic patient record system. 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.

The inspection did, however, highlight a number of positives, including the fact that staff understood how to protect patients from abuse and treated patients with compassion and kindness.

The CQC has ordered the trust to 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, to 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.

Dr Susan Gilby, chief executive at the Countess of Chester Hospital Trust, said: “The CQC’s report identifies a number of key areas for further improvement and development that are required at the trust, as well as recognising the work which has taken place to embed a culture of compassionate care and treatment across the trust’s services.

“The report illustrates where more progress must still be made to ensure the trust can provide the highest quality of treatment to the local community, which we are committed to delivering. In our maternity department, we have implemented and are continuing to develop measures to ensure we can consistently provide patients with the safe and effective care they have a right to expect.

“Despite unprecedented pressure, the trust’s urgent and emergency services were able to maintain a ‘good’ performance in terms of its provision of effective and caring treatment, which is a testament to the professionalism and commitment of our staff.

“We are now working hard across the trust to implement the CQC’s recommendations, so we can continue to make improvements and deliver increasingly high-quality care to our communities in the future.”

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