Countess of Chester Hospital Trust criticised in new inspection report

The CQC report said both Chester and Ellesmere Port hospitals were categorised as 'requires improvement' in all areas except caring, where staff provided a 'good' service across the board.

Maternity services had improved at the Countess since the last inspection and were no longer rated as inadequate, but urgent and emergency services had deteriorated and were now rated inadequate.

The latter was mainly due to long waiting times, noted to be worse than the national average, with increased numbers of patients and delays in discharging those who had been admitted.

Overall, inspectors recorded: "The trust faced the dual issues of too great a demand on urgent and emergency care services leading to an overcrowded accident and emergency department, compounded by reduced capacity in social care services and backlogs in assessments leading to significant numbers of patients stuck on wards waiting for discharge."

They added: "Corridor care had become normalised which compromised patient safety, privacy and dignity."

Inspectors recorded in their series of unannounced inspections, carried out between October and November 2023, the number of patients overall had increased by "about 20 per cent", with patients and ambulances from Wales attending as well as those from the local area".

During the inspection, the trust had declared 'OPEL 4', a system escalation when organisations are unable to deliver comprehensive care.

Between April and September 2023, there were 3,546 patients who had spent at least 12 hours following a decision to admit, and between May and October that same year, there were an average of 595 adult patients a month with an acute physical condition who had spent longer than 12 hours in the department. Some had waited longer than 60 hours, and there had been a patient with a mental health concern who had waited over 125 hours despite a bed being allocated the previous day.

Inspectors noted: "Staff were hard working but were tired. Morale appeared low due to constant daily pressures in the department...staff were encouraged to speak up about concerns but did not feel this was effective...senior leaders told us that they felt listened to by the board but felt that the issues were national and difficult to manage locally as a trust alone with the issues requiring a system response."

However, elsewhere in the hospital, staff were more positive about the trust, particularly in services for children and young people, where staff were "very positive" about the support they received.

Inspectors also raised concern at the hospital trust's financial challenges, with a forecast deficit at the end of the financial year ranging between £28.3 million (best-case scenario) and £43.5 million (worst case).

However, inspectors also highlighted areas of outstanding practice in the hospital, with the trust's maternity service having raised funds to publish a book in collaboration with a woman who had experienced baby loss. The book was published in October 2023 and raised awareness about stillbirth and gave support to bereaved families including support for siblings.

Inspectors noted: "The trust's services for children and young people had a strong visible person-centred culture with staff delivering exceptional and personalised care to babies, children, young people and their families", and the neonatal unit "had introduced new tools to communicate with women and birthing partners in real time and share videos and pictures using a secure communication system."

Jane Tomkinson OBE, CEO at the Trust, thanked the CQC for their report and the inspectors for their work during their visits.

Countess of Chester Hospital CEO Jane Tomkinson OBE.

She said: “We are extremely proud that despite the obvious and significant challenges we face, caring has been rated as good in every service the CQC inspected – this is undoubtedly down to the hard work and dedication of our staff and speaks volumes about the fantastic people that work at our Trust.

“We have a way to go but we know where the challenges are and what we need to do to improve further. We are already starting to provide consistently better care to our patients; all our staff are united in their determination to raise the quality of care and improve the experiences patients and their loved ones have using our services.”

Sue Pemberton, Trust Director of Nursing and Quality and deputy CEO, also acknowledged the journey ahead.

She said: "We know we have much more to do and our teams are actively delivering improvements every week. We are focused and will remain so until our services are consistently back to the standards our patients expect them to be.

“Treating our patients with compassion and kindness is a core value for our staff and it is testament to them that this was recognised by the CQC throughout their inspection.

"I would also like to pay tribute to the patients and families who are helping us reshape the way we deliver care at the Trust by working with us and actively giving us their feedback.”