Health bosses at the Countess of Chester Hospital Trust have been told "more work needs to be done" after the latest inspection.
The Care Quality Commission (CQC) visited the hospital in July, a few months after a previous inspection found maternity services and leadership to be "inadequate". The trust was given an overall rating of "requires improvement" by the CQC in the same visit.
July's visit focused on both maternity services and "how well-led the trust was overall". Both areas remain "inadequate" and the overall rating for the trust stayed the same despite evidence of "some improvements" being made.
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Karen Knapton, CQC's head of hospital inspections, said: “We saw some improvements had been made at Countess of Chester NHS Foundation Trust since our last inspection in February, including starting to reduce the number of people waiting for treatment from referral, however more work needs to be done to improve people’s care and experiences.
“We found senior leaders had the necessary knowledge and skills to lead, however they weren’t applying this to have enough oversight of the trust, to ensure it was effective and met people’s needs. It was encouraging to see there had been several new appointments to the board, but there hadn’t been enough time for their plans to be fully embedded in order for us to see their impact or sustainability.
“Included in the new appointments were a director of maternity and a head of maternity, who we were told, would attend board meetings to provide a stronger voice for maternity services. Also, the trust had recruited more staff who were due to start soon. Additionally, processes in maternity services had been put in place to review incidents in a timely manner so staff could learn from them, to prevent them from happening again.
“It was disappointing there were still significant issues with the new electronic patient record system. The trust must ensure staff are appropriately trained to use this system so that risk assessments and other patient information can be easily accessed. Also, some staff continued to access data on multiple systems which wasn’t effective and could put people at risk.
“We will continue to monitor the trust and return to check on progress. If we are not assured people are receiving safe care, we will not hesitate to take action in line with our regulatory powers.”
Cheshire Live reported CQC's investigation highlighted five specific concerns raised by inspectors during the July visit. These were:
- Mortality reviews were not completed in a timely manner. There was limited overview and scrutiny of mortality reviews, this had resulted in reviews not been completed in a timely manner leading to delays in learning.
- There were some systems in place for both strategic and operational governance, however these were not always operated effectively or completed in a timely manner. There was a lack of support and overview at a senior leader level.
- Whilst there were some systems in place to manage risks, and provide oversight at board and senior level, these were inconsistent.
- Clinical and internal audit processes were also inconsistent in their implementation and impact, which puts people at risk.
- The complaints system was not yet managed consistently and CQC saw limited evidence of staff being enabled to learn from these and apply them to practice within the service.
But they also identified three areas where there had been improvements. These were:
- Performance in relation to cancer care between March and May 2022 had improved.
- Risks relating to medicines management through the electronic patient record system, which were identified at the last inspection, had been addressed by the trust.
- There were significant plans in place to increase governance support across the trust and to improve risk management.
The report stated the maternity service "was making progress in monitoring the effectiveness of care and treatment". But it said the work was "still in progress", highlighting staffing pressures and the pending appointment of a "dedicated maternity governance team".
Staff were judged to be "experienced and qualified" with the right skills to meet the needs of women. Training and competencies had also been updated while records had been kept up to date.
But there was criticism in terms of the service's information management. There had been a recorded reduction in Postpartum haemorrhage (PPH) incidents but the inspector found that "delayed incident investigations" and "lack of available data" meant the service "could not always be assured that measures implemented were being effective".
The Countess of Chester Hospital NHS Foundation Trust, which runs the 600-bed hospital in Chester and the 64-bed Intermediate Care Service at Ellesmere Port Hospital, was issued with two "warning notices" as a result of the February inspection.
These told the trust it needed to make "significant improvements" in the quality and safety of healthcare provided in maternity services, with a shortage of staff and suitable equipment highlighted.
The notices also raised concerns about the referral systems, the implementation of the electronic patient record system and the management around incidents, complaints and learning from deaths and complaints.
The trust remains rated "requires improvement" for being safe, effective and responsive. It is rated "good" in the caring category, with the last report praising staff for their "kind" interactions with patients across its core services.
Dr Susan Gilby, Chief Executive of the Countess of Chester Hospital NHS Foundation Trust, said: “We welcome the CQC’s latest findings following their inspection of the trust’s maternity services and how well-led services are in July. Despite unprecedented pressures on services the CQC recognised that the trust had started to reduce the number of people waiting for treatment from referral, which is a testament to the hard work of colleagues.
"I am pleased that the CQC was also encouraged by our work to embed new board-level appointments, who will help strengthen our maternity services as we look to make further progress on the implementation of our improvement plan.
“The report identifies areas for continued improvement and development at the trust, including operational governance and the rollout of the new electronic patient record system. We are committed to making these improvements to ensure we deliver increasingly high-quality care to patients now and in the future.”
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