Ellesmere Port Hospital is part of Countess of Chester NHS Foundation Trust and provides medical care services, outpatient services, rehabilitation and intermediate care to patients over 65 years age. Patients admitted to this hospital no longer require acute medical support.

It has approximately 56 beds over three ward areas, of which one has shared care arrangements with other community providers.

There is a small outpatient facility which is shared with other community services that includes an ultrasound room and a plaster room. The x-ray department is close by with two rooms available.

We visited Ellesmere Port Hospital as part of our announced inspection of Countess of Chester NHS Foundation trust on 16th to 19th February 2016. During this inspection, the team inspected the following core services at Ellesmere Port Hospital :

• Medical care (including older people's care)
• Outpatients. We inspected but did not rate this service at Ellesmere Port Hospital.

Over- all we rated Ellesmere Port Hospital as ‘good’. We rated it good for being safe, effective, caring, responsive and well- led.

Our key findings were as follows:

Cleanliness and infection control

• The trust had infection prevention and control policies and procedures in place which were accessible to staff at this hospital.

• Staff followed good practice guidance in relation to the control and prevention of infection in line with trust policies and procedures.

• We observed staff following hand hygiene practice, bare below the elbow and using personal protective equipment (PPE) appropriately.

• There had been no cases of MRSA bacteraemia reported at Ellesmere Port hospital and one reported case of Clostridium difficile from April 2015 to November 2015.

• Side rooms were used as isolation rooms to support patients and increased risk of cross infection. There was clear signage outside the rooms so staff and visitors were aware of the increased precautions they must take when entering and leaving the room.

• Some areas were dusty is outpatient clinic rooms.

Nurse staffing

• The hospital undertook biannual nurse staffing establishment reviews as part of mandatory requirements and set key objectives though this work to support safer staffing.Data provided as part of this review in January 2016 identified that over-all the hospital had maintained over 95% of staffing levels planned against actual levels for nine months.

• Nursing staff in the departments worked effectively across both sites to meet the demands of the service. The outpatient’s department’s staff included registered nurses and dental nurses, advanced practitioners and health care assistants.

Medical staffing

• Medical treatment was delivered by skilled and committed medical staff.

• The information we reviewed showed that medical staffing was generally sufficient at the time of the inspection.

• A middle grade and senior house officer (SHO) provided a presence Monday to Friday with SHO cover Saturday & Sunday morning.  Three care of the elderly consultants  provided a ward round weekly.

• There were no consultant vacancies in elderly care across medical services trust wide however there were 7 trainee grade Dr vacancies.

Mortality rates

• Mortality and morbidity reviews were held in accordance with trust policies and were underpinned by policies and procedures. All cases were reviewed and appropriate changes made to help to promote the safety of patients. Key learning Information was cascaded to staff appropriately.

• The Summary Trust-level Mortality Indicator (SHMI) is a set of data indicators, which is used to measure mortality outcomes at trust level across the NHS in England using a standard and transparent methodology. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average England figures, given the characteristics of the patients treated at the hospital. Between August 2014 and July 2015 the trust score was 103, which was slightly higher than the national average.

• Notably the hospital had achieved a “B” rating for the Senital Stroke National Audit Programme (SSNAP) in 2014, which was a significant improvement from an “E” rating in 2013. The stroke service had been recognised regionally for using innovation to improve outcomes for patients

Nutrition and hydration

• There were systems in place to ensure that patients nutritional and hydration needs were met.

• Nutritional risk assessments (MUST) were completed on all of the patient’s records we reviewed although some were not weekly as per trust policy.

• Patients requiring monitoring of their fluid balance had red lids on their water jugs to act as a visible reminder to staff.

• Dieticians visited Ruby and Diamond wards daily and would review patients the same day if the referral was urgent.

• Patients had access to dementia friendly crockery to assist with eating and drinking and promote independence.

We saw several areas of outstanding practice including:

• The Stroke service were recently awarded Innovative Team of the Year 2015 by North West Coast Research and Innovation Awards for the work the team had undertaken to develop a robust auditing tool.

• The trust was working collaboratively with other agencies in delivering the ‘discharge to assess’ (D2A) project which included introduction of frailty ward at the Countess of Chester hospital and the GP led ward at Ellesmere port hospital.

• The trust were rolling out care and comfort worker roles to work across the wards to assist patients with nutrition andhydration feeding, and any other basic assistance including getting newspapers.

However, there were also areas of poor practice where the trust needs to make improvements.

The trust should:

• Ensure changes are made to improve the layout of ward areas to allow patients to be cared for in a safe environment.

• Ensure that all staff receive mandatory training including mental capacity act training.

• Ensure all staff are aware of escalation pathways and standard operating procedures.

• Ensure the electronic paper records system is robust and staff are sufficiently trained.

• The trust should ensure that all resuscitation equipment is checked and positioned appropriately in order that it is available in an emergency situation.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We carried out this inspection because we had identified at our previous inspection in November 2012 that patients were not supported to self-administer medicines as part of their rehabilitation plan and nursing records were not always kept up to date, which could have resulted in patients being given inappropriate care.

We spoke with six patients and two relatives, who all said they were happy with the care they were receiving at the hospital. They said they had no concerns about the way medicines were managed.

We found that the hospital had started to introduce a system whereby people could administer their own medicines, if able to do so, to assist in their rehabilitation.

We also found that the standard of nursing records had improved and care plans were up to date and accurate, thus ensuring patients received the care they needed.

We spoke with 24 patients and five relatives of patients who used the service. They commented that they felt comfortable with the service they received and told us that the staff were very helpful and supportive and had put them at ease. They said that the staff responded to call bells promptly and always asked permission before carrying out any examinations or care.

The patients we talked to said that staff had explained to them about their medical condition and that they were encouraged to ask questions if they didn’t understand anything. Patients said staff asked them how they wanted to be addressed, were respectful and always maintained their privacy.

All of the patients we talked to said that there were enough staff to meet their needs. We saw that a member of staff went to every patient at least once an hour to check if they were comfortable or needed anything.

The hospital did not have a medicines self-administration policy. This meant that patients could not be supported to self-administer medicines as part of their rehabilitation plan.

Nursing records were not always kept up to date, which could result in patients being given inappropriate care.