The County Hospital is part of The University Hospitals of North Midlands NHS Trust. It was known as Stafford Hospital until 31 October 2014, when it was part of Mid Staffordshire NHS Foundation Trust. In 2013, the foundation trust was put into administration by Monitor. The new trust was created on 1 November 2014, following integration with University Hospital of North Staffordshire NHS Trust.

We inspected this hospital in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided.

We visited the hospital on 23 April 2015 as part of our announced inspection. We also visited unannounced on the trust on Friday 1 May and Tuesday 5 May 2015. Our unannounced visit included A&E and Medical Care Services.

Overall we have rated this hospital as requiring improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services at the trust also required improvement at both a local and an executive level.

Our key findings were as follows:

• Staff were caring and compassionate towards patients and their relatives; we saw a number of outstanding examples of good care right across the trust.

  • There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.

  • Achieving safe staffing levels was a constant challenge in medical services and there was a heavy reliance on agency and locum staff to support this.

  • Systems and processes did not support patients flow through the organisation.

We saw outstanding work being done on the Specialised Neurological Unit at the County Hospital to improve the outcomes for patients

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

Importantly, the trust must:

• Review systems and processes to ensure patients flow through the organisation in a timely manner

• Implement the end of life individualised care plan as soon as possible so that patients who are actively dying are supported holistically. This would also support the nursing staff to meet all the needs of the patients.

• Review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.

• Review pathways between County Hospital and Royal Stoke to ensure patients transferred from the emergency department are kept safe and patients who transferred for treatments and procedures are done so efficiently and effectively.

• The trust must review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.

• Arrangements regarding DNACPR and mental capacity assessments must be improved so that people are safeguarded against decisions being made without their input.

• Improve the training opportunities for clinical staff with regard to Dying Matters

• The discharge process for patients who wish to go home so that fast track discharges can be completed within 48hrs.

Professor Sir Mike Richards

Chief Inspector of Hospitals

• There had been an improvement in the management of medicines from the last inspection.
• The four-hour time to treatment waiting targets were consistently higher than the national average, at County Hospital ED and reached the target of 95% on occasions.
• Staff treated patients with kindness and compassion. Patients were involved in the care they received.
• The service had stopped using agency staff which improved the continuity of care patients received.
• The Purple Bow scheme assisted staff to be responsive to patient and relative needs, and to provide a service over and above what is normally offered to patient visitors. This supported a positive experience for patients at the end of life, and their relatives.