CQC publishes reports following inspections at Macclesfield District General Hospital

The Care Quality Commission (CQC) has downgraded the ratings of urgent and emergency and medical services from good to requires improvement and rated maternity services as good at Macclesfield District General Hospital, run by East Cheshire NHS Trust.

Inspections were carried out in July and September as part of CQC’s continual checks on the safety and quality of NHS services.

Maternity services – the service is rated as good again.

Urgent and emergency services - inspectors found five breaches of regulation regarding safe care and treatment, staffing, complaints, duty of candour and person-centred care.

Medical services - inspectors found seven breaches of regulation regarding person-centred care, consent, safe care and treatment, complaints, how the service is managed, staffing and duty of candour.

The overall rating for Macclesfield District General Hospital remains requires improvement.

Chris Storton, CQC deputy director of operations in the north-west, said:

“At these inspections, we were disappointed to see a deterioration in the quality of care in medical and urgent and emergency services at Macclesfield District General Hospital. However, it was positive to see women and their babies continuing to receive good care in maternity services.

“Despite kind and compassionate staff working hard in medical and urgent and emergency services, they were sometimes failed by systems and processes that meant people didn’t always receive safe care when using services.  

“Ensuring people in medical services are cared for appropriately to prevent them getting pressure ulcers must be prioritised. In the six months prior to the inspection, 98 people developed pressure ulcers whilst staying at the hospital, which has made the hospital an outlier in the north-west due to the high amount. 

“People often experienced delays and overcrowding in A&E due to high demand and limited bed capacity. Understaffing added to these issues which affected how quickly people were seen and treated. However, we did see senior clinicians reviewing people arriving by ambulance to ensure they could be seen as quickly as possible despite the delays.

“Maternity staff received overwhelmingly positive feedback from women and their families who felt supported and treated with dignity and respect throughout their stay. There were clear safeguarding systems in place to protect people from abuse, and we saw examples of safeguarding and multi-agency working during our visit.

“Staff responded to a new IT system positively and it was encouraging that the system could identify people with additional needs or who might require support. This included alert flags for people with allergies, mental health needs, people with learning disability, autism or dementia.

“We have told the trust where it needs to make the necessary improvements and will continue to monitor the service closely to ensure people stay safe while this happens.” 

Following the inspections, inspectors found:

In maternity services:

• The service had a robust recruitment process to ensure staff were suitably qualified, experienced and competent.
• Staff ensured equipment was clean, maintained, and electrical safety tests had been completed.
• Pregnant women had access to a 24-hour telephone triage service, and improvements had been made to this system since the last inspection.
• Staff worked hard to meet women’s needs and provide care that was safe, supportive and enabled them to do the things that mattered to them.

In urgent and emergency services:

• Delays in people being discharged caused a knock-on impact to transfer to wards meaning people remained in the emergency department for longer than required.
• Staff didn’t always follow safe practices to manage the risk of infection.
• Leaders didn’t always ensure there were enough staff with the right skills, training and experience because of low compliance with specific mandatory training requirements and because the staffing in the paediatric emergency department wasn’t in line with national standards.
• Staff felt confident raising issues when they arose.
• Staff didn’t always assess and manage risks for people presenting with mental health needs.

In medical services:

• Leaders didn’t always detect and control potential risks in the care environment. There were issues with the aging building, some areas were unkempt and cluttered and fire safety wasn’t always adhered to.
• Staff reported delays for speech and language therapy (SALT) and dietician assessments which delayed people’s care.
• The service had poor compliance with Mental Capacity Act standards and inconsistent monitoring of sepsis and audit outcomes.
• Pharmacy professionals were visible on wards and attended ward rounds and team meetings to provide medicines advice and support.

The report will be published on CQC's website in the coming days.