Letby trust issued ‘warning notice’ after failure to improve

The trust’s UEC services have been rated “inadequate” following a CQC inspection in February, with the regulator warning that “previous concerns still hadn’t been addressed”.

The CQC report stated that, due to “the level of concerns found during the inspection”, the trust has been issued a warning notice requiring it to make “significant improvements” to the management and delivery of the UEC service.

The CQC inspected the trust after concerns were raised about access, patient flow, corridor care and care of people with mental health issues.

Its report claimed the ED’s “infection prevention and control were poor, with visibly dirty equipment and low audit compliance”. It added: “Staffing levels, training, and medicine management were inconsistent, with critical gaps in sepsis treatment and mental health risk assessments.”

The inspection found: “Governance and leadership were not effective, with repeated failures to address known risks such as outdated equipment, and poor audit outcomes. The culture was task-focused and lacking compassion and at times unprofessional.”

The report added: “People told us that they did not think there were enough staff [in the department], and that staff were doing their best but were distracted as they were so busy. In Healthwatch feedback, staff were described to be ‘run ragged’.”

Further concerns included trust leaders and staff not always listening to or understanding the needs and views of patient.

Poor flow and “limited capacity” in the “very busy” department had led to patients being held in ambulances for prolonged periods, and corridor care had become normalised.

A patient with suspected sepsis did not receive treatment according to national guidance, while people with complex needs, such as those with learning disabilities or mental health conditions, faced longer waiting times than other patients.

However, the CQC inspectors also said executive leaders were visible and supportive, and staff development was encouraged through various training and progression opportunities, which “had a positive impact on people’s care”.

Following the CQC inspection, the overall rating for the emergency services remained “inadequate”. The same rating was given to the judgements on the ED’s safety and effectiveness. While the department’s “responsiveness” has risen from “inadequate” to “requires improvement”, the rating for how caring it was has fallen from “good” to “requires improvement”.  

The overall rating for Countess of Chester Hospital FT remains “requires improvement”.

National spotlight

The trust remains in the national spotlight due to the actions of Ms Letby, who worked at the hospital’s neonatal unit and was convicted in 2023 of murdering seven babies and attempting to murder others in 2015 and 2016. Last month, three former trust executives were arrested as part of an ongoing police investigation. 

Lady Justice Thirlwall is leading an investigation into the implications of Ms Letby’s crimes, and is due to issue a report in early 2026. 

Former trust CEO Susan Gilby won a claim of unfair dismissal against the trust in February, forcing the resignation of the chair, Ian Haythornthwaite.  

The trust also faces struggles with performance, and has been placed in the highest tier of NHS England’s oversight regime because of its lengthy elective waiting lists.

CQC deputy director of operations in the north Karen Knapton said: “We have told leaders where we expect to see rapid improvements and will continue to monitor the service closely to keep people safe while this happens. 

“We will return to check on their progress and won’t hesitate to use our regulatory powers further if people aren’t receiving the care they have a right to expect.”

Countess of Chester chief executive Jane Tomkinson said: “We are disappointed by the recent rating of our urgent and emergency care services by the CQC… Whilst we have seen improvements, it is clear the actions taken in the last 12 months need to be enhanced to consistently deliver the experience and care our patients deserve.

“During the inspection and on receipt of the warning notice, we took immediate action. Our focus remains on addressing some long-standing challenges, and we are committed to supporting our teams to ensure that the actions we take lead to sustainable improvements in our services.”