Certain services at Macclesfield District Hospital require improvement.

That is the view of the Care Quality Commission (CQC), who carried out inspections at the hospital last year as part of continual checks on the safety and quality of NHS services.

In their report, due to be published in the coming days, the CQC downgraded the ratings of 'urgent and emergency' and 'medical' services from good to requires improvement.

Maternity services, meanwhile, have been rated as good.

This means that the overall rating for Macclesfield 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.

"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." 

Urgent and emergency services

Inspectors found five breaches of regulation regarding safe care and treatment, staffing, complaints, duty of candour and person-centred care in relation to the hospital's urgent and emergency services.

The report notes that 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.

Furthermore, staff didn't always follow safe practices to manage the risk of infection and didn't always assess and manage risks for people presenting with mental health needs.

Meanwhile, the inspectors felt that 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.

However, they did add that staff felt confident raising issues when they arose.

Mr Storton said: "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.

Medical services

With regard to medical services, inspectors found seven breaches of regulation relating to person-centred care, consent, safe care and treatment, complaints, how the service is managed, staffing and duty of candour.

They say that leaders didn't always detect and control potential risks in the care environment, while staff reported delays for speech and language therapy (SALT) and dietician assessments which delayed people's care.

There were also issues with the aging building, some areas were unkempt and cluttered and fire safety wasn't always adhered to.

Furthermore, the service had poor compliance with Mental Capacity Act standards and inconsistent monitoring of sepsis and audit outcomes.

On a positive note, pharmacy professionals were visible on wards and attended ward rounds and team meetings to provide medicines advice and support, the report states.

"Ensuring people in medical services are cared for appropriately to prevent them getting pressure ulcers must be prioritised," said Mr Storton.

"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."

Maternity services

Maternity services were rated as good by inspectors, who praised the hospital's robust recruitment process, ensuring staff were suitably qualified, experienced and competent.

They say staff worked hard to meet women's needs and provide care that was safe, while ensuring equipment was clean, maintained, and electrical safety tests had been completed.

The report also notes that pregnant women had access to a 24-hour telephone triage service, and improvements had been made to this system since the last inspection.

Mr Storton added: "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."

You can read East Cheshire NHS Trust's response to the report here.