Chief Inspector of Hospitals finds that Kent and Medway NHS and Social Care Partnership Trust requires improvement

England’s Chief Inspector of Hospitals has told Kent and Medway NHS and Social Care Partnership Trust that it must improve the quality of some of its services following an inspection by the Care Quality Commission.

Overall the trust has been rated as requiring improvement. The majority of staff were caring, compassionate and treated people with dignity and respect and although the trust provided some good and some outstanding services, improvements were needed for services to be consistently safe, effective, well led and responsive.
Kent and Medway NHS and Social Care Partnership Trust provides health and social care, including mental health and other specialist services, to 1.7 million people. More than half of the trust’s services are provided in the community, in people’s homes, clinics and schools. The trust also has specialist inpatient services for people needing intensive treatment.

During the inspection in March a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited 37of the trust’s hospital wards and several of its community services, spoke to over 219 patients, relatives and carers and interviewed 329 members of staff. Full reports on all core services are available at http://www.cqc.org.uk/provider/RXY

Following the inspection, CQC issued two warning notices requiring the trust to make urgent improvements in the older persons’ continuing care ward at Littlestone Lodge at Dartford. Inspectors said the trust had been failing to assess and monitor the service, or ensure that the welfare and safety needs of people were properly met.

At Littlestone Lodge, inspectors identified poor practice and unsafe care, including the unsafe, covert administration of medicine.  Patients were not receiving effective assessment and care for physical health and mobility needs or pain management, and all patients were wearing incontinence pads whether or not they were needed. At the time of the inspection, the inspectors requested that immediate action was taken to address the physical health needs of two patients.

A team of inspectors subsequently returned to check that the required improvements had been made. They found the service had made many improvements and as such had met the requirements of the warning notice.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), said:

“Kent and Medway NHS and Social Care Partnership Trust provides a range of essential services to the people of Kent. Our inspection found that there was great variation in the quality of those services.

“Some of the care environments were not safe enough. We found seclusion rooms that were too small, and designated health based places of safety (section 136 suites) that were not fit for the purpose for which they were being used.

“Bed occupancy levels of the wards that admitted people of working age who have mental health problems were very high. There were delays in finding beds in a psychiatric intensive care unit beds for patients who needed that level of care. There had been at least three occasions where patients were nursed in the section 136 suite or in a quiet room; with one patient having to sleep on a beanbag because no bed was available.

“We were particularly concerned about what we found at Littlestone Lodge. We believe that the managers of the trust should have taken more decisive action sooner to tackle the problems.“On the other hand, it is a credit to all the staff employed by the trust that we have rated the trust as ‘good’ overall for staff being caring.  In fact we rated the forensic service and the wards for people with learning disabilities wards as outstanding in how caring their staff were. We also rated the forensic services ‘outstanding’ overall. In all clinical areas we found staff who were compassionate and passionate about delivering good care to patients.

“The trust had worked hard to reduce its vacancy rate but there was still a high use of agency and bank staff. The trust was also actively trying to improve staff morale.

“Inspectors found that the quality of care plans varied from ward to ward. In many areas care plans were not detailed or specific to patients’ needs and often did not demonstrate how people were involved in their care, particularly on older persons, inpatient, community and acute inpatient wards.

“The dignity and privacy of the patients were not always protected due to failure to meet guidance on same sex accommodation. These issues were most prominent in acute inpatient , rehabilitation  and older people’s wards, although there were clear plans in some areas to rectify these issues.

“The governance and monitoring processes in place were not identifying risks to patients’ care and incidents were not always reported. Where governance processes had identified areas of improvement at ward and trust level, the response was not always robust enough or timely.

” The trust was actively trying to reduce its use of prone restraint – which can put patients at risk. Despite a reduction of 20% in 2014, prone restraint was still used 294 times over the year – although this was found to be lower than in some similar trusts.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. We will return in due course to check that the improvements that we have identified have been made”.

The Care Quality Commission has identified a number of areas for improvement, including:

•  the trust must ensure the protection of patients and staff against the risks associated with unsafe or unsuitable premises, namely all seclusion rooms on three of the wards in the forensic service line.
• the trust must ensure that the storage and recording of medication, including self-administration processes, is safe and secure and must ensure that staff follow its policies for the safe management and administration of medicines
• the trust must protect patients against the risks associated with the unsafe use and management of medicines on Penshurst ward by ensuring patients and others do not have access to both the stock medicine cupboard and the mobile medicine trolley

The reports highlight several areas of outstanding practice including:

• the trust provides a ‘carer support worker’ service which offered advice, support and general non specific information to any person who provided unpaid care.
• there was an excellent and robust psychology department that provided an innovative and individualised treatment programme tailored to patients’ needs.
• staff respected patients’ diversity and human rights. The Brookfield Centre had information such as ward activities and food menus displayed in English and Slovakian to support patients’ language needs.
• there was a transitional living ward which was a self-contained flat with its own bedroom, living area to assist patients become independent.

The reports which CQC publishes today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

On Friday 24 July the Care Quality Commission presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team’s findings.

Kent and Medway NHS and Social Care Partnership Trust requires improvement