CQC rates Medway NHS Foundation Trust as Inadequate and recommends trust remains in special measures

England’s Chief Inspector of Hospitals has recommended that Medway NHS Foundation Trust should remain in special measures following its latest inspection by the Care Quality Commission.

Inspectors found the trust still needed to make significant improvements to ensure it was consistently delivering care which was safe, effective, caring, and responsive to people’s needs. Overall the trust has been rated as Inadequate. At the time of the inspection in August and September the Chief Inspector of Hospitals, Professor Sir Mike Richards raised his immediate concerns about standards of patient safety in the accident and emergency department with the trust, NHS England and local commissioners.

CQC found that at the busiest times, the Emergency Department was not able to cope with the numbers of patients attending. People in need of treatment were waiting too long to see a doctor, or were being left unattended while they waited.

Following that intervention, the trust and commissioners took action to ensure that there were more staff on duty and patient flow throughout the Emergency department was more effective

The latest report also highlights continuing concerns with medical care, surgery and outpatient and diagnostic services which were also rated Inadequate. Full reports and ratings for all core services are available at http://www.cqc.org.uk/provider/RPA
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Professor Sir Mike Richards, the Chief Inspector of Hospitals, said:

“Since September we have made sure that we have been kept fully aware of all action taken by local clinical commissioning groups, local authorities and NHS England to ensure that the trust’s urgent and emergency services can deliver safe, effective, compassionate and high quality care, and we are continuing to work closely with all agencies.

“While those immediate safety matters have been dealt with for the time being, I am not satisfied that the underlying issues throughout the trust have been resolved. It is disappointing to report that performance may even have deteriorated in some areas, despite the support which has been offered to the trust up until now.

“Once again we have rated Medway NHS Foundation Trust as Inadequate for safety, responsiveness and being well-led. This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve.

“It is our shared view with Monitor that this situation must not be allowed to continue. It is clear that the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future.

“We are now considering, along with partner agencies, the best option available in order to improve services rapidly for the local population. In these circumstances, it would be inappropriate to recommend that the trust leave special measures.”

The trust had originally been placed into special measures by Sir Bruce Keogh in July 2013 because of concerns about mortality rates and standards of care.

After further inspections by CQC in 2014, the chief inspector of hospitals, Sir Mike Richards recommended that the trust should remain in special measures.

During the latest inspection, inspectors found that although there had been some improvement since 2014, staffing levels across the hospital were still found to be too low to meet people’s needs. The trust remained heavily reliant on the good will of staff to undertake extra shifts and temporary agency and bank staff to ease the pressures.

On the medical wards, clinical areas were not clean and hygienic and some needed refurbishment. Not all staff were completing their mandatory training and there were shortfalls in nurse staffing levels. Patients were frequently treated in mixed-sex wards, or were not discharged when they were ready to leave hospital.

Inspectors were concerned at how the trust managed and responded to incidents. Not all staff had access to the system for reporting incidents. There was no evidence to suggest that lessons had been learned following a never event.

The trust was consistently not meeting their two-week targets for patients suspected with cancer and there were delays in patients getting scans, which meant they had to wait too long for treatment.

At board level, inspectors questioned the ability of the board to drive the level of improvement required or to hold the leadership to account, especially in relation to concerns about quality, safety and specifically the longstanding poor mortality rates.. The vision and values of the organisation were not well developed or understood by staff and some staff, including members of the executive team, reported feeling bullied.

Inspectors found that despite the overall findings, across the trust, the staff provided compassionate care in almost all their interactions with people in their care. Patients spoke positively about the staff and said that they considered that their privacy and dignity had been maintained in most cases.

CQC has told the trust it must make improvements in 31 areas, including:
Patient flow must be improved. This must be achieved without impacting other services provided within the departments and have a risk balanced approach so not to impede on other services delivered
The environment within the emergency department must be reviewed to meet patient demand effectively.
The trust must ensure that patients leaving the critical care unit are discharged within four hours to improve the access and flow of patients.
The two week cancer pathways for each speciality must be reviewed, with clinical oversight of those patients waiting in order to lessen the risks to those patients.
The quality of the senior leadership must be reviewed to ensure efficient, supportive and quality leadership.
The trust must manage allegations of bullying and whistleblowing, and performance management in line with agreed policies.

The Care Quality Commission will present 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