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13 August 2014, 06:00
The Chief Inspector of Hospitals has rated East Kent Hospitals University NHS Foundation Trust as Inadequate and recommended it be placed into special measures
This is the statement from the Care Quality Commission
England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has recommended that East Kent Hospitals University NHS Foundation Trust be placed into special measures following a Care Quality Commission inspection.
The recommendation follows the publication of his first report on the quality of care provided by the trust, which inspectors rated Inadequate. Services at the trust were rated as Inadequate for safety and leadership, and as Requires Improvement for effectiveness and responsiveness. Caring was rated as Good.
Overall, inspectors found that there was a worrying disconnect between those running the trust and frontline staff. A recent staff survey had flagged long standing cultural issues, such as bullying and harassment, and a number of staff came forward to raise serious concerns with CQC about the culture of the trust and the care being delivered. The number of staff who would recommend the trust as a place to work or be treated fell significantly below the England average.
Risks to patients were not always identified, and where they were, were not always acted on by the trust. A number of clinical services across the trust were poorly led, and there were concerns about staffing levels in a number of areas, especially in A&E, in children's care, and at night. Poorly maintained buildings and equipment were identified in a number of areas.
Audits were, at times, ineffective and providing false assurance to the leadership team. While an incident reporting system was in place, usage of the system varied. Patient safety incidents were not always identified and reported.
Inspectors visited William Harvey Hospital, Ashford, Kent and Canterbury Hospital, Canterbury, and Queen Elizabeth the Queen Mother Hospital, Margate, in March. The full reports on the hospital and the wider trust are available from: http://www.cqc.org.uk/provider/RVV.
Inspectors rated William Harvey Hospital as Inadequate for Accident and Emergency (A&E), surgery, and children?s care. The hospital was rated as Requires Improvement for medical care, maternity and family planning, end of life care and outpatient services. Intensive and critical care was rated as Good. The hospital was rated as Inadequate overall.
Inspectors found that staff at William Harvey Hospital were caring and responsive to people's needs, but that there were not always enough appropriately skilled staff on duty to make sure that people got the care they needed.
Records of waiting times in A&E at William Harvey Hospital did not accurately reflect how long people had waited to be seen. Children's care needs were not always appropriately met at the hospital. Some outpatient clinics were routinely overbooked, which led to long waiting times, and follow up appointments were often cancelled and rescheduled leading to delays.
CQC told the trust that it must take action in a number of areas at William Harvey Hospital, including ensuring that:
- There are always enough suitably skilled staff on duty to meet people?s care needs in a timely way, including appropriately trained paediatric staff in all areas of the hospital where children are treated.
- The patient environment is clean, well maintained and fit for purpose, and equipment is well maintained and available when needed.
- Staff are better informed of end of life care arrangements, and provision of end of life care is reviewed to ensure a consistent approach.
Kent and Canterbury Hospital was also rated as Inadequate overall by inspectors. Surgery at the hospital was rated as Inadequate, while critical care was rated as Good. Emergency care, medical care, children's care, end of life care and outpatient services were all rated as Requires Improvement.
Inspectors found that staffing levels were also a problem at Kent and Canterbury Hospital, especially with regard to appropriately trained paediatric staff in non-child specialist areas.
Inspectors saw an example of good practice in the critical care unit, where patient diaries were used to support patients with memory loss or poor recollection. Patients who were being cared for on medical wards gave positive feedback about the care that they were receiving.
CQC told the trust that it must take action in a number of areas at Kent and Canterbury Hospital, including ensuring that:
- There is an identified lead at board level who takes responsibility for services for children and young people.
- Adequate administrative support is made available in outpatient services, and the risks to patients using these services due to delays and cancellations is properly assessed and mitigated.
- Arrangements for end of life care are clarified to staff to ensure that the patient is protected against the risk of receiving inappropriate care.
Inspectors rated Queen Elizabeth the Queen Mother Hospital (QEQM) as Requires Improvement overall. A&E was rated as Inadequate, while critical care was rated as Good. Medical care, surgery, maternity and family planning, children's care, end of life care and outpatient services were all rated as Requires Improvement.
CQC identified issues with staffing levels in A&E at QEQM. The department was very reliant on temporary staff which was creating a risk to patient safety. Many patients were experiencing delays in leaving hospital due to delays in their medication being ready. Patients attending pre-assessments before undergoing surgery were experiencing long waits.
The hospital was poorly led, and services for children and young people were not effective. Inspectors were told by staff at QEQM that they were reluctant to take part in staff surveys because they believed that their response would not be confidential and there would be adverse consequences for making negative comments.
Inspectors saw that staff were caring, and that practice had been changed in maternity services, and was being changed in outpatient services, as a result of learning from patient incidents.
CQC told the trust that it must take action in a number of areas at QEQM, including ensuring that:
- Safety is made a priority in A&E.
- Discharge planning and flow through the hospital is responsive to people?s needs.
- Patients are not subject to unnecessary delays for outpatient appointments, either to get an appointment or when waiting in the department.
CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
"When we inspected all three hospitals run by East Kent Hospitals University NHS Foundation Trust, we were extremely concerned at the disconnect we identified between the senior team and the staff working on the frontline. We saw ineffective leadership in action across a number of clinical services, and that the board was at times receiving false assurance through governance procedures.
"It is a lack of effective leadership, alongside care failings across the majority of services we inspected, which has led me to recommend to the foundation trust regulator Monitor that the trust be placed in special measures. This will allow the trust to receive the additional support that I believe it needs to deliver safe, caring, effective and responsive services to the local populations it serves.
"We, alongside our partners in the wider healthcare system, will continue to keep a close eye on the trust and will inspect again in due course to assess whether or not adequate progress is being made."
An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts made announced visits to sites run by the trust in March.
Inspectors also visited the sites unannounced as part of the inspection, held focus groups with staff, and held a public listening event. The report which CQC publishes today is based on a combination of their findings, information from CQC's Intelligent Monitoring system, and information provided by patients, the public and other organisations.
CQC inspectors will return to the hospital in due course to check that the required improvements have been made.