Medway:NHS Trust Rated Inadequate Again

The Chief Inspector of Hospitals, Professor Sir Mike Richards, has recommended that Medway NHS Foundation Trust remains in special measures until urgent improvements are made at Medway Maritime Hospital.

The recommendation follows the publication of his first report on the quality of care provided by the trust, which was found to be inadequate. NHS regulator Monitor put the trust into special measures in July last year following Sir Bruce Keogh’s report into concerns around mortality rates and standards of care.

At the CQC inspection in April, inspectors rated Accident and Emergency (A&E) and surgery at the hospital as Inadequate, while medical care, maternity, end of life care and outpatients were rated Requires Improvement. Critical care and children’s care were rated Good. 

Overall, CQC rated the hospital Inadequate, as it did the wider trust after it was rated Inadequate for safety, responsiveness and leadership.

Inspectors found that insufficient progress had been made in A&E since the last inspection there, although there had been significant improvements in maternity since that had last been inspected. Patient flow through the hospital was inefficient, both in terms of delayed admissions from A&E and lack of proactive discharge.

There were too few nurses and junior doctors on duty. Despite recent recruitment, there was a reliance on agency and locum staff, especially out of hours. Consultants were not providing a seven-day service.

Levels of mandatory training were too low, and too few staff knew about the availability of training. Data quality throughout the hospital was poor, which resulted in the trust board taking assurance from data that was inconsistent and, at times, unreliable. Governance processes were not robust or standardised.

CQC has told the trust that it needs to make urgent improvements in a number of other areas including ensuring that:
• It continues to actively monitor trends in its mortality rates.
• Initial assessments of all patients (including children) are in line with national standards, and that there are enough nurses with paediatric expertise in A&E.
• All equipment is in date and checked consistently, and that all wards are fully equipped to meet people’s needs.

Inspectors also found some areas of good practice, including:
• The Oliver Fisher Neonatal Intensive Care Unit.
• The improvements made by the maternity team since the last CQC inspection.
• A staff awards scheme which had been introduced to enable patients and visitors to tell the trust about staff who had delivered outstanding care.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: "Despite some areas of development, notably in maternity and children’s care, overall Medway NHS Foundation Trust has made inadequate progress in the past year for me to recommend that it should leave special measures at this time.

"People deserve to be treated in services which are safe, compassionate, effective, and responsive to their needs. We will continue to monitor the trust closely and will inspect again as soon as we are able to assess whether or not adequate progress is being made. At that stage, I will be in a position to advise Monitor again on whether the trust is ready to leave special measures or whether further action is needed."

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 April. 

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.

Medway NHS Foundation Trust has reacted to the report, calling it a 'balanced and fair reflection of where we are with our improvement journey, and is entirely consistent with what the Board had expected'.
In a statement, Steve Harris. the Trust's Chief Nurse said: "Since the Keogh review last year, significant progress has and is being made in a number of areas to improve patient safety and experience. Forty-one of the 50 improvement actions in the Trust's Keogh plan have been delivered, in addition we have 160 more nurses caring for our patients than we did 12 months ago, however there is still more to be done.
"The Board agreed earlier this year to focus on five priorities, around improving basic standards, patient flow, recruitment, control and clinical leadership, all of which align with the concerns highlighted in today's report and work is already underway in each area. We have also implemented some urgent actions in response to the concerns raised by the CQC, which include improving staffing levels in emergency care and increasing the size of our short stay Acute Medical Unit, alleviating congestion in the emergency department."