The emergency department at the Queen Elizabeth The Queen Mother Hospital in Margate remains graded as ‘requires improvement’ following an inspection by the Care Quality Commission.
Inspections at QEQM and at William Harvey Hospital in Ashford took place on March 3-4.
At QEQM inspectors concluded the service still requires improvement but rated it as ‘good’ for being well-led and ‘good’ for caring.
William Harvey Hospital was rated as ‘good’ for caring, but requires improvement for being safe, effective, responsive, and well-led.
The CQC issued two requirement notices, relating to mandatory training, reducing the unplanned reattendance rate and waiting times, and monitoring improvements on patient outcomes.
East Kent Hospitals Trust, which is responsible for both sites, has been told areas that require improvement include the need to improve waiting times, ensure all staff complete training and improve the way medication is prescribed and reviewed.
The Trust has taken immediate action to address these issues, including reviewing pharmacy support in the emergency department, and providing more training. There is now a pharmacy team dedicated to supporting the emergency floor.
At QEQM, inspectors found “staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs”, “supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment” and focused on the needs of patients receiving care.
The report also found staff kept detailed records of patients’ care and treatment, swiftly completed risk assessments, and acted on their findings quickly. They acted on and shared learning from incidents and complaints. Staff had the right mix of skills and experience and more staff had been recruited.
They said “leaders understood and managed the priorities and issues the service faced”, and staff “felt respected, supported and valued. They were focused on the needs of patients receiving care.”
East Kent Hospitals’ chief executive Susan Acott said: “Staff in the emergency department have worked hard to improve and that work was recognised by the CQC.
“We fully accept that we still have a lot of work to do to achieve the consistently high standards we want for all our patients in this very complex service.
“We recognise the improvements the CQC requires us to make, and we will continue to implement changes to the emergency department to enable staff to provide the highest standards of care.”
Inspectors identified having mental health support workers on every shift to care for patients with mental health needs as outstanding practice during their visit.
Their report also praised the way doctors, nurses and other healthcare professionals worked together for the good of patients, and noted the compassionate way all staff dealt with patients, including porters and receptionists.
The report added: “We observed episodes of care during which patients were truly respected and valued as individuals.
“Patients were empowered as partners in their care both practically and emotionally. This was especially the case for those patients who presented with mental health conditions or those patients who were recognised as vulnerable.”
CQC’s Deputy Chief Inspector of Hospitals, Dr Nigel Acheson, said: “During our inspection of East Kent Hospitals University NHS Foundation Trust, we found a number of improvements at Queen Elizabeth the Queen Mother Hospital.
“Staff at QEQM understood the service’s vision and values, and how to apply them in their work. They felt respected and valued and were focused on the needs of patients receiving care and were committed to improving services continually. The service was engaging well with patients and the community to plan and manage services.
“However, at William Harvey Hospital our main concerns surrounded staffing and safety in the department. Despite staff treating patients with compassion we found that there were not always enough qualified staff on duty, this had an impact on the quality and safety of care of patients within in the department.
“The service did not always plan care to meet the needs of local people or take account of patients’ individual needs and patients found it hard to give feedback on care. People could not always access the service when they needed it and did sometimes have to wait too long for treatment. Staff did not always provide patients with pain relief when they needed it.”
“But, our inspectors also found that mental health support provisioned by the trust through both services had improved, as had their paediatric emergency department services from our last visit.
“We fed our findings back to the trust following our inspection so that it can make the necessary improvements. We will return to check that those improvements have been made at a later date”.
County councillor Karen Constantine, who is a member of the health scrutiny panel, said: “I am regularly contacted by residents about issues at the emergency department. Last year I wrote to Susan Acott MD to raise some concerns about the waiting area being over full and the long waits that people were experiencing. I received a response which said there had been a 7% increase in the number of attendees. I was also told of staffing shortages of nurses at QEQM.
Full details of CQC’s inspection findings for QEQM can be found at: https://www.cqc.org.uk/location/RVV09