The Care Quality Commission (CQC) has issued a warning notice to East Kent Hospitals University NHS Foundation Trust saying it must make immediate improvements in three services following an inspection in July.
CQC carried out an unannounced focused inspection of the trust’s urgent and emergency department (ED), medical care (including older people’s services) and children and young people services at the Queen Elizabeth the Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford. Inspectors also looked at the management and leadership of the trust overall.
The inspection was undertaken as part of continual checks on the safety and quality of healthcare services and to check on the progress of improvements the trust was told to make at a previous inspection.
At Queen Elizabeth the Queen Mother Hospital:
Children and young people the overall rating improved from requires improvement to good as have the ratings for how effective and responsive the service is.
How well-led the service is has dropped from good to requires improvement. Safe and caring have again been rated as good.
Medical care dropped overall from good to requires improvement as have the ratings for how responsive and well-led the service is. The safety of medical care has again been rated as requires improvement and how effective and caring services are remain rated as good.
Urgent and emergency care in both services were inspected but not rated and remain as requires improvement overall from previous inspections.
The inspection highlighted a palliative care pilot at QEQM’s Sandwich Bay ward as an example of outstanding care.
Urgent and emergency care
The inspection at the QEQM found that in urgent and emergency care an effective handover process for people who had been in the emergency department for more than 24 hours was not in place. This led to a delay in treatment and lack of continuity of care for some people.
Inspectors found staff did not always have an effective oversight of people for their time in the department and people were not always treated with dignity and respect. This included during medical and clinical assessments when in overcrowded areas.
However, the CQC says the needs of local people were met and it was easy for people to give feedback. They also found staff treated people with compassion and kindness.
Medical care
In medical care the inspection found there were not always enough staff to care for people. Staff did not always make sure equipment, such as resuscitation trolleys, were checked regularly and accurately and were safe to use.
Near misses or potential harm were not always reported and staff did not always ensure they followed their Standard Operating Procedure when placing people in escalation areas.
However, staff understood how to protect people from abuse, treated people with compassion and kindness and it was noted that one ward had a double room for couples who could be cared for together.
Children and young people
In services for children and young people inspectors found they were receiving good care and treatment with enough to eat and drink and access to pain relief when they needed it.
Children and young people were treated with compassion and kindness. Their privacy and dignity was respected and staff took account of their individual needs
Key services such as education facilities, paediatric physiotherapy were not available seven days a week and there were not always enough medical staff to care for children and young people and keep them safe.
The service did not always have reliable information systems to help manage risk.
Outstanding palliative care
Inspectors did highlight a palliative care pilot at QEQM’s Sandwich Bay ward as an example of outstanding care.
The project created five cubicles for palliative and end-of-life patients, with specialist training for nursing staff. It opened in February this year.
Patients receive daily input from the palliative care team and have open access for visitors. The scheme proved so successful it is now being expanded to Ashford
Consultant nurse Lucie Rudd said: “We have been so impressed by the commitment of the team on Sandwich Bay to this pilot, so it was not a surprise that their dedication and compassion was highlighted by the CQC team.
“This project has shown that end-of-life and palliative care can sit with the wider clinical team, and every one of us can play a part in supporting our patients and their families.
“While we can support with planning the care needs and symptom management for the last days and weeks of life, the day-to-day care is about kindness and understanding, and that is something the Sandwich Bay team have by the bucketload.
“I hope this recognition will give them a boost, and inspire the teams at WHH who are now preparing to launch their own palliative care beds.”
William Harvey Hospital
At the William Harvey Hospital in Ashford children and young people has again been rated as requires improvement as have the ratings for effective and responsive. However safe and caring remain rated as good and well-led has dropped from good to requires improvement.
Medical care has again been rated as requires improvement overall as have the ratings for how responsive and safe the service is. Caring and well-led have dropped from good to requires improvement. The rating for how effective the service is remains as good.
The overall rating for the trust stays as requires improvement.
Warning notice
Neil Cox, CQC deputy director of operations south, said: “During our inspection of East Kent Hospitals University NHS Foundation Trust, we were aware there had been several changes in membership of the board over recent years, which had made it difficult for the trust to adopt and take forward previous plans that had been in place. We saw this reflected in the differences we found between services and hospitals, and the leadership in some services.
“We found that while leaders understood the priorities and issues the trust had, they didn’t always take the appropriate action needed to resolve them. Some executives were visible and approachable in the service, but most staff we spoke to also told us of a disconnect between the board and frontline staff.
“Staff told us there was a lack of trust-wide ownership of the pressures faced by the emergency department. Speciality teams didn’t always collaborate effectively with the emergency department teams. This caused problems with the flow of people coming in and out of the department. This meant people sometimes waited too long to receive treatment. We saw there was a plan in place to manage the overcrowding, but the implementation wasn’t as effective as it could have been.
“We have issued a warning notice to ensure the trust concentrates on the areas where we have concerns and will return to check that the required improvements have been made. If further improvements are not implemented and embedded, we will not hesitate to take further action to ensure we are confident people are receiving the safe, consistent care they deserve.”
Improving services
Tracey Fletcher, Chief Executive, East Kent Hospitals, said: “We are working hard to improve services across East Kent Hospitals and I want to thank our staff for their commitment during what has been a period of significant change.
“We welcome the CQC’s report, which highlights a number of issues that we have been working hard to address. There is and will continue to be, a strong focus on the work required to put the Trust on a more sustainable footing. We are building a substantive leadership team and are embedding an organisational structure designed to ensure staff and services have the stability and the right level of support to meet the needs of our local population going forward.
“Since these inspections in May and July, we have improved how we work across the hospitals to support our emergency departments and the safety and experience of our patients. The building programmes at our emergency departments, which have extended and reconfigured both departments to provide better facilities, have also progressed and are near completion.
“While improvements have been made, there is more for us to do and we must ensure that positive changes are truly sustained. At the same time, it is important that we recognise the excellent examples of care in our Trust, some of which have been described as outstanding practice by the CQC today.
“I would like to assure our local communities that we are fully committed to delivering improvements for patients and demonstrating further progress to the CQC next time they visit.”
The last phase of the Queen Elizabeth The Queen Mother Hospital emergency department is due to complete in early 2024, which will mean an increase in capacity of 7 care spaces.
The reports are due to be published on the website today [December 20].
