Warning notice issued to East Kent Hospitals Trust to make immediate improvements in three services

QEQM Hospital emergency department (Image WW Martin)

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].

 

20 Comments

  1. You built a new A & E Department, now you need to staff it properly, you can’t expect the same amount of staff to run a bigger A&E Department.

    • Have you been to the AE in recent times? It’s a whole world of weird , there are those who seem to use it as some sort of social hub, others that make regular visits to validate their disability claims, there’s currently a family that turns up every night with multiple kids demanding that one is seen for some reason or another, they create a fuss if not at front of the queue and are qucikly passified once they get a prescription of some sort. People turning up with seemingly their whole extended families and then the drunks/junkies and brawlers that turn up often with the police.
      The staff there have the patience of saints and people skills of the gods. The triage system means those that need immediate help get it , others that are just there for the fun of it have to wait.
      When i had the misfortune to be in there, having been seen within minutes and it been decided i was at no immediate risk, bloods were taken and i was told it’d be a long wait for the results. The circus that went on around me was a vision to behold.
      Regular stream of the grotesquely fat complaining of being out of breath or that their ankles/ knees /hips/ back hurt. One person recounding to anyone who’d listen about the failures of the nhs to cure their copd and that having stopped their 40 year 60 a day habit they felt they should be as good as new, no inkling of understanding that the damage was done long ago and not reversible, apparently they attended about 3 times a week.
      The nhs is being dragged down by too many who abuse it and expect to be instantly cured of self incurred health issues without of course dealing with the underlying issues.
      Without a wholesale change of attitiude nothing is going to change.
      At one time and maybe they still do, the ambulance service had someone who went round to those that a used the service to try and explain why their actions were unreasonable and find ways of altering that behaviour.
      A couple of years ago there was a person that had heart problems but drank red bull and vodka to excess every evening and would call 999 complaining of chest pains and breathing problems nigh on every night, the resources this one person used was considerable.

      • I was at the Urgent Treatment Centre about a year ago and got talking to a woman from another part of Kent who was clearly very unwell and had been experiencing nasty symptoms for many months without managing to get a diagnosis. She was found to have a potential pancreatic tumour and was whizzed off for explorative surgery. Given that waiting times and outcomes for people with pancreatic cancer are abysmal in this country I was really impressed by the speed with which things happened.
        I have been sent their a few times now after protesting to all & sundry that I simply need a GP appointment within a few weeks. But my GP practice isn’t really functioning due to lack of GPs. I apologise profusely at QEQM and suck up the fact that one has to, for example, take a urine sample back to the nurse you’ve just seen and plonk it on her desk in front of the next patient sitting there. However, unfortunately there has always been something wrong and QEQM’s rigorous approach in something like third-world conditions is laudable.
        Yep, many people are in a right mess, lifestyles have gone to hell in a handcart, people dying of malnutrition-related conditions used to be too thin but nowadays the same essentially happens to many who are obese. Easier to have sympathy for an emaciated person maybe? But chaos, despair and deprivation are behind many ‘poor choices’ and disease. And I hope to hell the staff at QEQM do not get a kicking, they are wonderful.

      • How could members of the public help for a couple of hours or more by getting water, tea , coffee to people waiting and the staff ?
        There must be lots we could do without nursing experience. Form filling could be done by helpers fetching and carrying also making sure the place was tidy, All this without getting in the way of staff and only doing what is asked of them.

  2. The inspection was in July.
    In December the CQC issues an “immediate” notice.
    Why the rush?

    Maybe if the NHS was properly funded, people wouldn’t be stuck in A&E for more than 24 hours.

    • You could give the NHS unlimited funding and they’d still say they need more!
      Too many pen pushers and wastefulness is a massive issue in the NHS and has been for year’s.

  3. Too busy creating something that looks like a scene from The Shining or an ‘Art Gallery’ to focus on patient care.

    Afraid it takes more than a new ‘safe pair of hands’ & a lick of paint to change things-the old deal of changing the hordings & a paint job to try to make people forget the failings, but the same old you know what. It should be in special measures & a new plan is needed.

  4. The trust is too big,it is badly run because they cannot recruit top quality staff.Dead wood and Dollops reign free because good staff are driven out or cannot be recruited.
    The regulator can regulate all they want but nothing will change.It requires restructuring and an understanding that parts of East Kent are deprived and have been for decades.Some of highly subjective comments on other A+E users merely reflects the deprived nature of parts of Thanet.
    As stated, some primary care services are non existent and the burden is thrown on A+E, with disasterous consequences, for all to see.

  5. “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”.
    Seems like we get what we deserve, according to CQC!

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