England’s Chief Inspector of Hospitals has welcomed improvements at Medway NHS Foundation Trust following an inspection by the Care Quality Commission.
A team of inspectors from the Care Quality Commission visited Medway Maritime Hospital in April 2018 to check the quality of six core services: emergency and urgent care, medicine (including older persons care), surgery, critical care, outpatients and diagnostic imaging. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
Inspectors have some found improvements, although there are still some areas where further improvements are required to ensure that patients receive consistently safe care.
Overall the trust remains rated as Requires Improvement for the quality of its services.
The trust is also rated as Requires Improvement for whether its services were safe, responsive and well-led. The trust is rated as Good for whether its services were effective and caring.
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Inadequate for using its resources productively.
Deputy Chief Inspector of Hospitals, Amanda Stanford, said:
“Medway NHS Foundation Trust has come a long way in the last five years and I am pleased to see that the team has implemented a number of changes since our last inspection in 2016. However, there is still a lot more work to be done particularly in ensuring a culture of safety exists across the whole of the trust.
“We found that the senior leadership team had the ability to ensure improvements could be delivered and to address any risks to performance.
“Having driven some real improvement it has taken some time to identify the next step. The board now need to concentrate on the strategic direction of the trust and allow staff to continue to embed the operational improvements
“We will return in due course to check their progress.”
Urgent and emergency care services have again been rated as Requires Improvement. The trust was still not meeting national requirements for consultant cover. There was still poor patient flow through the department and this affected patient capacity. This meant patients may wait for several hours in the majors waiting area. Patients experienced significant delays whilst awaiting specialist review or to be placed in a bed on a ward.
Staff described the culture within the service as open and transparent. Staff felt they could raise concerns and were listened to. Leaders were found to be visible and approachable
Inspectors found significant challenges remained in surgery particularly in retaining nursing staff. There were not enough nurses and clinical support staff to provide safe care and treatment within surgery. However, risk assessments were completed with full and correct processes around the management of medicines and were in line with trust policy.
Within diagnostic imaging or radiology, inspectors found there was no clear strategy for achieving priorities and delivering good quality, sustainable care. There were key vacancies in the department. The information systems in place did not allow for the monitoring of demand and capacity. This affected their ability to manage access and flow of patients within the department.
Inspectors rated medical care as Good with a new clear organisational structure promoting a positive culture that supported and valued staff. Staff reported they were encouraged to raise concerns and received feedback on their performance, speaking in positive terms about the team working with medical and specialist support to provide care.
In critical care, people’s needs and preferences were taken into account when delivering and organising services. These included coordinating care with other services as well as families and carers. But, there was a lack of middle management stability and there were concerns over key staff leaving the service.
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Medway NHS Foundation Trust has come a long way in the last five years
Amanda Stanford, Deputy Chief Inspector of Hospitals