Chief Inspector of Hospitals publishes his findings on the services provided by Dartford and Gravesham NHS Trust at Darent Valley Hospital, Dartford

7 February 2014

England's Chief Inspector of Hospitals has published his first report on the services provided by Dartford and Gravesham NHS Trust at Darent Valley Hospital, in Dartford, Kent.

Overall, the report concludes that the majority of services at the hospital were good, and that the majority of patients spoken to were positive about their experiences. There was found to be an open culture where staff were positive, engaged and very loyal to the organisation. The staff and management were open and transparent about the challenges they faced, but there are areas where the trust needs to make improvements.

You can read the full report on the Darent Valley Hospital profile page.

A number of examples of good practice and examples of shared learning were found in the hospital, although in some cases the learning from serious incidents took up to 12 months to implement. The trust had taken action in some areas where staffing issues had been identified, including increased nursing staff levels on some wards, an increase in the number of porters in the pharmacy department and the recruitment of additional midwives.

Areas were identified where the trust was facing significant challenges, most notably in the Accident and Emergency (A&E) department. Emergency admissions had increased due to a reduction in other local services. While the trust was managing issues on a day by day basis they were not solving the key underlying problems, in particular bed management and capacity, and inappropriate attendance at A&E.

Also in A&E, there were insufficient numbers of nurses qualified in the care of children and a high use of locum middle grade doctors, which had the potential to impact on patients’ safety. Inspectors found that the acute assessment wards were mixed sex at times which could compromise patients’ dignity.

CQC has told the trust that it should take action to improve at Darent Valley Hospital in a number of areas including:

• Ensuring that the required number of staff with the correct skills are employed and managed shift by shift.
• Making sure that patients are treated with dignity and respect at all times, especially in the area of the operating department where patients are received.
• Respecting patients’ privacy and right to confidentiality at all times particularly in A&E.
• Ensuring that at all times patients are cared for in a safe environment that is designed to meet their needs.
• Ensuring that learning from the reporting of incidents is cascaded and that any changes to practice required following a serious incident are implemented in a timely manner.
• Taking action to ensure that good practice guidance is being considered and used in all areas, particularly A&E.

CQC also found good practice in a number of areas, including:

• An integrated discharge team had been introduced to help with the safe, effective and timely discharge of patients.
• The number of midwives had been increased and improvements had been made to the environment in the maternity unit.
• The hospital’s bed management meetings were multidisciplinary and included executive team members and ward sisters.
• End of life care provided at the hospital was safe, effective, caring, responsive and well led.
• There was a positive approach to managing the needs of people with dementia.
• A code of conduct for nursing assistants had been developed and launched in the trust.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent two days announced at the hospital during December. They examined the care provided in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients.

Inspectors also visited the hospital 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.

CQC’s Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: “We found that most of the services at Darent Valley Hospital were good. The majority of patients told my team that they were happy with the care and treatment that they had received, and we identified a number of examples of good practice. Overall, we found a culture where staff were positive, engaged and very loyal to the organisation, and the staff and management at the hospital were open and transparent about the challenges they faced.

“We did, however, find a number of fairly basic areas in which the trust needed to improve. We’d expect people’s privacy and dignity to be respected at all times, and for people to always be cared for in an environment that is designed to meet their needs, by an appropriate number of staff.

“We acknowledge that the trust faces big challenges in its A&E department, and that finding a solution to these challenges is going to involve a joined up approach by the wider health economy. We hope the necessary steps will be taken to deliver a better service to local people.”

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

CQC inspectors will return to Darent Valley Hospital in due course to follow up on the findings of this inspection and to report on the trust’s progress in making required improvements.

-ENDS-

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike is implementing his new approach to hospital inspection with 18 NHS trusts which represent variation of care across England. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.

Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?