England’s Chief Inspector of Hospitals has recommended that Medway NHS Foundation Trust in Kent should exit special measures following an inspection by the Care Quality Commission.
Inspectors have found significant improvements at Medway Maritime Hospital – although there are still areas where further improvements are required to ensure that patients receive consistently safe care.
The trust had originally been placed into special measures in July 2013 following Sir Bruce Keogh’s review of hospitals with higher than average mortality rates. Subsequent inspections had given the trust an overall rating of Inadequate.
Following the latest inspection carried out over five days during November and December the chief inspector, Professor Sir Mike Richards, has informed NHS Improvement that he believes the trust has made enough progress to come out of special measures. The overall trust rating is now Requires Improvement.
CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“I am very pleased to report that since our last inspection we have found good evidence that the trust is making steady progress."
“Two years ago, we rated the trust as Inadequate overall because of concerns relating to patient safety, the organisational culture and governance throughout the trust. Since that time we have been keeping a close watch, with support from the local clinical commissioning groups and NHS Improvement."
“I have no doubt that the additional support from Guys' and St Thomas' NHS Foundation Trust has helped the trust to address the shortcomings that have been identified, but much of the credit must go to the new leadership team at the Medway Hospital and to the commitment and hard work of the staff."
“There is no doubt that substantial improvements have been made. The leadership team is now fully established and there is a strong sense of forward momentum. That strong leadership and clear communication are leading to a workforce who are now much better engaged and whose morale is now much higher."
“There are a number of areas where we have identified poor practice and that require attention. We will return later this year to check: I will be disappointed if we find that the trust has not continued to make further progress.”
Full reports including the latest ratings are available on our website.
Inspectors found that all of the core services had made improvement. The executive team, although fairly new, was performing as an effective unit with a shared vision and clarity of purpose. Staff spoke of a significantly better organisational culture.
There had been improvements made to the triaging and management of patients in the emergency department. Patients were no longer treated in a corridor. The handovers and safety briefings in the Emergency Department were effective and ensured staff managed risks to people.
A programme of training, along with enhanced risk assessment tools had led to an improved incident reporting culture. The trust had significantly improved its mortality rate and is no longer an outlier for the hospital standardised mortality rate.
Support to vulnerable patients such as those living with dementia and those with learning disabilities had been significantly improved. New pathways and services had been introduced to deliver enhanced care for patients.
Although assessment of risks to emergency patients Safety had improved there were still concerns over staffing levels in the emergency care and maternity departments.
The inspection has identified a number of areas for further improvements including:
The trust must ensure that all staff have appropriate mandatory training, and receive an annual appraisal.
The trust must ensure fire safety is a priority. Although the trust has taken steps to make improvements some areas were found where fire safety and staff understanding needed to be improved.
The trust must ensure people using services should not have to share sleeping accommodation with others of the opposite sex. All staff must be trained to have an understanding of the regulation regarding same sex accommodation.
The trust must ensure clinical areas are maintained in a clean and hygienic state, and the monitoring of cleaning standards falls in line with national guidance. The trust must take action to ensure emergency equipment (including drugs) are appropriately checked and maintained.
The Care Quality Commission will present 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 will return in due course to check that further improvements have been made.
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I am very pleased to report that since our last inspection we have found good evidence that the trust is making steady progress
CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards