Maidstone and Tunbridge Wells NHS Trust rated as Requires Improvement overall by Chief Inspector of Hospitals

England's Chief Inspector of Hospitals has rated the services provided by Maidstone and Tunbridge Wells NHS Trust as Requires Improvement overall following an inspection by the Care Quality Commission in October.

Overall, the trust's services were rated as Good for being caring, but as Requires Improvement for being safe, effective and responsive and as Inadequate for being well led.

A full report from the inspection, including ratings for all core services provided at Maidstone Hospital and the Tunbridge Wells Hospital at Pembury is available here.

CQC found that leadership within the trust was not robust, and that neither governance processes nor the culture within the trust could ensure that services would be of high quality.

Inspectors found that staff were caring and compassionate, and that they treated patients with dignity and respect. Both hospitals were visibly clean, with falling infection rates. Patients considered that they had been given sufficient information and counselling to enable them to make informed decisions about their care and treatment.

Inspectors also found, however, that patient flow across the trust was poor. Patients deemed fit to be discharged from intensive care units frequently experienced significant delays in being transferred to a ward and scheduled operations were cancelled due to a lack of available beds. Medicines management needed to be improved in some areas, and patient records were not always stored securely, well organised or accessible.

While levels of nursing staff were generally good, medical cover in the Intensive Care Unit was not consistent with national core standards and created a risk to patients. There were insufficient numbers of single rooms at Maidstone hospital to meet people's needs. This impacted on the privacy and dignity of patients, especially those who were on an end of life pathway.

CQC also rated each hospital run by the trust individually.

Maidstone Hospital was rated Requires Improvement overall. It was rated as Good by inspectors for maternity and gynaecology, Requires Improvement for urgent care, medical care, surgery, children’s care, end of life care and outpatient services, and Inadequate for critical care.

The Tunbridge Wells Hospital at Pembury was also rated as Requires Improvement overall by inspectors. CQC rated all the core services provided at the hospital as Requires Improvement apart from critical care, which was rated as Inadequate.

The full reports on the trust and on each hospital are available here.

CQC identified a number of areas where the trust must make improvements, including:

• There must be adequate consultant cover at weekends in the Intensive Care Unit at Tunbridge Wells Hospital.  People should not be delayed for more than four hours when a decision has been taken to admit them or to discharge them, and as far as possible people should not be  discharged at night.
• At Maidstone Hospital, the trust must ensure that sufficient ward rounds take part on the Intensive Care Unit, that people are admitted and discharged within four hours, and that patients are not moved to other wards at night.  The governance structure in the unit must be improved to support better multi-disciplinary working by clinical staff.

Inspectors identified a number of areas of outstanding practice across the trust, including:

• The Maidstone Birth Centre had developed and produced the Maidstone birth couch for use by women in labour. 
• On Mercer Ward at Maidstone Hospital, the role of dementia care worker had been created to focus on the needs of people with dementia and their families. An activities room had been designed, furnished and equipped to meet the specific needs of people with dementia, and this was widely used. 
• The breast care service provided very good care from before the initial diagnosis of cancer through to completion of treatment. Good support and holistic care was provided to patients requiring breast surgery. 
• On Ward 20 at the Tunbridge Wells Hospital at Pembury, there was a focus on dementia care. Staff had won funds from the Dementia Challenge fund to create a dementia café for use by people living with dementia, their friends and their families.

CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"When we inspected the hospitals run by Maidstone and Tunbridge Wells NHS Trust, we saw that quick work was needed to improve the governance of the trust and of a number of the core services we inspected. There was a great deal of variation, both in the ability of the senior directorate level management teams to run their services effectively, and in the level of robust clinical oversight of services.

"While the trust acknowledged immediately that these improvements needed to be made when we told them so, we should not have needed to tell them – which highlights how much this work is needed.

"Across both hospitals, we saw staff treating people with dignity and respect, and we noted their willingness to engage with the inspection process. They saw our time there as a good way to drive improvements in the care the hospital provided, and helped us build up an excellent picture of current good and poor practice within the trust.

"People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors' findings and begun to take action where it is required. We will return in due course to check that the improvements we have identified as being needed have been made."

The inspection team, which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts, visited the hospitals over a period of three days. They also made unannounced visits as part of the inspection.

Ends

For media enquiries, contact 020 7448 9401, during office hours, or out of hours, contact 07789 876508. For general enquiries, call 03000 61 61 61.