The Care Quality Commission (CQC) has published a report following an inspection of Maidstone and Tunbridge Wells NHS Trust, in March and April.
An unannounced focused inspection of end-of-life (EOL) services was carried out as part of our continual checks on the safety and quality of healthcare services. Inspectors also looked at management and leadership of the trust to find out how well-led the trust is.
Following this inspection, at a trust level well-led was re-rated as good. The overall trust ratings of safe, effective and responsive retain the rating of requires improvement from 2018 and caring retains the rating of good.
EOL services have again been rated overall as requires improvement, as has the rating for being effective. Well led declined from good to requires improvement. Responsive improved from requires improvement to good. Safe and caring remain rated as good.
The overall trust remains rated requires improvement.
Neil Cox, CQC’s deputy director of operations in the south, said:
“Following our inspection of Maidstone and Tunbridge Wells NHS Trust, we found an experienced leadership team who had the capability and integrity to ensure they had oversight of what was happening across the trust and make changes needed to improve people’s care.
“During our inspection of EOL services, we observed staff treating people and their loved ones with dignity and care. Staff took time with people to ensure they felt supported. They introduced themselves and were compassionate to those who were experiencing pain, discomfort or distress.
“However, while we found some excellent volunteer support for the trust, some services, including the EOL team and the specialist palliative care team, weren’t always available seven days a week.
“The palliative care team had one consultant employed by the trust. They provided consultant cover across both hospital sites and were responsible for reviewing everyone who had been identified as approaching the EOL pathway. After the inspection we were advised a second palliative care consultant had been appointed which would improve care for people.
“People nearing the end of their lives and placed on the EOL pathway were supposed to have an individualised care plan. However, the specialist palliative care team informed us this wasn’t always happening in a timely manner as people weren’t always identified as being end of life. There was a potential risk that people approaching end of life might not be reviewed appropriately, or staff looking after them might not be given adequate support and guidance which must be addressed as a priority.
“We will continue to monitor the trust, including through future inspections, and we look forward to find what future improvements have been put in place.”
During the inspection of the trust leadership inspectors found:
- Leaders ran the trust well using reliable information systems and supported leaders to develop their skills
- The trust’s vision and values were well understood, and people were clear on their role in making the trust strategy work
- Staff felt respected, supported, and valued
- The trust engaged well with people and the community to plan and manage services
- All staff were seen to be committed to continually improving services for people
- Three hundred and eighty senior leaders had completed the Exceptional Leaders Programme (ELP), introduced as part of their culture and leadership programme.
However:
- Risks were not always identified and recorded for all services
- The delivery of the equality and diversity and inclusion strategy was reported to be variable with middle managers reported to not be fully engaged.
During the inspection of EOL care inspectors found:
- The malnutrition universal screening tool had not always been used to identify and score nutritional and hydration requirements once a person had moved onto the EOL pathway
- Not all staff had completed their safeguarding training
- There was a reliance on limited information in some areas to measure the responsiveness, effectiveness, and quality of a service. Risks were not always identified and recorded for all services.
However:
- Porters were aware of the infection prevention control measures to take when transporting people and could describe training they had received. This included transporting people with cultural or religious differences or who had an infectious disease
- Access to the mortuary for authorised staff was by a secure key-card system. All access requirements were monitored and reviewed on a yearly basis.