The Care Quality Commission (CQC) has told East Kent Hospitals University NHS Foundation Trust that it must make immediate improvements in three services following an inspection in July.
CQC carried out an unannounced focused inspection of the trust’s urgent and emergency department (ED), medical care (including older people’s services) and children and young people services at William Harvey Hospital and the Queen Elizabeth the Queen Mother Hospital. Inspectors also looked at the management and leadership of the trust overall.
The inspection was undertaken as part of continual checks on the safety and quality of healthcare services and to check on the progress of improvements they were told to make at a previous inspection.
At William Harvey Hospital:
- Children and young people – has again been rated as requires improvement as have the ratings for effective and responsive. However safe and caring remain rated as good and well-led has dropped from good to requires improvement
- Medical care has again been rated as requires improvement overall as have the ratings for how responsive and safe the service is. Caring and well-led have dropped from good to requires improvement. The rating for how effective the service is remains as good.
At Queen Elizabeth the Queen Mother Hospital:
- Children and young people - The overall rating has improved from requires improvement to good as have the ratings for how effective and responsive the service is. How well-led the service is has dropped from good to requires improvement. Safe and caring have again been rated as good
- Medical care – has dropped overall from good to requires improvement as have the ratings for how responsive and well-led the service is. The safety of medical care has again been rated as requires improvement and how effective and caring services are remain rated as good.
Urgent and emergency care in both services were inspected but not rated and remain as requires improvement overall from previous inspections.
The trust was again rated as requires improvement for how well-led it is overall across the organisation. These rating changes have not affected the overall rating for the trust which stays as requires improvement.
Following the inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to how they were managing each department.
Neil Cox, CQC deputy director of operations south, said:
“During our inspection of East Kent Hospitals University NHS Foundation Trust, we were aware there had been several changes in membership of the board over recent years, which had made it difficult for the trust to adopt and take forward previous plans that had been in place. We saw this reflected in the differences we found between services and hospitals, and the leadership in some services.
“We found that while leaders understood the priorities and issues the trust had, they didn’t always take the appropriate action needed to resolve them. Some executives were visible and approachable in the service, but most staff we spoke to also told us of a disconnect between the board and frontline staff.
“Staff told us there was a lack of trust-wide ownership of the pressures faced by the emergency department. Speciality teams didn’t always collaborate effectively with the emergency department teams. This caused problems with the flow of people coming in and out of the department. This meant people sometimes waited too long to receive treatment. We saw there was a plan in place to manage the overcrowding, but the implementation wasn’t as effective as it could have been.
“At William Harvey Hospital we found there weren’t enough emergency department or paediatric emergency medicine consultants to safely meet the Royal College of Emergency Medicine or The Royal College of Paediatrics and Child Health guidelines which was a risk to children’s health.
“We have issued a warning notice to ensure the trust concentrates on the areas where we have concerns and will return to check that the required improvements have been made. If further improvements are not implemented and embedded, we will not hesitate to take further action to ensure we are confident people are receiving the safe, consistent care they deserve.”
At William Harvey Hospital inspectors found the following:
In urgent and emergency care:
- The privacy and dignity of people could not always be respected because the department was overcrowded
- The lack of flow between the emergency department and the wider hospital, had a significant impact on both people needing treatment and staff
- There was a disconnect between the emergency department and services within the hospital and a lack of trust-wide ownership of the challenges faced by the emergency department
- The service did not have enough staff to care for people and keep them safe
- Incidents or near misses were not always being reported in line with trust policy
- However, staff in the emergency department worked together to benefit people
- Staff felt respected, supported and valued, and were focused on the needs of people receiving care. The service promoted equality and diversity in daily work.
In medical care:
- There were not always enough staff to care for people. Communication with people was not always effective when making decisions about their care. Safe systems were not always in place to manage risk including fire safety, infection prevention and control, and peoples’ privacy and dignity. Not all leaders ran services well and information systems were not always reliable or effective in supporting staff to develop their skills. However, staff understood how to protect people from abuse
- People were treated with compassion and kindness and staff provided emotional support to people, families, and carers.
In services for children and young people:
- The individual needs of children and young people receiving treatment and care were not always taken into consideration
- Concerns were not always recognised and escalated by leaders. Key services such as education facilities, paediatric physiotherapy were not available and there was no plan to address this at the time of inspection. However, staff treated children and young people with compassion and kindness
- Children and young people were protected from avoidable harm, and frontline staff managed safety well.
At Queen Elizabeth the Queen Mother Hospital inspectors found the following:
In urgent and emergency care:
- An effective handover process for people who had been in the ED for more than 24 hours was not in place. This led to a delay in treatment and lack of continuity of care for some people
- Staff did not always have an effective oversight of people for their time in the department
- People were not always treated with dignity and respect. This included during medical and clinical assessments when in overcrowded areas
- However, the needs of local people were met and it was easy for people to give feedback
- Staff treated people with compassion and kindness.
In medical care:
- There were not always enough staff to care for people
- Staff did not always make sure equipment, such as resuscitation trolleys, were checked regularly and accurately and were safe to use
- Near misses or potential harm were not always reported by staff
- Staff did not always ensure they followed their Standard Operating Procedure when placing people in escalation areas
- However, staff understood how to protect people from abuse
- Staff treated people with compassion and kindness
- One ward had a double room for couples who could be cared for together.
In services for children and young people:
- Children and young people were receiving good care and treatment with enough to eat and drink and access to pain relief when they needed it
- Children and young people were treated with compassion and kindness. Their privacy and dignity was respected and staff took account of their individual needs
- Key services such as education facilities, paediatric physiotherapy were not available seven days a week
- There was not always enough medical staff to care for children and young people and keep them safe
- The service did not always have reliable information systems to help manage risk.