Medway NHS Foundation Trust

Updated 30 July 2021

We carried out an unannounced inspection of the trust’s medical care service and an unannounced focused inspection of its children and young people’s service.

At our last comprehensive inspection of the trust, the trust was rated requires improvement overall. Our most recent previous core service inspection was an inspection of the trust’s urgent and emergency care service in December 2020. We rated this specific service inadequate overall. It was the findings from this inspection along with other intelligence, including from trust and stakeholder engagement that led to this inspection at this time, as we had concerns about the quality of services.

During the core service inspections we spoke with 54 staff members including nurses, doctors, managers, allied healthcare professionals, housekeeping and support staff. We held junior doctor focus groups attended by 17 junior doctors and reviewed 31 sets of patient records.

We also inspected the well-led key question for the trust overall. We decided to carry out a well-led assessment at this time, as we had concerns as to the capability and capacity of the trust’s leadership team. The trust had been subject to significant intervention from NHS England and NHS Improvement across several areas of trust service delivery, including support for the trust’s executive being provided by their Intensive Support Team.

As part of our assessment of well-led NHS England and NHS Improvement carried-out a well-led assessment of the trust’s financial governance, which is included in our well-led summary.

Generally the ratings for both the core service inspections and the well led assessment improved.

• We rated the key questions of safe and well led for its children and young people service as good. We rated its medical care service as requires improvement overall.
• We rated well-led as requires improvement.

For the medical care core service inspection we found:

• Medicines brought in by patients were not always recorded at admission and there had been several incidents were medicines had gone missing across a number of wards.
• The service did not always have enough staff to keep patients safe from avoidable harm and to provide the right care and treatment. However, managers regularly reviewed and adjusted staffing levels and skill mix to meet the needs of the patients including using locum and bank staff to help keep patients safe. The service was actively recruiting nursing and medical staff from overseas.
• There were clear lines of accountability from the department to the board through the directorate governance structure, but these were not always effective. There was a lack of oversight of issues identified as a risk to patient and staff safety which had not been identified or addressed by the leadership team until we raised them during our inspection. For example, on the temporary coronary care unit, there was a lack of infection prevention and control compliance and the environment was inappropriate creating many risks.
• Patients were not always put on the correct patient pathway which delayed the start of their treatment and increased the risk of deterioration.
• Paper records were still in use and not always fully completed or filled contemporaneously in line with trust policy.
• The service had a back log of serious incidents that were overdue for investigation.
• The service did not always meet their target for responding to complaints.

However:

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. We observed positive interactions between staff and patients. Staff introduced themselves to patients before providing care and included patients in discussions about their care. This was an improvement from the last inspection.
• Staff kept detailed records of patients’ care and treatment, although there were separate systems for this. The service primarily used an electronic patient record system but we noted some patient care was recorded on a paper system.
• The service treated patient concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
• Staff assessed and monitored patients and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• The service had a vision for what it wanted to achieve and each care group had developed individual strategies to achieve this. Staff were aware of the vision and strategy and the part they played in achieving this.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Staff followed guidance in relation to social distancing and the use of personal protective equipment on the wards we visited. However, we escalated our concerns to trust leaders about the coronary care unit as it was unclear if social distancing guidelines were being met due to the environment.
• Staff felt respected, supported and valued by their colleagues. They told us of strong working relationships that had been formed during the COVID-19 pandemic. However, we received mixed views on the support they received from local and executive leaders.

For the children and young people core service inspection we found:

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well.
• The service controlled infection risk well.
• Staff assessed risks to children and young people, acted on them and kept good care records.
• The service managed medicines well.
• Leaders ran services well using reliable information systems and supported staff to develop their skills.
• Staff understood the service’s vision and values, and how to apply them in their work.
• Staff felt respected, supported and valued.
• The service was focused on the needs of children and young people receiving care.
• Staff were clear about their roles and accountabilities.
• The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 30 April 2020

Updated 30 April 2020