The Care Quality Commission
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Darent Valley Hospital

Overall: Good read more about inspection ratings

Darenth Wood Road, Dartford, Kent, DA2 8DA (01322) 428100

Provided and run by:
Dartford and Gravesham NHS Trust

All Inspections

11 October 2022

During an inspection looking at part of the service

We inspected the maternity service at Darent Valley Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

Dartford and Gravesham NHS Trust provide maternity services at Darent Valley Hospital and local community services. The maternity service supported 4,704 mothers to birth and 4,757 babies were born in 2021. This included 52 sets of twins.

Maternity services include:

  • Antenatal Clinic
  • Mixed antenatal and postnatal ward (Cedar ward)
  • Postnatal ward (Aspen ward)
  • Fetal Medicine Unit
  • Home from Home Birth Centre
  • Labour ward
  • Triage (Tambootie ward)
  • Community midwifery
  • Special Care Baby Unit (Walnut ward)

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well led key questions.

We did not rate this hospital at this inspection. The previous rating of good remains.

How we carried out the inspection

We visited all areas within the hospital birth centre. We spoke with 13 mothers/partners and 41 members of staff. We reviewed performance information about this service before we visited. We reviewed 8 sets of maternity records and 4 prescription charts. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, incidents and audit results.

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

21 February 2022

During an inspection looking at part of the service

A summary of CQC findings on urgent and emergency care services in Kent and Medway.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Kent and Medway below:

Kent and Medway

The health and care system in this area is made up of many health and social care providers and is supported by stakeholders, commissioners and the local authority. We found front line staff working across all services were doing their best in very challenging circumstances and had continued to do so throughout the COVID-19 pandemic.

Increased system wide collaboration, particularly between health and social care was needed to alleviate the pressure and risks to patient safety identified in some services we inspected. However, we did find some good collaborative working; for example, staff in acute and ambulance services had been working together to reduce handover delays, and primary and community services worked together to reduce attendances in Emergency Departments.

We found some access issues in primary care and some GP practices were not allowing patients to enter the building without staff permission; since our inspections, action has been taken to ensure patients can access their GP Practice freely. We did find examples of innovative practice including employing a variety of different healthcare professionals in GP Practices and across Primary Care Networks to better meet the needs of their patients ensuring people receive the right care at the right time. There was also funding available to provide interpreting and translation services to support people from diverse communities and to support people arriving in the UK from Ukraine.

Primary Care Networks were working well with community services to alleviate the pressure on ambulance and acute services where possible, particularly in out of hours services. In addition, technology was being utilised to improve services and provide timely access to patient information, especially for staff providing out of hours care.

Staffing issues and high levels of absence due to COVID-19 had impacted on services across Kent and Medway. GP Practices in this area had a larger number of patients per GP and demand had increased; however, in many cases this was well managed. The NHS111 service had experienced staffing issues as well as increased demand; this had resulted in significant delays in call answering times for people trying to seek advice.

Ambulance response times had also been poor across Kent and Medway. Whilst operational staff had done all they could to maintain response times to serious and life-threatening calls, response times to less serious calls were unacceptable, and performance had continued to be poor for a long time. This had widespread impact on people in Kent and Medway, and particularly on people living in care homes. Social care staff had to provide long periods of enhanced care to people waiting for an ambulance response whilst also caring for other residents.

There continued to be long ambulance handover delays at hospitals in Kent and Medway; however acute and ambulance services had worked well together to reduce these delays and improve handover processes.

Emergency departments inspected in Kent and Medway continued to be under significant pressure. However, we found some improvements since previous inspections, including improvements in leadership and the culture within the departments. Staff worked hard to meet current demands and felt positive about the improvements they had seen. Some social care services had raised concerns in relation to the care provided to people with dementia and autism in emergency departments. Where specific concerns were raised, these were being investigated.

There were delays in patients receiving care and treatment caused by poor patient flow across urgent and emergency care pathways. There were many urgent and emergency care pathways available within hospitals in Kent and Medway, however staff acknowledged these were not all working well or being fully utilised. Referral pathways between emergency department and urgent treatment centres aimed to meet people's needs and reduce pressure on acute services. However, we identified issues with inappropriate referrals, long waiting times and inconsistent risk assessments putting people at risk of harm. Patients also reported delays in their treatment due to inappropriate referrals. System partners were aware of issues with UEC pathways and had an action plan in place to address them.

We also found delays in patient discharge from hospitals and a shortage of social care capacity to enable people to leave hospital in a safe and timely way. In addition, social care services reported concerns about poor discharge processes. Examples included insufficient information about changes to medicines or people discharged into care homes who required a level of care for which staff were not trained to provide.

Staff working across Kent and Medway require additional support to manage the continued pressure on services. We also identified opportunities to upskill staff, for example, training additional social care staff in areas such as detecting early signs of deterioration in health. Increased collaboration between health and social care services and stakeholders is needed to address issues with patient flow across urgent and emergency care pathways. These pathways also require evaluation to ensure they are as efficient and effective as possible to meet the needs of people in Kent and Medway.

14 May to 13 June 2019

During a routine inspection

Our rating of services improved. We rated it them as good because:

  • Generally, staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it. Staff we spoke with had a good understanding of who the safeguarding named lead was, and they could describe how to raise a concern or seek advice.
  • The hospital generally managed patient safety incidents well. Staff recognised and reported incidents and near misses.
  • The hospital had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • Staff consistently assessed, monitored and managed risks to patients who used their services. This had improved since our last inspection. Staff used a nationally recognised tool to identify deteriorating patients and escalated them appropriately. The trust had sepsis guidelines on how to screen for and manage sepsis.
  • The hospital provided care and treatment based on national guidance and evidence-based practice. Policies and procedures were available and accessible to staff via the trust intranet. Policies we viewed as part of our inspection were in date and in line with best practice and national guidelines. Clinical guidance was also available on the trust intranet.
  • Staff made sure patients had enough to eat and drink. Especially those with specialist nutrition and hydration needs. Specialist support from staff such as dieticians and speech and language therapists were available for patients who needed it.
  • Staff delivered kind and compassionate care to patients and their carers.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • The hospital planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • There were systems in place to aid the delivery of care to patients in need of additional support such as dementia or learning disabilities. The trust employed a learning disability liaison nurse and a dementia specialist nurse.
  • Peoples concerns, and complaints were listened and responded to. There were effective systems and processes to learn and improve from complaints.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the hospital for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • There was good oversight of performance and leaders used the results to help improve care. All staff identified risks to good care and the service took action to eliminate or minimise risks.
  • Generally, staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

However:

  • The urgent and emergency care service did not mirror the general findings of the hospitals services. The leadership of the service did not have sufficient oversight of the quality and safety of the service provided.
  • In urgent and emergency care, the nursing leadership team lacked stability. Some staff did not feel engaged in the planning and delivery of services.
  • The urgent and emergency care service did not control infection risk well. Staff did not always keep equipment and the premises clean and they did not always use control measures to prevent the spread of infection.
  • In urgent and emergency care, patients did not always receive treatment within agreed time frames and national targets.
  • In urgent and emergency care, staff treated patients with compassion and kindness. However, because of the constraints of the physical environment, it was not always possible for staff to respect patients’ privacy and dignity and maintain their confidentiality.
  • The average length of stay for non-elective surgery at the trust was worse than the England average and showed little improvement since our last inspection.
  • There was poor compliance to safeguarding adults training for nursing and medical staff.
  • There was no Mental Capacity Act specific training at the time of the reporting period. The trust advised that a new course was introduced on 1 April 2019.

5 and 6 December 2013

During a routine inspection

The ratings in this report were awarded as part of a pilot scheme to test CQC’s new approach to rating NHS hospitals and services.

Darent Valley Hospital offers a comprehensive range of acute hospital-based services to around 270,000 people in Dartford, Gravesham, Swanley and Bexley. The hospital opened in September 2000. The hospital building is run as part of a private finance initiative. This means the building is owned by The Hospital Company (Dartford) Limited, a private sector company, and the trust leases the building. Darent Valley Hospital now has around 463 inpatient beds and specialties that include day-care surgery, general surgery, trauma, orthopaedics, cardiology, maternity and general medicine. The hospital has a team of around 2,000 staff.

Dartford and Gravesham NHS Trust was selected as part of the Chief Inspectors of Hospitals’ first new inspections as a trust considered to be in the middle ground between low and high risk of poor care. This inspection focused on Darent Valley Hospital.

Dartford and Gravesham NHS Trust is registered for the following regulated activities to be provided at Darent Valley Hospital:

  • Diagnostic and screening procedures
  • Maternity and midwifery services
  • Surgical procedures
  • Termination of pregnancies
  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder or injury.

Since the trust registered with the Care Quality Commission (CQC) in 2010, Darent Valley Hospital has been inspected four times. At the last inspection in November 2012 the trust was found to be compliant with all regulations inspected.

Our inspection team included CQC inspectors and analysts, doctors, nurses, patient ‘experts by experience’ and senior NHS managers. Experts by experience have personal experience of using or caring for someone who uses this type of service. The team spent two days visiting the hospital, and two further unannounced visits were conducted the following week. One of these included an evening/night time visit.

Maternity, outpatients, children’s services and end of life care were found to be good. In all services across the hospital, most staff were committed to the trust and said it was a supportive environment to work. Patients were generally positive about their experience and the care they received.

The trust faced challenges after the recent collapse of merger plans, and it had not yet developed an alternative vision for the organisation. There were a number of examples of good practice and examples of shared learning in the hospital, although in some cases the changes in practice in response to learning from serious incidents took up to 12 months to implement. The main challenge was the demand on the accident and emergency (A&E) department and the rise in emergency admissions. A significant causal factor had been the recent reduction of acute services in the immediate vicinity. The trust was managing issues on a day by day basis but not solving the key underlying problems, in particular bed management/capacity and inappropriate attendance at A&E. It is acknowledged that the trust cannot solve these problems on its own, as they will require a whole healthcare community approach.

The trust had taken action in some areas where staffing issues had been identified. This had included increased nursing staff levels on some wards, an increase in the number of porters in the pharmacy department and the recruitment of additional midwives. In A&E there were insufficient numbers of nurses qualified in the care of children and a high use of locum middle grade doctors, which had the potential to impact on patients’ safety.

Patients’ dignity was being compromised by the continued use of mixed sex wards and facilities in the Clinical Decision Unit where staff told us they always have mixed sex accommodation and the Medical Assessment Unit, which we observed as a mixed sex ward. This also occurred in the intensive care area when patients no longer required intensive care. Patients’ right to privacy was being compromised by personal information being on display in open areas, for example on computer screens in the A&E and confidential information being discussed in public areas such as corridors. The area in the operating theatre where people were received into the department also compromised patients’ privacy and dignity, as it was an open area. Since April 2011, the hospital's bed occupancy rate had consistently been above the national average of 86.5%, rising as high as 96.1% for the period of Apr-Jun 2013. This was impacting on patient safety through the use of additional beds in areas not designed or equipped for this purpose.

In some areas, the trust was considering and implementing national guidelines, but in A&E we found guidance was not always being followed, for example with the management of children’s pain. Also some of the guidance that was available was not the most current such as resuscitation guidelines. Staff told us that the trust was a supportive environment in which to work and that training was available, though the trust’s own training records showed that attendance at the trusts mandatory training was below the trusts expected level. This was low as 66% in some areas compared to the trusts target of 85%. There was a system in place to monitor attendance at the trust’s mandatory safety training and follow up non-attendance, but this was ineffective in some cases. There were 285 members of staff whose training was out of date and were not booked to attend a session.

Overall, we found a culture where staff were positive, engaged and very loyal to the organisation. The staff and management were open and transparent about the challenges they faced.

5 December 2013

During an inspection

5 October 2012

During a routine inspection

Five compliance inspectors carried out a planned visit to Darent Valley Hospital on the 4 and 5 October 2012. During the time we spent in the hospital we visited nine wards and the accident and emergency department (A&E). We also included a short visit to the newly opened Evergreen unit which specialised in the medical and health assessment of older people.

We were supported on the inspection by an Expert by Experience. This was a person who had personal experience of using or caring for someone who had used this type of care service. We also used the Short Observational Framework for Inspection (SOFI) in Beech and Spruce wards as some patients had dementia and/or were not able to tell us about their experiences. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We spoke with 43 patients and 12 relatives of people who used the service. In addition we spoke to 28 members of staff working at all levels within the hospital. The staff told us that they felt well supported. They said that they liked working at the hospital and had the training and information they needed. We found that significant progress had been made in the four outcome areas that required improvement at the last inspection. We met with senior Trust staff. They told us about their systems for monitoring the quality of the service and about improvements they had made and were planning.

We were told that most patients or their representatives had been involved in making decisions about their care and treatment. We spoke with patients who said that their privacy and dignity was respected and confirmed that staff drew curtains around their bed when attending to their personal care needs. During the SOFI exercises we largely observed that patients who required help to eat were given appropriate assistance by staff, and were helped in a respectful way and were not rushed. Most patients told us they appreciated the way staff supported them and provided care. We were told, "They give you their time although they are very busy". Most patients were positive about the quality of care they had received and felt their overall experience of the hospital had been a good one. For example, one patient said, "I simply can't fault the care given to me here".

We received positive comments from patients about the standards of cleanliness in the hospital and the hygiene control measures in place to protect them from unnecessary harm. For example, a patient told us, "I've got no complaints about the cleanliness and I see staff washing their hands and using the hand sanitizers'. Another patient told us they were more than satisfied with hygiene levels on the ward. They said that staff took infection control measures seriously, wore aprons and gloves and washed their hands regularly. A very small number of staff however were observed to not always wash their hands between seeing to patients, or when they moved from different bed bays, this did not reflect best practice. Where we had concerns our observations were brought to the attention of senior staff on duty and issues were dealt with quickly and appropriately during our visit.

22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

16 June 2011

During a routine inspection

Four compliance inspectors carried out a visit to Darent Valley Hospital on 13 and 15 June 2011 and a fifth inspector carried out a specific observational exercise called a Short Observational Framework for Inspection (SOFI) on one ward on 15 June 2011.

During the time spent in the hospital we visited nine wards, (Beech, Cedar, Ebony, Juniper, Linden, Maple, Oak, Redwood and Spruce) and the Accident and Emergency department, including the Emergency Department Walk In Clinic (EDWIC).

We spent time speaking with people who use the service and their relatives to find out about their views and experience of the care the hospital gave. We spoke to staff at all levels from ancillary staff on the wards to the Trust board. We spent time talking with the people who had overall responsibility for infection control and to those with responsibility for handling complaints. We observed care practice; including a specific observational exercise (SOFI) and reviewed samples of documentation such as care plans, monitoring charts and information that the hospital gives to people on all the wards we visited.

Throughout the time of our visit we spoke to twenty-six of the people who used this service and seven of their relatives. They said that the hospital was kept clean and had suitable day time facilities for visitors although some visitors told us that parking could be difficult. They said they were happy with the visiting times and that these could be flexible if there was good reason. Most people praised the staff for the quality of care they received and for their diligence, helpfulness and kindness. There were a few people who told us that some staff were less thoughtful, particularly when it came to meeting basic care needs.

Nearly all of the people we spoke to told us that they thought the standards of care were generally high and that they were treated with respect and dignity.

People told us that they had been given good explanations about their treatment and that they had been asked to give their consent. On all of the wards we visited we found that some people were not able to make their needs known or give consent due to their failing mental capacity.

28 March 2011

During a themed inspection looking at Dignity and Nutrition

The people who used this service told us that their care was generally good. They said that the nurses were kind and respectful but were often very busy and took a long time to answer call bells. Some people told us that they were concerned that some people did not have access to call bells because they were in an additional bed in the window area or because, due to confusion, they did not understand how to use the call bell.

People's views on the quality of the food varied. They told us that there is always a choice for the main meal. They said that they could choose between two hot meals, sandwiches and a salad. Some people told us that they did not like the food and that the quality was poor whilst others said that they enjoyed their meals and that the food was good. All the people we spoke to said that they were offered plenty to eat and drink. Some said that they did not feel like eating and had to leave a lot of their food. They described mealtimes as, 'Not the most enjoyable experience'; 'Quite lonely in a single room, it would be nice to have a dining room to share with other people'; 'Very good'; and 'OK'.