Medway Maritime Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This meant we looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood their experience and how they were treated mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We reviewed 3 quality statements. At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement.

The service did not always treat people with kindness and compassion. Staff could not always protect their privacy and dignity. Staff could not always respond to people in a timely manner. However, they treated them as individuals and supported their preferences. Staff gave people choice in their care and encouraged then to maintain relationships with family and friends. The service supported staff wellbeing.

The evidence showed some shortfalls. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was still in breach of the legal regulation in relation to how people were not treated with dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed some shortfalls. The service did not always respect the privacy and dignity of patients. However, staff treated colleagues from other organisations with kindness and respect.

We spoke with over 50 patients over 2 days. On day 1 of our assessment, we spoke with 10 patients in majors. Five patients told us they did not feel cared for due to the environment and limited access to staff. They told us they were not treated with dignity and compassion. Patients described their experience as “horrendous”, “too noisy,” and said, “I haven’t slept.”

We observed that excessive noise could have been avoided. For example, medical pump alarms sounded for over 10 minutes on several occasions. Staff did not appear to have capacity to silence the alarms while attending to other patients.

On day 2 of our assessment, we spoke with a further 10 patients in majors. Two patients in temporary escalation areas continued to raise concerns about privacy and dignity. However, most were aware of their plan of care and felt they had been treated with compassion, which was an improving picture.

Leaders had adjusted how they managed temporary escalation areas, including ending the use of corridor care. However, concerns remained about how staff maintained privacy and dignity and what actions the department were taking to improve this.

Staff told us the department’s environment and staffing levels sometimes prevented them from providing high-quality care. They said the department was regularly understaffed, particularly in majors, and described this as a persistent issue.

Matron daily reports supported this view, with many noting that staff allocations had not met recommended levels over the past 12 months.

The service Friends and Family Test (FFT) results for the last 12 months showed that 70% to 80% gave positive feedback. The trust’s target was 80%. Patient participation in the survey ranged from 6.7% to 8.4%.

In April 2025, the service received complaints which matched our observations and related to poor communication, long waits, delays in diagnostic results, issues with admission, transfer and discharge, staff attitude, and a lack of privacy and dignity.

We had mixed feedback from patients. People in Area 3, who faced long waits, said they were not kept updated about their treatment or waiting times.

However, people in Area 1 and 2 felt well cared for and informed. They understood that staff were working under difficult circumstances.

Staff supported patients to understand and manage their care and treatment when they were able to. They considered personal, cultural, social and religious needs. Patients appreciated this.

The 2024 CQC urgent and emergency care survey found that privacy was rated as 7.6 out of 10. This was about the same as other trusts.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The evidence showed significant shortfalls. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. However, the service listened to or understood people’s needs, views and wishes.

Staff did not consistently identify or respond to changing patient risks. Data showed between May 2024 and January 2025 the average time to see clinician was 94 minutes. In majors, we observed delays in answering call bells. Staff left 1 call bell unanswered for over 5 minutes. On several other occasions, call bells were not answered within 3 minutes.

People struggled to locate staff when they needed support. Patients in temporary escalation areas raised ongoing concerns about privacy and dignity, particularly when toileting. They could not identify staff to assist them, and the bays positioned around staff desks for observation did not offer privacy. As a result, patients were expected to carry out personal care tasks in view of staff and others in the department. This included toileting and exposure of private areas such as the abdomen and groin regions.

Consultants reported that crowding and treatment delays affected privacy, dignity and routine checks. They said patients in temporary escalation spaces could not be properly monitored under current conditions.

Audits showed staff did not always assess or manage patients’ pain effectively. In October 2024, 1 audit found delays in prescribing pain relief and a lack of reassessment after 1 hour. A follow-up audit in April 2025 showed minimal improvement.

Staff did not always recognise specific risks such as falls or pressure ulcers, as some nursing assessments were incomplete. This was significant for patients cared for on trolleys, which affected their mobility and pressure care needs.

We raised this with leaders at the end of day 1. On day 2, risk assessments had improved, and senior nurses and duty managers completed checks to ensure they were updated. We reviewed a sample of these checks after the assessment.

The 2024 CQC urgent and emergency care survey found that the question relating to help from staff while waiting was rated as 4.7 out of 10. This was about the same as other trusts.

The evidence showed some shortfalls. They did not always promote staff wellbeing or enable staff to deliver person-centred care. However, they did acknowledge the importance of doing so.

The service did not consistently promote staff wellbeing or support person-centred care. Medical and nursing staff raised serious concerns about their safety. We escalated this to leaders, who assured us action was underway. However, staff continued to report physical and emotional distress, frequent verbal abuse, and delays of up to 5 minutes in security response.

From April to December 2024, there were 185 security incidents in the CDU, 161 incidents in the emergency department, 56 incidents in the waiting room, and 42 incidents in the resuscitation area. Staff raised concerns about the care and staffing with leaders but felt these were not resolved yet. They told us action plans were completed but had not addressed their concerns. Leaders told us, they had sympathy for staff regarding security concerns and told us they used mechanisms such as staff forums, incident reviews, and direct engagement to continue to listen and act upon concerns. Leaders also highlighted that a detailed analysis of violent and aggressive incidents was presented monthly at their Health, Safety and Security Group to enhance monitoring in this area.

Nurses said support often arrived after handover, leaving a gap in the morning when pressure was highest. They felt earlier support, would benefit both staff and patients. Despite these challenges, nursing staff felt conditions were starting to improve.

Staff said time pressures, poor facilities and high patient numbers often prevented them from delivering the care they were trained to provide. Some said they would not want their own relatives treated in these conditions.

Some staff described feeling overwhelmed, frustrated and emotionally fatigued. However, many others felt proud of their work and teamwork.

However, medical staff, including resident doctors, said they felt supported and valued the teaching and supervision provided. They took part in audit projects and welcomed recent changes, though they said further improvements were needed. However, despite this some medical staff felt there were areas that could improve associated with workload, staffing and security.

Nursing and medical staff were satisfied with the appraisal process and saw opportunities for career development.

The trust offered a wellbeing programme aligned with its People Strategy and the NHS Health and Wellbeing Framework. Staff could access counselling through affiliated external organisations.

The trust trained around 180 Mental Health First Aiders and planned to train 70 more in 2025/26. Leaders recognised staff achievements through annual awards.

Most staff told us that they felt supported and valued by their immediate line managers. However, in the 2024 NHS staff survey only 38% of Acute and Emergency Medicine (including emergency department) staff were either satisfied or very satisfied in relation to the extent of which the organisation valued their work. This was worse than the trust average of 41%.