Medway Maritime Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We assessed 4 quality statements for the effective key question. At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant people’s outcomes were not always consistently good, and people’s feedback confirmed this.

People were not always involved in the assessment of their needs because staff did not always review assessments in a timely manner when the department became crowded. Some clinical guidelines were outdated and needed review. However, care was based on latest evidence and good practice. People always had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed some shortfalls. Audits and quality improvement projects were incomplete in terms of findings.

Some temporary staff told us they had not completed their local induction. We fed this back to managers, who referenced their communication tool “big 4” which included a reminder on improving the completion of local induction checklists.

Some audits and quality improvement projects remained ongoing, staff and leaders had not yet demonstrated how these initiatives had improved patient care. For example, surgical pain interventions for hip fractures, quality of blood samples, and compliance with national guidelines for urgent CT head scans were seen following the assessment. Leaders told us following the on-site assessment that since February 2025, the audit programme for the department had progressed 7 out of 18 audits to completion. These audits had been presented and discussed through the needed governance structures. However, some of the audits were incomplete in terms of their findings and it was unclear how the results of these audits were used to improve the service.

Staff participated in The Royal College of Emergency Medicine (RCEM) 2025 Healthcare Quality Improvement Plan (QIP). QIPs are a structured approach to improving the quality of care delivered in an Emergency Department (ED) and focus on specific areas of emergency care, like mental health, care of older people, and time-critical medication.

Staff had access to the information to assess, plan, and deliver care and treatment. Clinical guidelines were up to date and reflected national guidance and best practice. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them.

The service had significantly improved ambulance handover times using the Hospital Ambulance Reception Improvement System (HARIS) programme. They had achieved 75% of handovers in 15 minutes.

Managers told us that staff were experienced and qualified and were enabled to have the right skills and knowledge to meet the needs of people. Managers dealt with poor staff performance promptly and effectively. However, some staff told us that they did not always have the needed skills required for the management of people in mental health distress. Staff felt they did not always know what to do to calm people in mental health distress and this was more concerning for them when an RMN was not available in the CDU.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, staff worked closely with teams from the community, mental health and in-house specialist teams, such as dieticians, speech and language therapist team (SALT), frailty and ambulance staff.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. The service catered for dietary needs with gluten, dairy and meat-free options and a separate menu for people with swallowing difficulties who required a puree or soft diet. Staff knew which patients required thicken fluids and were aware of food and drink that could have an adverse effect on patients.

Bed tables were accessible for patients and patients in temporary escalation areas had trays for their laps. Staff offered food and hydration to patients on a regular basis.

Resident doctors told us they had a dedicated teaching day once a month from 8am to 5pm. During this time, medical locum staff covered their duties. They received training to support them in their roles. For example, many middle-grade doctors had recently attended an Advanced Trauma Life Support course.

Managers provided nursing staff of all levels with opportunities to learn. Staff were supported to keep their professional knowledge and practice up to date.

Managers considered skill development and staff aspirations. Managers matched staff to patients who required one-to-one support, based on their skills and experience.

Managers told us they provided new staff, including bank and agency with an appropriate induction. This included basic care competencies and fire orientation. Medical staff had an additional 2-day face to face induction on emergency medicine principles.

The evidence showed a good standard. The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service held regular and effective multidisciplinary team (MDT) meetings. Staff told us the meeting structure worked well, kept everyone informed and enabled good team working across the department.

Managers attended a clinical site meeting at 8.30am to brief the wider hospital on the status of the department. This included the number of people in the department, the number of people with a decision to admit (DTA), and the number of people waiting over 12 and 24 hours. This data fed into the wider hospital data set collected from other departments and was used to predict upcoming capacity for DTA patients to be transferred to wards.

Managers and staff attended a daily situation report (sitrep) meeting at 9.30am. Staff used the electronic patient record (EPR) system to identify and review individual patients in the department and their onward clinical plans. They discussed patients arriving by ambulance and average waiting times for specific areas of the department. Staff provided bed updates for the critical care unit (CCU) and intensive care unit (ICU) for the wider hospital. Further sitrep meetings were held at 12.30pm and 3.30pm, which modelled the same agenda.

Staff shared information about patients at effective handover meetings. The service had separate nursing and medicine handovers focused on patient care. A senior nursing handover occurred at the end of each shift, and a written record was filled out to reflect the staffing, capacity, and alert status of the department.

The service had effective working relationships with most of the teams who supported the department. These included (but were not restricted to) the acute oncology service, tissue viability, children and young people’s mental health services, and the adult psychiatric liaison service. Staff also worked with discharge teams, community practitioners and palliative care teams.

However, we received mixed feedback about how well specialties worked with the department. Leaders told us that to improve this, they had collaborated with specialty colleagues to agree internal professional standards to support the existing referral policy. This included details such as timeliness of review and diagnostic tests. It also clarified that if there remained disagreement over which specialty team should take charge of the clinical care for a patient, the doctor in charge of the emergency department would escalate with their specialty colleagues.

We were told that consultants and senior nurses had monthly meetings which followed a set agenda. However, we found that the nursing meetings had not run from April 2024 to February 2025 due to annual leave which raised concerns over how department issues were discussed during this period.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. Staff did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff did not always ensure that outcomes were positive and consistent. For example, the service identified through a RCEM review of pain management in October 2024 that they were not meeting RCEM guidelines of administering pain medication within 15 minutes of initial assessment or reviewing pain score after an hour. Staff repeated this audit in April 2025 with a similar performance. However, leaders told us that they felt the audit had benefits which included an improvement in pain score documentation, pain medicine prescribing rates, and pain score reviews after 1 hour.

Staff reported challenges with the accuracy of some computer systems. They said these issues caused difficulties with communication and the monitoring of patients in the department. Staff expressed concern that this may have indirectly affected patient outcomes. However, staff used computer systems to monitor waiting times and referrals for diagnostic tests and investigations.

The service used recognised tools to support the early detection and response to clinical deterioration. Staff used the National Early Warning Score 2 (NEWS2) as the clinical assessment tool to determine clinical need and monitoring for signs of deterioration. Staff ensured patients were reviewed by a suitable clinician or transferred within the department or to a ward, depending on their condition.

During our assessment, we observed staff in the resuscitation area using NEWS2 scores to discuss and prioritise patients during handover meetings.

Data showed between May 2024 and January 2025 the unplanned reattendance rate for adults was 1.8% which was in line with the national average.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions.

We reviewed 20 patient records and found that staff had correctly assessed capacity to consent, and people understood their plan of care.

Staff made best interest decisions when patients lacked capacity. They recognised the importance of respecting the person’s wishes, feelings, culture and history.

The service respected advanced care plans when available. Staff kept family members and advocates updated about care.

The service provided an audit completed in April 2025 which showed 100% compliance to the Mental Capacity Act (MCA) 2005.

The service used a nationally recognised tool (the 4 ‘A’s Test’) to assess patients for the risk of delirium. Staff completed a delirium audit for the period February to May 2025. The audit showed that staff completed a delirium test for 95% of patients who met the criteria to be tested (patients presenting with new or unknown confusion, or over 65 years old).

Staff had access to the mental health team 24 hours a day to support them and patients. This was through the psychiatric liaison service run by the partnership mental health trust. Staff told us they felt the service was responsive and supportive.

Staff understood the specific requirements of taking consent from children, including the Gillick competency. The Gillick competency is when children under 16 can consent to their own treatment if they are believed to have enough intelligence, competence and understanding to fully appreciate what is involved in their treatment.