Medway Maritime Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

We assessed 3 quality statements for the responsive 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 did not always feel well-supported, cared for or treated with dignity and respect.

The service was not easy to access. People were not always involved in decisions about their care. The service provided information people could understand but were in the process of improving this further.

However, people knew how to give feedback and were confident the service took it seriously and acted on it. Staff worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to withdraw or not receive care.

This service scored 46 (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 shortfalls. The service did not always make sure people were at the centre of their care and treatment choices. However, they did work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Patients said they did not always feel at the centre of their care and treatment at busy periods in the department.

Staff could not always make reasonable adjustments due to crowding and limited staffing. Despite efforts, patients did not consistently receive the support they needed to access the service. For example, one patient needed support with their mobility when toileting. Due to their mobility and frailty challenges, they were left for long periods on a commode without the ability to seek assistance.

However, patients felt involved in planning and shared decision-making when staff were available. In the 2024, urgent and emergency care survey, the department scored in line with other trusts for patient involvement. Patients and relatives said staff showed good intent and a willingness to help, even when busy.

Staff recognised and supported patients’ multi-faith needs where possible.

Staff supported patients with complex mental health needs to stay settled and monitored associated risks. They cared for these patients in the Clinical Decision Unit (CDU) with help from agency mental health nurses and staff nurses. However, the environment was not suitable for meeting mental health needs over extended periods.

The department had 7 dementia champions supporting patients living with dementia. Volunteer enhanced care buddies also provided additional support.

After the department’s latest Patient Led Assessment of the Care Environment (PLACE) assessment, staff introduced clocks showing the time, day and date to help patients with cognitive challenges stay oriented.

The department was supported by 2 learning disability nurses who could be called when needed. Nursing managers and the learning disability team were developing a sensory box with resources for patients with learning disabilities.

Although we did not observe care for these patients during the assessment, patients or carers could speak with the team to request a hospital passport to express their needs.

Staff supported patient’s religious and spiritual beliefs. Chaplin support could be accessed from the wider hospital and there was a dedicated chapel on the hospital site that could be accessed by all faiths.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, they were working towards solutions.

The service did not consistently meet the Accessible Information Standard (AIS). The department and trust had an AIS workplan highlighting gaps, particularly in staff recognising patients who needed reasonable adjustments due to poor documentation.

The workplan also identified the need to improve translation services, with actions underway and solutions expected by August 2025. For example, one solution leaders told us retrospectively following our on-site assessment was that they had funded and trained 25 staff in British Sign Language (BSL) and has a further 25 staff members awaiting a start date for their training. Managers were also developing a BSL service, as recommended by an external report.

However, managers introduced mandatory training on learning disability and autism in April 2025 and aimed to expand AIS training further.

The department provided leaflets on treatments, local services and complaints in accessible formats, including braille, enlarged font, and electronic versions with read-aloud and translation functions.

A hearing loop supported patients with hearing impairments. In the 2024 urgent and emergency care survey, the trust scored 6.9 out of 10 for hospital environment and facilities, in line with other trusts.

Staff notified external bodies when required, and we found no concerns with information governance.

The service provided real time waiting information for patients arriving in the department. Digital displays reporting wait times were available to patients who had not yet been treated and regularly updated.

Staff used a computer system to share patient information with other health and care providers. GP discharge letters were generated and sent electronically to the relevant practice within 24 hours of the patient's attendance at the department. This ensured that the GP was aware of the patient attending the emergency department and the outcome.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed significant shortfalls. The service did not make sure that people could access the care, support and treatment they needed when they needed it.

Patients could not always access care, treatment, and support promptly due to capacity constraints and patient flow across the hospital.

Patients described long waits in the department, especially when waiting for ward admission. At the time of our assessment, the longest wait was 40 hours, excluding patients with mental health needs who waited significantly longer.

Data showed between May 2024 and January 2025 that the average time non admitted patients spent in the department was over 4 hours and admitted patients was over 32 hours.

Evidence showed that 10 to 21 patients with mental health needs per month waited over 24 hours in the Clinical Decision Unit (CDU). Patients and families said clearer communication from staff would have helped manage expectations and reduce uncertainty.

Department managers and staff said patients could not always access timely support and treatment due to flow and capacity pressures. Delayed ward discharges for patients awaiting social care contributed to this. Staff said flow issues had become normalised. They viewed temporary escalation and waiting areas as an improvement, but not a long-term solution.

Staff cared for inpatients in outpatient clinic rooms within the Same Day Emergency Care (SDEC) area. In one case, 3 patients shared a clinic room with privacy dividers and had waited over 48 hours. Staff had not completed nursing or risk assessments, and we raised this with senior managers who took immediate steps to ensure that these assessments were completed.

Managers later told us SDEC was used as a temporary escalation area. They acknowledged assessments should have been completed but said staff were unaware they could access the system from SDEC computers.

Using the SDEC as a temporary escalation area limited its availability for patients who did not require emergency department care and could otherwise have been safely and efficiently treated and discharged directly from SDEC.

Specialty referral processes contributed to delays in the department. Patients did not always experience smooth transitions between services due to unclear referral criteria, leading to disagreements between teams, particularly in vascular, surgical and orthopaedic cases.

In one example, a patient arrived at 1.59pm, was triaged at 2.07pm, and faced a 4-hour delay due to disagreement between medical and surgical teams over responsibility. Staff said such disputes were common, especially for vascular patients. The department lacked an in-house vascular team and relied on external input, which caused further delays. One patient was seen at 9am with a vascular emergency and by 5pm had still not received any update on their care. Staff said patient stays over 24 hours caused confusion due to multiple medical teams taking over care. A senior clinician managed handover, but poor communication often affected continuity.

Managers acknowledged the issue and said senior staff had revised referral pathways after a 2024 event with department and specialty team leads. They planned to launch new frameworks shortly and expected improvements, though noted these would take time to embed. Leaders were also developing processes associated with improving delays in the department. For example, medical clinicians provided an in-reach service for patients awaiting a specialist review in the department. We were partially assured and recognised that managers had identified this as a key factor affecting flow.

Despite concerns in the department, ambulance handover performance was strong, with minimal delays over 30 minutes. Senior managers said they prioritised admitting patients from ambulances to avoid delays with patients requiring ambulances in the community. They believed assessing risk inside the department was safer and helped release ambulances to support the wider system.

Clinical site managers maintained effective communication with the ambulance service, feeding into the clinical site meeting structure to manage dynamic risk.

Leaders escalated concerns and declared critical incidents in response to demand pressures. On day 1 of our assessment, the department enacted Operational Pressures Emergency Level (OPEL) 4 to highlight the need for additional support.

Managers and staff remained alert to discrimination and inequality, and leaders understood the impact of local socio-economic deprivation.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.