Medway Maritime Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

We reviewed 6 quality statements. At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant that service leadership and culture assured the delivery of high-quality care.

Staff felt supported to give feedback and were treated equally, free from bullying or harassment in the department. However, they felt actions taken by leaders could be communicated better. There was a culture of continuous improvement with staff given time and resources to try new ideas. However, there were not always clear outcomes from the projects undertaken. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Leaders mostly understood risks but did not always mitigate them fully. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas.

This service scored 68 (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 a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders had a future strategy for the department aligned with the trust’s clinical strategy. They aimed to centre the flow model around Same Day Emergency Care (SDEC) to ease pressure on other areas, improve performance on length of stay, and strengthen staff cover. However, this relied on the service not using SDEC as a temporary escalation area and caring for patients for extended periods of time. Leaders also planned to develop more community-focused urgent treatment centres and continue promoting education, public health, and research into best practice. However, they did not have a dedicated vision and values document.

Leaders and staff were actively working to improve the department’s culture, focusing on openness, inclusion and empowerment.

Leaders demonstrated growing awareness of local demographics and social needs in Medway and Gillingham. They recognised the impact of socio-economic deprivation on patients with mental health needs and had begun adapting the CDU to better support patients requiring extended stays.

The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The department operated under a triumvirate leadership structure which was made up of the general manager, the clinical medical lead, and the head of nursing. This fed into the senior managers of the department for both the nursing and medical side of staffing.

Leaders and staff were actively working to improve the department’s culture by focusing on openness, inclusion and empowerment. They prioritised safe, high-quality and compassionate care, with staff consistently showing kindness, dedication and a strong work ethic.

Managers modelled these values and supported their teams, earning positive feedback from staff who said they did their best under challenging circumstances.

Staff and managers said the trust leadership team supported them and understood their daily challenges. Staff felt the department had improved since our last assessment but believed further progress was still needed.

Department managers led with integrity, openness, and honesty and made sure they aligned to the organisational strategy when possible. Leaders mostly understood the key risks to the department. They understood the issues, challenges and priorities in their service.

Leaders said the department’s culture had improved since our last assessment and reported early success with new approaches to patient flow. They acknowledged ongoing challenges, including staffing pressures across the trust, but felt supported by their line managers and saw opportunities for growth within the organisation.

Leaders had effective support and opportunities to develop and maintain their skills. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities.

The evidence showed some shortfalls. Staff were not always sure their concerns led to action, but they felt safe to speak up.

Leaders did not always clearly communicate how they responded to staff concerns. For example, although the department had monitored staff security since 2024, some staff were unsure how their feedback had been acted upon, raising questions about transparency.

However, staff said they felt able to speak up and believed leaders listened. Staff described a culture of openness and said leaders were generally receptive.

Department managers supported staff who raised concerns, and staff felt comfortable approaching their line managers. They acknowledged that cultural improvements since our last assessment were underway but would take time to embed.

Patients and carers felt confident using the complaint process and expected a response. Senior leaders handled complaints, and advanced cases included opportunities for face-to-face feedback. Leaders said they valued all feedback and used it to drive improvements where possible.

The trust had moved recently to an independent freedom to speak up service in September 2024.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The evidence showed some shortfalls in governance and risk management. Responsibilities, roles and systems of accountability were not always clear or consistently applied. Leaders did not always act on the best available information about risk, performance and outcomes, nor share it securely when appropriate. Systems and processes failed to manage risks effectively, particularly during periods of crowding, which compromised patient safety.

Staff continued to raise concerns about staffing levels, personal safety and the handling of incident feedback. Despite some actions such as corridor reconfiguration to manage overflow, these measures only partially reduced risk and did not resolve the underlying issues. Several end-of-shift manager reports highlighted high-risk situations managed without sufficient staffing. While staff escalations were acknowledged and support was offered, long-term solutions to persistent challenges with flow and staffing had not been implemented.

Escalation protocols did not alleviate crowding, which staff described as an accepted norm. Computer systems also contributed to difficulties with patient flow and identification. Although leaders set goals to manage these risks, they were unable to achieve them due to ongoing pressures.

Despite these challenges, leaders demonstrated proactive oversight through daily safety huddles and clinical site meetings, and escalated capacity concerns to the wider hospital. They used accurate information to inform decisions and employed tools such as a nationally recognised staffing tool and heat map analysis to optimise staffing.

The departmental risk register reflected key concerns—crowding, patient dignity, SDEC overnight use, safety of patients with mental health needs and budget constraints. The risk register included graded risks and action plans.

Leaders responded to incidents by introducing new security measures following events where patients with mental health needs left the SDEC and CDU areas without authorisation. They increased security presence and reviewed car park structures to improve safety. Fire safety risks were also addressed through updated evacuation plans for patients cared for in temporary escalation areas, which led to a successful Fire Service inspection.

Governance structures included departmental meetings feeding into the wider emergency care and medicine triumvirate. Leaders used a clear framework to ensure essential information such as learning from incidents and complaints was shared. The triumvirate began formally minuting meetings in February 2025.

Trust leaders engaged with improvement programmes and sought external advice. There were business continuity plans for emergencies and natural disasters.

Staff maintained clear roles and responsibilities, and systems ensured confidentiality of data used to monitor and improve care quality.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

Leaders actively engaged with other organisations and responded constructively to feedback. For example, they strengthened their relationship with the local mental health NHS trust by sharing resources to support staffing in the Clinical Decision Unit (CDU). They also worked closely with the local Integrated Care Board (ICB) to secure approval for a new mental health hub, which had recently been authorised for development.

Staff worked effectively with the local ambulance service, demonstrating flexibility and responsiveness when notified of incoming trauma cases. They valued the information provided by ambulance crews and used it to facilitate detailed handovers, enabling safe and timely care. Leaders also worked closely with their ambulance counterparts at a senior level to continue to assess the ongoing strategy.

Leaders were responsive to external organisations and patient groups. For example, they acknowledged recent Healthwatch reports and reviewed emergency department practices to ensure staff felt supported. Staff did not raise concerns about culture and reported improvements since our last assessment.

Staff and leaders felt multidisciplinary (MDT) working within the department was good. Staff highlighted the contribution of community practitioners from the local community NHS trust, particularly in supporting social care identification and improving patient flow.

People’s views and experiences were gathered and acted on to shape and improve the services and culture. People who used services, those close to them and their relatives were actively engaged and involved in decision-making to shape services and culture. For example, people’s views were gathered to draft the visiting charter. The trust produced Community Engagement Updates which outlined all the events and projects that had taken place.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research.

The trust used a recognised improvement programme methodology. The improvement programme helped to improve the care and services provided to the people of Medway and Swale and patients at the centre of all hospital activities. It was designed to give staff the skills, tools and confidence to make small changes that matter most. The 5 key priority areas included Patients, People, Sustainability, Quality and Systems and Partnerships.

Department leaders promoted a culture of learning, innovation, and improvement in the department. They encouraged creative approaches to delivering good experience, outcomes, and quality of life for patients to combat the operational challenges faced by the department when it was busy.

Leaders in the department supported 21 quality improvement and audit projects at both national and local levels. These reviewed areas such as the front door flow model of the department, surgical pain interventions for hip fractures, quality of blood samples, and documentation and compliance with NICE guidelines for urgent CT head scans.

Medical and nursing staff benefited from structured learning and supervision and there was good feedback associated with this.

Leaders commissioned a cultural transformation programme which looked at causes of aggression and why it was occurring in the department. An information gathering phase finished in April 2025 and the review of findings and early implementation work was due to commence in May 2025.