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Queen Elizabeth The Queen Mother Hospital Requires improvement


Inspection carried out on 24 October to 25 October 2018

During an inspection to make sure that the improvements required had been made

We inspected services for children and young people at Queen Elizabeth the Queen Mother Hospital on 24 and 25 October 2018. The inspection visit on 24 October was unannounced and began at approximately 8.30pm.

This responsive inspection was undertaken because we had received concerning information from members of the public and staff about the Emergency department and children’s inpatient wards. We had also identified concerns about the care of children during our May 2018 inspection when we inspected the emergency department and operating theatres but did not review services for children and young people as a separate core service.

As part of this inspection, we reviewed the care and treatment of children and young people from birth to 18 years in the two acute hospital sites with children’s inpatient units. Some outpatient services for children are provided at the Kent and Canterbury Hospital site and from Buckland Hospital in Dover, but there are no inpatient services there. We did not inspect clinics or community services as the inspection was focused on the areas of concern.

We rated the children and young people’s services at Queen Elizabeth the Queen Mother Hospital as Inadequate overall. We fed back our immediate concerns to the chief executive officer, the director of nursing and quality, the medical director and the quality improvement programme lead.

The services for children and young people were not safe.

  • Resources for children and young people with mental health problems were not sufficient to ensure they, other children and staff remained safe.
  • The recognition and management of deteriorating patients was inconsistent and senior clinicians did not follow the trust protocols or national guidance on the management of sepsis.
  • People were at risk of cross infection of communicable diseases because of poor facilities and poor practice.
  • Staffing levels were insufficient to meet the needs of children and young people.
  • There was insufficient attention paid to safe medicines management.
  • Incidents were not identified, nor reported and there was very limited learning from incidents.

The services for children and young people were not effective.

  • The trust could not identify shortfalls in care nor benchmark their performance against other trusts as there was limited participation in national audits.
  • Local audit results were inaccurate and there were conflicting results from different audits. An example of this was a report of sepsis that gave falsely positive information and which could not have been accurate based on the early warning scores contained within the report.
  • Pain was not always managed in a timely manner.
  • Fasting times before surgery did not follow current best practice and put the needs of the service before the needs of the children.
  • Staff had no training in de-escalation techniques or managing children with mental health problems.
  • Staff reported that staff shortages were such that they could not attend planned training.
  • The trust did not resource children’s services at Queen Elizabeth the Queen Mother Hospital in line with the current intercollegiate guidance.
  • There were gaps in the seven-day service provision that meant children had to be treated in adult environments by adult staff.
  • Out of Hours consultant cover did not meet the intercollegiate standards.

Improvements were needed in the care and compassion shown to children and families.

  • Receptionists in the main accident and emergency department were sometimes offhand with parents of children. We observed that staff did not make eye contact nor smile at parents who were very anxious and needed reassurance.
  • One receptionist told a mother of a visibly unwell child that she was lying about not being triaged.
  • Senior staff used unfavourable stereotypes when describing parents, particularly those from specific areas.

The services for children and young people were not responsive.

  • The flow of children and young people through the accident and emergency department was confused and not understood by staff.
  • Senior staff and operational staff argued in front of the inspection team about which was the correct pathway for children to move through the department.
  • Children were required to wait in the adult waiting area. This included at night when it was crowded and when some adults were likely to be drunk or volatile.
  • The service for children with mental health problems was insufficient and failed to protect the children, other children or staff. Whilst this service was commissioned by the Clinical Commissioning Group from a third party, the inadequacy should have been addressed by the trust.
  • There was limited provision for and a lack of understanding of the needs of children and young people with learning disabilities or autism.
  • There were frequent breaches of the four-hour emergency department target.
  • Urgent referrals were not always seen within the expected referral to treatment times.
  • The journey to theatres had not been adapted to be child friendly.
  • A lack of overnight accommodation for mothers of babies on the Special Care Baby Unit meant that establishing breastfeeding was more difficult, increased the risk of maternal mental ill health and was likely to impact negatively on mother and baby bonding.
  • There was very limited consideration of the needs of young people aged 16 years to 18 years.

The services for children and young people were not well led.

  • There was not a clear, well understood vision and strategy for the service.
  • Governance and risk management processes were ineffective and provided false assurance to the board.
  • Leadership was confused with a lack of oversight of all the children using trust services.
  • Staff reports of the culture within the service were variable with some reporting bullying, oppression and not being listened to.
  • The NHS Staff Survey results for 2017 showed that overall the trust was in the worst 20% of trusts nationally for staff engagement. The results had worsened for many key findings since 2016.

We saw several areas of good practice including:

  • Parents reported very positively about the care and support the staff on the Special Care Baby Unit offered them.
  • Child bereavement boxes had been purchased by the hospital charity for use in the emergency department when a child had died.
  • The routine use of heel warming made heel prick blood testing less painful and more effective.
  • Staff who were exceptionally busy dealing with a high demand and very sick children remained kind and gentle towards the children.
  • Staff had a clear understanding of their safeguarding role and responsibilities and there was an effective system to provide prompt child protection medicals when needed.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Provide suitable accommodation for children and young people with mental health problems.
  • Review their booking and triage processes to ensure all staff are clear about the pathway children take through the emergency department and to minimise the time before they are assessed by a qualified children’s nurse.
  • Ensure that equipment checks required by trust policies are carried-out.
  • Ensure the safe management of medicines.
  • Ensure that clinicians are aware and follow trust policy and national guidance on the safe management of deteriorating children, testicular torsion and sepsis identification and management.
  • Ensure that children wait in the children’s waiting area at all times. They must not be exposed to volatile behaviour, inappropriate television programmes and unpleasant sights and sounds in the adult waiting area.
  • Review the care of children aged 16 years to 18 years and ensure that their needs are fully considered.
  • Ensure submission of data to national audit programmes to allow benchmarking against other children’s services and to drive improvements.
  • Ensure that they adhere to a local audit plan and use the results to drive service improvements.
  • Carry out a learning needs analysis for nursing staff working with children and young people to assist in identifying what training is necessary and where there are gaps in staff skills and knowledge.
  • Ensure that staff are provided with the necessary training and support to ensure they can carry out their work competently.
  • Ensure compliance with the Health and Social Care Act 2008: code of practice on the prevention and control of infections. To include ensuring there are appropriate isolation facilities in the children’s emergency department for children with communicable diseases.
  • Review their policy and usual practice on pre-operative fasting for children to ensure it is aligned to national guidance.
  • Ensure that up to date policies and protocols are available to staff.
  • Ensure that the needs of children and young people presenting in mental health crisis are considered and met.
  • Ensure the views of children and young people are taken into consideration to aid service provision and make sure the care and treatment meets their needs and reflects their preferences.
  • Ensure that there are no breaches of the four-hour admission to treatment target for children attending the emergency department.
  • Develop a clear vision for children’s services that is recognised and shared by all staff caring for children and young people.
  • Ensure that data and information provided to the board is an accurate reflection of the services being provided to avoid the risk of false assurance.
  • Undertake an assurance review of their children’s service to identify gaps in their assurance and governance processes.
  • Ensure that there is clear, accountable leadership of services for all children from birth to 18 years (and beyond 18 years for looked after children and children in need).

Additionally, the trust should;

  • Provide staff with training in the care of children and young people with autism and learning disabilities.
  • Ensure that the pathway for providing care when a child dies is known and understood by all staff likely to be affected.
  • Provide all staff including senior leaders with training in equality and diversity.
  • Consider providing customer service training for reception staff in the emergency department.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 16 - 17 May 2018

During a routine inspection

Our rating of services stayed the same. We rated it them as requires improvement because:

We rated safe, effective, responsive and well-led as requires improvement, and caring as good. We rated four of four core services as requires improvement.

Inspection carried out on 5th,6th 7th September 2016 and Unannounced 21st September 2016

During an inspection to make sure that the improvements required had been made

The Queen Elizabeth the Queen Mother Hospital (QEQM) is one of five hospitals that form part of East Kent University Hospitals NHS Foundation Trust (EKUFT). The Trust provides local services primarily for the people living in Kent. EKUHFT serves a population of approximately 759,000 and employs approximately 6,779 whole time equivalent staff.

The QEQM hospital has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services.

Following our last inspection of the Trust in August 2015, we carried out an announced inspection between 5th and 7th September 2016, and an unannounced insection on 21st September 2016.

This is the third inspection of this hospital. This inspection was specifically designed to test the

requirement for the continued application of special measures to the trust. Prior to inspection we risk

assessed all services provided by the trust using national and local data and intelligence we received from a number of sources. That assessment has led us to include four services (emergency care, medical services, maternity and gynaecology and end of life care) in this inspection.

Overall we rated the Queen Elizabeth, the Queen Mother Hospital as Requires improvement

Our key findings were as follows:


We rated The Queen Elizabeth, Queen Mother Hospital as Requiring improvement for safe because:

  • There was a shortage of junior grade doctors and consultants across the medical services at the hospital. This meant that consultants and junior staff were under pressure to deliver a safe and effective service, particularly out of hours and at night.

  • The trust did not use a recognised acuity tool to assess the number of staff needed on a day-to-day-basis.

  • In Maternity, a lack of staffing affected many areas of service planning and the care and treatment of women. This included not meeting national safe staffing guidelines, meaning 1 in 5 women did not receive 1:1 care in labour.

  • We found poor records management in some areas. Staff did not always complete care records according to the best practice guidance.
  • The trust did not have adequate maintenance arrangements in place for all of the medical devices in clinical use. This was a risk to patient safety and did not meet MHRA (Medicines & Healthcare products Regulatory Agency) guidance. The trust did not have adequate maintenance arrangements in place for the 483 medical devices used in maternity and gynaecology.
  • Mandatory training rates for topics such as adult safeguarding and information governance were low.


  • We saw robust systems in place for reporting and learning from incidents both locally and trust-wide.

  • Ward and departmental staff wore clean uniforms and observed the trust’s ‘bare below the elbows’ policy. Personal protective equipment (PPE) was available for use by staff in all clinical areas.

  • The hospital was clean and met infection control standards.


We rated The Queen Elizabeth, Queen Mother Hospital as Requiring improvement for effective because:

  • Documents and records supporting the learning needs of staff were not always competed and there were gaps in the records of training achieved.

  • The trust had not completed its audit programme. This meant the hospital was not robustly monitoring the quality of service provision

  • Appraisial rates across the hospital needed to be improved.

  • There was poor compliance in the use of the end of life documentation across the wards we visited which was reflected in the May 2016 documentation audit undertaken by the SPC team.


  • Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation.
  • Comfort rounds had been performed and audited. These provided good assurance that pain assessments had been performed, analgesia administered.


We rated The Queen Elizabeth, Queen Mother Hospital as Good for caring because:

  • Staff treated patients with kindness and compassion.
  • Patients and relatives we spoke with were complimentary about the nursing and medical staff.
  • Patients were given appropriate information and support regarding their care or treatment and understood the choices available to them.


We rated The Queen Elizabeth, Queen Mother Hospital as requires improvement for responsive because:

  • Performance indicators such as patients being seen within four hours in A&E remained below trust target and national averages.

  • Delayed discharges remained a concern. However, as part of this response we observed an operational communications meeting, which showed the trust was addressing patient flow through the hospital.

  • The hospital was not offering a full seven-day service. Constraints with capacity and staffing limited the responsiveness and effectiveness of the service the hospital was able to offer.

  • Patients’ access to prompt care and treatment was worse than the England average for a number of specialities. The trust had not met the 62-day cancer referral to treatment time since December 2014. Referral to treatment within 18 weeks was below the 90% standard as set out in the NHS Constitution and England average for six of the eight specialties from June 2015 to May 2016.
  • Services did not always meet people’s needs, for example, women had to divert to another hospital on 22 dates between January 2015 and June 2016. Also, the trust did not monitor the percentage of women seen by a midwife within 30 minutes and a consultant within 60 minutes during labour.


  • The trust employed specialist nurses to support the ward staff. This included dementia nurses and learning difficulty link nurses who provided support, training and had developed resource files for staff to reference. Wards also had ‘champions’ who acted as additional resources to promote best practice.

Well led

We rated The Queen Elizabeth, Queen Mother Hospital as requires improvement for well led because:

  • In some areas risk management and quality measurement were not always dealt with appropriately or in a timely way. Risks and issues described by staff did not correspond to those
  • Where changes were made, appropriate processes were not always followed and the impact was not fully monitored in maternity and gynaecology services
  • No separate risk register was available for palliative /end of life care. A separate risk register would allow the risks to this patient group be discussed regularly at the end of life board, and allow plans to be made to alleviate any identified risks.
  • Changes in leadership in end of life care and maternity services had only recently been realised and as a result had yet to fully
  • address the issues relating to these services


  • The hospital had well-documented and publicised vision and values. Their vision was to provide ‘Great healthcare from great people’, with the mission statement ‘together we care: Improving health and lives’. These were readily available for staff, patients and the public on the trust’s internet pages, posters around the hospitals and on the trust’s internal intranet.

We saw some outstanding practice including:

  • Improvement and Innovation Hubs were an established forum to give staff the opportunity to learn about and to contribute to the trust’s improvement journey.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure the number of staff appraisals increase to meet the trust target. So that the hospital can assure itself that staff performance and development is being monitored and managed.

  • Ensure the trust’s agreed audit programme is completed and where audits identify deficiencies that clear action plans are developed that are subsequently managed within the trust governance framework. To have assurance that best practice is being followed.

  • The trust must ensure that there are sufficient numbers of staff with the right competencies, knowledge, qualifications, skills and experience to meet the needs of patients using the service at all times. This includes medical, nursing and therapy staff.

  • Ensure there are systems established to ensure there are accurate, complete and contemporaneous records are kept and held securely in respect of each patient.

  • The trust must ensure that all staff have attended mandatory training.

  • The trust must ensure that there are adequate maintenance arrangements in place for all of the medical devices in clinical use.
  • The trust must take steps to ensure the 62-day referral to treatment times for cancer patients is addressed so patients are treated in a timely manner and their outcomes are improved.
  • Ensure there are sufficient numbers of midwives to meet national safe staffing guidelines of 1:1 care in labour.
  • Ensure maternity data is correctly collated and monitored to ensure that the department’s governance is robust.

In addition the trust should:

  • Review the physical environment within maternity services to ensure it meets the needs of the patients. Specifically temperature control
  • Ensure that the trust programme to improve overall culture also focuses on individual cases of bullying and harassment.
  • Continue to reduce the number of bed moves patients experienced during their stay.
  • Monitor ambient room temperatures where medication is stored.
  • Review the maintenance of medical devises.
  • Include venous thromboembolism data on the department dashboard.

There is no doubt that further improvements in the quality and safety of care have been made since our last inspection in July 2015. At that inspection there had been significant improvement since the inspection in March 2014 which led to the trust entering special measures. In addition, leadership is now stronger and there is a higher level of staff engagement in change. My assessment is that the trust is now ready to exit special measures on grounds of quality, However, significant further improvement is needed for the trust to achieve an overall rating of good.

Professor Sir Mike Richards Chief Inspector of Hospitals

Inspection carried out on 13-17 July 2015

During a routine inspection

The Queen Elizabeth the Queen Mother Hospital (QEQM) is one of five hospitals that form part of East Kent University Hospitals NHS Foundation Trust (EKUFT). The Trust provides local services primarily for the people living in Kent.

EKUHFT serves a population of approximately 759,000 and employs approximately 6,779 whole time equivalent staff.

The QEQM hospital has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services.

Following our last inspection of the Trust in March 2014 when we found many of the services provided to be inadequate, EKUHFT was placed into special measures by the regulator Monitor. This announced inspection was undertaken to monitor and assess what progress the Trust had made in addressing our concerns.

We carried out an announced inspection of EKUHFT between 13- 17 July 2015. We also undertook unannounced visits the following week on 29 July 2015.

At this inspection although we found the hospital overall to require improvement we noted there had been improvements made in the majority of services we inspected.

Our key findings were as follows:


  • At the last inspection we told the Trust they must ensure there were appropriate levels and skills mix of staffing to meet the needs of all patients. At this inspection we found that although staffing overall had improved through a sustained recruitment initiative and the use of agency and bank staff, recruitment continued to be a problem for the hospital. The numbers, skills and qualifications of staff did not always reflect the needs of patients.
  • Although the Trust had revised the adverse incident and serious incident policy and had trained more staff in incident investigation and Root Cause Analysis, patients were not always protected from inappropriate or unsafe care because staff were not always reporting incidents. Where incidents were reported there was good evidence that learning was shared and actions taken to prevent reoccurrence.
  • The environment was not always a safe place to care for patients. For example there was only one obstetric operating theatre for both emergency and elective procedures; the flooring in the corridor areas on St. Augustine’s ward was uneven, dirty and badly worn with tears in the covering. The toilets did not always conform to requirements under the Disability Discrimination Act (DDA) and were unable to accommodate patients with walking aids. Shower and bathrooms were used as storage facilities and cluttered making them unfit for patient use. The layout of the day care unit did not meet best practice in infection control and presented a contamination risk; Fire safety concerns were raised in both the midwifery wards, theatres and on St Augustine Ward. The poor state of the environment was an issue raised at the previous inspection.
  • Access to and availability of equipment had improved since our last inspection through the implementation of an equipment library. However equipment was not always cleaned and checked in line with trust policy and there areas in the hospital where appropriate equipment was not readily available. For example there were insufficient fetal monitoring machines in the maternity department, a weighing machine and stand aid on St Augustine Ward had not been serviced and decommissioned autoclaves remained in theatres.
  • We found that the theatres did not comply with national guidance in relation to risk assessment; the environment, and staff training.
  • Staff were aware of the policies for infection prevention and control and adhered to them. The majority of clinical areas we visited were visibly clean and tidy.
  • We found that attendance at mandatory training had improved along with the system for recording and monitoring attendance although the mandatory training targets and agreed actions had not been achieved.
  • The recording of patient assessments and the documentation and monitoring of patients’ treatment, needs and observations had improved since our last inspection. Patient observations were undertaken electronically and regular audits were undertaken to check that information was recorded appropriately.


  • Most of the services we inspected provided effective care. National guidance was used to inform the care and treatment of patients and services participated in national and local audits.
  • At the last inspection we found that the paper and electronic policies, procedures and guidance that staff referred to when providing care and treatment to patients were out of date. The Trust had undertaken a major review of the Trusts policies and procedures and apart from the emergency department and medication policies, the majority were now current and reflected best practice.
  • We found that although the wards and consultants offered a seven day service they were not always supported by other services. This limited the responsiveness and effectiveness of the service the hospital was able to offer and on occasions delayed discharge. For example there was no access to therapy staff, dieticians or speech and language therapists (SALT) at weekends on the stroke ward. Pharmacy services only available until midday at weekends, which impeded timely discharge for patients who were unable to obtain their discharge medication.
  • We found that patients were always asked for their consent before any intervention and this was always appropriately recorded.
  • There was good multidisciplinary working throughout the hospital.
  • In general patients received timely effective pain relief and their nutritional needs were being met.


  • Patients throughout the hospital commented positively on their experiences. They told us they received kind and compassionate care, which maintained their dignity and respected them as individuals.
  • We saw caring and compassionate care being delivered throughout the hospital but in particular we observed staff in the outpatients and diagnostic and imaging department treating patients, relatives and visitors with respect and thoughtfulness.


  • We found that the hospital did not always have sufficient bed capacity to meet the needs of the patients admitted. This meant that patients were often moved between wards during their stay, they were admitted to non-specialty beds where their own doctors were difficult to contact and consultant reviews less likely to occur. The lack of capacity had negative implications for the safe care and treatment patients.
  • Patient flow through the surgical services was limited by availability of beds at times, caused by delayed discharges. In turn delayed discharges associated with provision of on-going support, rehabilitation and delays in take home medication adversely impacted on the hospital’s bed capacity. This was raised as a concern at the last inspection.
  • In the emergency department there was no emergency assessment room for patients with acute mental health needs.
  • Surgical referral to treatment times were not being met over consecutive months for surgical specialties. Theatres were not always effectively utilised and this affected performance.
  • Improvements were needed for the day-care environment, as this did not provide sufficient privacy.
  • Arrangements were in place to support people with disabilities and cognitive impairments, such as dementia. Translation services were available and information in alternative languages could be provided on request.
  • The complaints process was understood by staff and patients had access to information to support them in raising concerns. Where complaints were raised, these were investigated and responded to. Where improvements were identified, these were communicated to staff through a range of methods.

Well Led

  • The Trust had implemented a Special Measures Action plan following our last inspection. The action plan identified where issues had been raised during inspection and outlined actions to be taken by the Trust along with an agreed timescale. This action plan had been RAG rated on delivery of objectives.
  • We found that the Trust had taken action to refocus its vision and mission strategy. Staff at QEQM were articulate in understanding the Trust’s vision and described how the organisation’s mission to provide safe, patient focussed and sustainable health services with and for the people of Kent was simple but something they felt committed to.
  • There was a clear direction of focus underpinned by the values of providing effective care, respecting one another, people feeling safe and involved and able to contribute to change. Work was in progress to develop the directorate strategic aims and principles. Although there was now a clear direction of focus in many of the services, others such as the midwifery unit lacked a clear strategy and strategic direction.
  • However many of the leadership, organisational and developmental changes were in their infancy and had not had time to deliver the necessary changes to the patient experience.
  • Some services such as the midwifery service had been through a period of instability of leadership which led to a great deal of staff dissatisfaction and unrest. Although progress was being made to stabilise the midwifery service with appointments to a number of interim, acting and substantive posts, a number of staff remained unhappy.
  • The Trust had identified there had been a culture of bullying and harassment within the trust. We found at QEQM there were still pockets where staff felt intimidated and were not confident to speak out. The Trust told us of the actions and initiatives that were taking place to address these concerns.
  • Governance arrangements throughout the hospital had been strengthened and were starting to provide more robust information to staff at all levels and to the Trust Board.

We saw several areas of outstanding practice including:

  • Outpatients where substantial changes had taken place since our last inspection and the service offered was focused on ensuring that patients received a positive experience when attending the hospital.
  • The pre-operative joint clinic is recognised as enhancing patient outcomes.
  • The Nurse leadership in outpatients was outstanding with staff inspired to provide a good service to patients. The main outpatient’s matron provided knowledgeable and inspiring support to staff working hard to maintain and improve the service.
  • The care pathway for patient discharged with ridged cervical collar in place is acknowledged for contributing to on-going response care to individuals.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must take action to ensure that HTM 05-01 is complied with in operating theatres, particularly with respect to; risk assessment; the environment, and staff training.
  • The trust must take action to remove the decommissioned autoclave from theatres.
  • There must be sufficient numbers of suitably qualified, skilled, and experienced midwifery staff available to deliver safe patient care in a timely manner.
  • The environment and facilities in which patients are cared for must be safe, well maintained, fit for purpose and meet with current best practice standards.
  • There must be sufficient equipment in place to enable the safe delivery of care and treatment, that the equipment is regularly maintained and fit for purpose to reduce the risk to patients and staff.
  • The Trust must ensure the hospital has sufficient capacity to cope with the number of women in labour and new born babies on a day to day basis.
  • The wards must be supported in providing a full seven day service by appropriate numbers of support services such as radiology, physiotherapy and pharmacy.
  • There must be robust systems in place to monitor the safe management of medicines to ensure that national guidelines are reviewed appropriately and their implementation monitored.
  • Ensure that required signatures are included in CD registers.
  • Ensure that temperature checks are monitored and recorded on fridges used to store medicines and food supplements.

In addition the trust should:

  • The trust should ensure that the mandatory training targets and agreed actions are achieved.
  • Consider how it can address staffs knowledge and understanding with respect to the Mental Capacity Act (2005) and deprivation of liberty safeguards.
  • Ensure that all safety checks on equipment are carried out.
  • Consider how it may improve the environment in the day surgical unit.
  • The trust should consider how it may move forward with the implementation of the dementia care work to bring it to fruition.
  • The trust should continue to improve referral to treatment times across all specialities to ensure that patients are treated in an acceptable timeframe following referral to the service.
  • Standardising inotropic infusions to avoid the risk of potential drug errors when staff engage in cross site working.
  • There should be a formal vision and strategy for women’s health services to enable the development of a modern maternity service which is woman centred, underpinned by a sound evidence base and benchmarked against best practice standards.
  • Methods of maintaining the stability of leadership within the maternity department should be established.
  • The routine administrative burden on maternity staff at weekends and out of hours should be reduced in order to free midwifery staff to look after patients.
  • Staff should be encouraged to report non-clinical incidents in order that action can be taken to protect patients from avoidable harm.
  • The electronic system for allocating NHS numbers to new born babies should be functioning, in order to avoid the risk of babies missing screening tests through a manual process with insufficient printers available.
  • There should be a robust system in place to measure, monitor and analyse common causes of harm to women during pregnancy and childbirth.
  • Continue to work with commissioners to ensure there is adequate funding and resources for the End of Life service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 6, 19 and 20 March 2014

During a routine inspection

The Queen Elizabeth The Queen Mother Hospital in Margate is an acute hospital. It is one of three hospitals that form the East Kent University NHS Foundation trust. It has a total of 388 beds, providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services. The hospital dates back to the 1930s when the original building was constructed. Between 1996 and 1998 most services were relocated and expanded into a new main hospital building linked to the original facilities. The hospital has a specialist centre for gynaecological cancer and modern operating theatres, Intensive Therapy Unit (ITU) facilities, children’s inpatient and outpatient facilities, a new Cardiac Catheter Laboratory and Cancer Unit.

We inspected services at The Queen Elizabeth The Queen Mother Hospital, namely the accident and emergency, medical care, surgery, critical care, maternity and family planning, children and young people, end of life care and outpatients.

Overall this hospital was rated as ‘requires improvement’. The hospital was rated as ‘requires improvement’ for safety, effectiveness and responsiveness. Caring was ‘good’ and well-led was ‘inadequate’. The Accident and Emergency services were rated as ‘inadequate’.

Our key findings were as follows:

  • The A&E department did not have sufficient levels of staffing to ensure a safe service was provided. There was an over-reliance on locum staff which created risks to safety.
  • Safety in the A&E department was not a sufficient priority.
  • The hospital was not well-led.
  • Many patients experienced delays in leaving hospital because they were waiting for their medications. One patient we met had waited five hours.
  • We were told that staff were reluctant to fill in the staff surveys as they did not believe it was confidential and did not trust the organisation not to penalise them for making adverse comments.
  • Patients who attended pre-assessment before undergoing surgery experienced long waits before seeing the doctor. We met two patients who had waited over two hours and staff told us this was not unusual.
  • There was not enough staff to provide a safe service to women during their pregnancy. The midwife to birth ratio was up to beyond 1:33. This was above the national recommended ratio of midwives to births of 1:28.
  • Services for children and young people were not effective.
  • Not all ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNA CPR) forms documented the involvement of patients and their relatives. Some were not signed by a senior health professional.
  • Staff were disempowered to make changes in the outpatients service. They were aware of the issues but they felt unable to make improvements to the service.

We saw several areas of outstanding practice including:

  • Staff were caring
  • There were good clinical outcomes for patients who had a stroke. The length of stay for stroke patients was 13.2 days with an expected rate of 17.5 days compared to similar trust’s (January to December 2013 data).
  • The critical care unit monitored its performance and data from Intensive Care National Audit and Research Centre (ICNARC) and showed that patient outcomes were good.
  • Staff had learnt and changed practices as the result of ‘Never Events’ in the maternity services.
  • Incident reporting was leading to learning and changes in the outpatients’ service.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure there are appropriate levels and skills mix of staffing to meet the needs of all patients.
  • Ensure safety is a priority in A&E.
  • Ensure patients leave hospital when they are well enough with their medications.
  • Ensure that maintaining flow through the hospital and discharge planning is effective and responsive. Patients must not be moved numerous times, and not during the night. When patients are well enough they must leave hospital.
  • Ensure that staff are aware that at a board level there is an identified lead with the responsibility for services for children and young people.
  • Ensure staff are fulfilling their roles in accordance with current clinical guidance.
  • Ensure medications are stored safely.
  • Ensure the administration of all controlled drugs is recorded.
  • Ensure that procedures for documenting the involvement of patients, relatives and the multi-disciplinary team ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNA CPR) forms are followed at all times. All forms must be signed by a senior health professional.
  • Ensure patients are not experiencing unnecessary waits for follow up appointments at outpatients and when waiting in outpatients for appointments.
  • Ensure there is adequate administrative support for outpatients. On the day of our inspection one medical secretary was responsible for sending out 1,660 GP appointment letters and had not met the within 72 hour target.

In addition the trust should:

  • Ensure quicker response time to prevent escalation of Grade 2 pressure ulcers to Grade 3.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 7 May 2013

During an inspection to make sure that the improvements required had been made

We spoke with 10 patients, 14 staff and four relatives across the four wards we visited at the hospital.

All the patients we spoke to told us they were treated with dignity and respect. However, some patients told us that doctors did not always pull the curtains when discussing care or examining them, but the nurses always did.

One patient said “The nurses are great. There are some people here that need help to eat and they get the help they need”. One relative said “The care has been really good and any minor complaints I have had, have been sorted out by the ward manager”.

Patients said the wards were kept clean and nurses always washed their hands.

Inspection carried out on 16 August 2012

During a routine inspection

We spoke with 70 people across the six wards we visited at the hospital.

All the people we spoke to told us they were treated with dignity and respect.

They said: "The staff are doing a wonderful job, they are polite and respectful". "I can't fault any of the staff; I have received a first class service." "This ward is brilliant, not like other wards I have been on."

People said the staff took time to discuss with them how things were going. One person said, "They always tell me what is happening like when the consultant is due to do his rounds ". Another person told us, “It is good that they discuss everything in the open. You don’t feel that they are hiding things from you”.

On all the wards most people said that they were satisfied with the food provided. One person said, “You couldn’t wish for a better service I reckon”. Another person said that they had wanted more gravy and that it was “no trouble at all”.

People said the wards were kept clean and nurses always washed their hands but they did comment that they did not see the doctors wash their hands.

People spoke positively about the staff. They said the staff were polite and nice but they were busy. A person on Cheerful Sparrows Male said, "They're very kind and polite to me. They take their time and treat me well."

All of the people spoken with did not have any complaints about the service but did say they would speak to a member of staff or a relative if they had any concerns. "I would definitely say something if things went wrong, but I have no complaints".

Inspection carried out on 21 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.

Inspection carried out on 15 September 2011

During a routine inspection

People told us they were involved in their treatment and support. "I was given some leaflets when I first came here. I don’t think there is any room for improvement. I think my privacy and dignity has been maintained when I need privacy I've had it".

People felt safe using the service and that there were usually enough staff on duty. "The staff are so careful about looking after you they make sure you do not fall". “The staff are all so kind and friendly and the care they provide is second to none”. "It is a very open culture here we can ask each other anything or go to the management about any concerns".

They said that staff were well trained, polite, kind and caring. "Staff are very polite indeed I can not fault them". "Staff really understand what I need… they take great pains to explain things."

In some cases people said that they were given opportunities to say what they thought about the service. "I have not given my opinion about the service but feel at home and I know exactly what is going to happen. I could not have been better treated."

Inspection carried out on 13 April 2011

During a themed inspection looking at Dignity and Nutrition

Most people were happy with their care and treatment. Some people said they were pleasantly surprised. They said that staff treated them with respect and were particularly complementary of the male staff who they said were extremely polite. People said that their treatment was clearly explained to them and they were involved in making decisions about what they wanted. People felt their dignity was respected. Some people felt that the curtains were insufficient to maintain their privacy when having conversations about their care and treatment.

Most people liked the food and said there was enough and there were choices on the menu. Some people who were on special diets did not feel that these were well catered for and did not think that the staff were always aware of the foods they could not tolerate. They said there were not always suitable alternatives. People liked the peaceful mealtimes.