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Maidstone Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 March 2018

A summary of services at this hospital appears in the overall summary above.

Inspection areas

Safe

Requires improvement

Updated 9 March 2018

Effective

Requires improvement

Updated 9 March 2018

Caring

Good

Updated 9 March 2018

Responsive

Requires improvement

Updated 9 March 2018

Well-led

Good

Updated 9 March 2018

Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 3 February 2015

All the patients we spoke with told us they had been treated with dignity and their privacy protected. They spoke highly of the staff in outpatients and radiology. Patients found staff polite and caring. However, many patients complained to us about waiting times in outpatient clinics.

Staff were reporting incidents, and these were discussed at the clinical governance meetings within the directorates. Systems were in place to reduce the risk and spread of infection. Medicines were stored and administered safely. The department held its own training records, which were up to date and demonstrated that most staff had attended mandatory training.

The trust had met its national targets and consistently performed higher than the national average with regard to radiology waiting times. There had been a backlog in reporting computerised tomography (CT) and magnetic resonance imaging (MRI) scans for several months, but there was evidence at the visit that these were being resolved. An ongoing backlog in clinic letters being sent out had not been resolved. There was a risk of patients receiving delayed or inappropriate treatment, and considerable stress caused to staff.

Staff demonstrated a commitment to patient-centred care, and we found many examples of such care and attention to patients’ conditions and preferences.

Maternity and gynaecology

Good

Updated 3 February 2015

Systems were in place to ensure that safety was a priority for maternity and gynaecology services. Women and their babies were treated in a well-equipped environment. National evidenced-based best practice, professional standards and expert guidance were routinely used to ensure that mothers’ needs were assessed and care delivered that was safe and effective.

Feedback from people who used the maternity service was positive about how staff treated them. Women who wanted to give birth at the Maidstone Birth Centre (MBC) were assessed to ensure they were suitable for a low-risk-environment birth. Staff were engaged with innovative practices; they were making changes that had a direct impact on women and improved their experiences.

Medical care (including older people’s care)

Good

Updated 9 March 2018

  • Since our last inspection in 2015, we saw a number of changes.
  • There was an improved culture of incident reporting. Incidents were recorded on electronic systems that incorporated fail-safes about aspects such as duty of candour.
  • Patients and relatives we spoke with gave positive feedback about the care they received on the unit.
  • Staff showed compassion when dealing with patients and protected their privacy and dignity.

However:

  • Although medicines were better managed and more available, some aspects of medicines management still needed improvement.

Urgent and emergency services (A&E)

Good

Updated 9 March 2018

  • Between October 2016 and September 2017 there was an upward trend in the monthly percentage of ambulance journeys with turnaround times over 30 minutes at Maidstone Hospital.
  • Over the period an average of 42% of ambulance journeys had a turnaround time over 30 minutes.
  • From August 2016 to July 2017 the trust reported 364 “black breaches”, with an upward trend over the period. A black breach occurs when a patient spends more than 60 minutes on an ambulance waiting to be seen in the emergency department.
  • A significant backlog of incident investigations and limited evidence of learning from incidents meant we were not assured safety improved as a result.
  • Triage processes were inconsistent and did not always keep people safe. In addition the results of triage records indicated a need for improved quality.
  • Audits identified a need for improvement in the quality of patient records.
  • There was very limited evidence of health promotion work or intervention despite a significant number of patients presenting with alcohol or drug overdoses, or with suicidal intent.

However:

  • The Royal College of Emergency Medicine recommends that the time patients should wait from time of arrival to receiving treatment is no more than one hour. The trust met the standard for all months over the 12 month period between September 2016 and August 2017 although this did not include patients who arrived by ambulance.
  • The unit performed consistently well in the national patient-led assessment of the care environment (PLACE) and in weekly environmental audits. In the previous 12 months, the unit performed better than national and trust averages in all categories.
  • From September 2016 to August 2017, the trust reported no incidents classified as never events for urgent and emergency care.
  • The recruitment of practice development nurses had significantly improved the training and professional development opportunities for staff. This improved tracking and assessment of staff competencies and enabled individuals in different roles to work and develop together.
  • There was a demonstrable track record of well-coordinated multidisciplinary working that contributed to patient outcomes.
  • From January 2017 the trust showed a general trend of improvement in performance against Department of Health access and flow metrics, including the national standard to be seen, discharged or admitted within four hours.
  • There were clear and demonstrable improvements in clinical governance and leadership, and this was reflected in the morale of staff and initiatives to improve performance and risk management.

Surgery

Requires improvement

Updated 9 March 2018

  • The hospital improved in safety, effectiveness and leadership.
  • Safeguarding training levels for nursing staff met or exceeded targets and staff demonstrated good knowledge of safeguarding principles.
  • Records keeping systems had improved. Records we reviewed in the hospital were complete legible and organised.
  • Patient pain levels were closely monitored, staff were proactive about pain management and patients reported good pain management.
  • The trust exceeded its target for Mental Capacity Act (MCA) mandatory training, staff demonstrated a thorough understanding of the MCA and records reflected that capacity was being assessed in line with guidance and consent was gained prior to care being provided.
  • Patients told us they felt they were treated with dignity and respect. They noted that staff were caring, genuine, friendly and kind.

Intensive/critical care

Good

Updated 9 March 2018

Since our last inspection in 2015, we saw a vast number of improvements in critical care.

  • There was a good culture of incident reporting and learning, and all incidents were recorded on the trust wide electronic reporting system.
  • Medicines were well managed.
  • Patient outcomes were mostly in line with or better than other similar critical care units.
  • Compliance with national guidelines had improved.
  • Patients and relatives we spoke to gave positive feedback about the care they received on the unit.
  • Staff showed compassion when dealing with patients.

However:

  • The environment did not promote privacy and dignity for patients.
  • It was not clear of all intensive care unit deaths were discussed at the morbidity and mortality meetings.
  • Delayed discharges from the unit stayed an issue.

Services for children & young people

Good

Updated 9 March 2018

  • Staff recognised incidents and reported them. Managers investigated incidents and shared lessons learn with the paediatric directorate.
  • There was comprehensive assessment of children, including a history of any past or current mental health problems alongside the assessment of their physical health needs. This included age-related pain assessments and children’s pain levels were regularly assessed and acted upon.
  • Children had individualised care pathways for their care and risk assessments were completed for all patients including National Paediatric Early Warning Scores in order to rapidly detect any child whose health was of deteriorating.
  • Staff had training in the assessment and management of sepsis antibiotics were given in line with guidance. Reports on antimicrobial prescribing and sepsis management were escalated to the board through the trusts governance framework.
  • Staff demonstrated an understanding of the relevant consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005, with regard to children over 16 years and the Children Acts 1989 and 2004.
  • There was evidence of good multidisciplinary working both within the trust and with external stakeholders.
  • The service was responsive to children, young people and their family’s needs. They delivered personalised care and took into account needs and choices of different people.
  • There was a children’s strategy in place that staff we spoke to knew about and were committed to improving child health experiences and outcomes. There was a clear governance framework in place that was led by the chief nurse.
  • Staff told us they were supported and felt valued; they thought highly of the matron who they said was very visible supportive and kept them well informed.

However:

  • Although it was evident that lessons learned in the children’s services was shared within the directorate and practice changed as a result, it was less clear how learning was systematically identified, disseminated or audited across the trust.
  • There were no safeguarding level 3 trained staff on adult wards where 16-18 year old patients were cared for.

End of life care

Requires improvement

Updated 3 February 2015

The specialist palliative care team (SPCT) was available five days a week for face-to-face contact, and the hospice provided telephone out-of-hours and weekend cover. Medicines were provided in line with guidelines for end of life care. ‘Do not attempt cardio-pulmonary resuscitation’ (DNA CPR) forms were not consistently completed in accordance with trust policy, and there were no standardised processes for completing mental capacity assessments.

The SPCT provided four study days per year for trained nurses, and trust staff were able access palliative care study days provided by the hospice in the Weald. Medical end of life training was delivered as part of the doctors’ formal education programme. Leadership of the SPCT was good; quality and patient experience were seen as priorities.

All patients requiring end of life care were referred to the SPCT. However, often no specialist input was required by the team. Patients were cared for with dignity and respect and received compassionate care. There was a multidisciplinary team approach to facilitate the rapid discharge of patients to their preferred place of care. Relatives of patients receiving end of life care were provided with free car parking.