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Chief Inspector of Hospitals recognises progress made at East Kent Hospitals NHS Foundation Trust, but recommends it remains in special measures

Published:
17 November 2015
Provider:
East Kent Hospitals University NHS Foundation Trust

Chief Inspector of Hospitals has rated East Kent Hospitals University NHS Foundation Trust as Requires Improvement but recommended that the trust should remain in special measures for a further six months following its latest inspection by the Care Quality Commission.

The trust has been rated as Requires Improvement overall, achieving a rating of Good for being caring.

Inspectors found that William Harvey Hospital, Queen Elizabeth Queen Mother Hospital and Kent and Canterbury Hospitals require improvement. Both Buckland Hospital and Royal Victoria Hospital were rated as Good.

The full reports and ratings are available on the CQC website.

Inspectors found that since the previous inspection the trust had made significant attempts to improve the culture of the trust. The leadership was now very visible and appeared to have tackled the issues of bullying. But, inspectors did find further improvement is needed in the emergency department and children’s care.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said:

“In the past year there have been significant changes to the senior management group at East Kent Hospitals University NHS Foundation Trust. The team has worked well together, with external support, to address the issues identified in our inspection last year. However, the improvements identified are recent and continuation of this improvement must be seen as a priority for the team and the trust.

“While the trust continues to make progress, I remain particularly concerned by the deteriorating performance of the emergency department, and the impact this is having on the quality and timeliness of services for patients. We also identified a lack of action to replace the Liverpool Care Pathway for people nearing the end of life despite this being noted in our last inspection.

“I feel optimistic that the trust will continue to improve but it will require continued support for the foreseeable future. Others with a responsibility for health services in the area need to help address the problems the trust cannot deal with on its own. In these circumstances, I am recommending that the trust remains in special measures for a further six months.”

“Inspectors found the hospitals were clean, but the escalation ward at Queen Elizabeth the Queen Mother was not fit for purpose. Here there was a lack of equipment and staffing of the ward was not managed effectively.

“Efforts by the trust to recruit staff were improving although there were still challenges. For example, the use of agency and locum staff was increasing and the process to assess the competency of temporary staff could be improved.  It was clear to the inspectors that staff at all levels in the trust felt passionately about their jobs and provided compassionate care. The only inconsistency was the emergency department where inspectors observed decision making and behaviours which were at odds with the rest of the trust.

“Compared to CQC’s last inspection there was positivity about the changes in culture within in the organisation. Action is now being taken to address bullying and incident reporting is now much more transparent and open. However, despite progress there are still pockets of behaviour, disengagement and instability that require attention.”

CQC saw several areas of outstanding practice including:

  • The outpatient improvement plan had significantly improved the service for patients. This transformational change has been well structured and designed to deliver improvements in access, availability of notes and overall patient experience. Its success is an example of outstanding nurse leadership.
  • The trust had introduced an ‘innovation and improvement hub’ where staff could meet and discuss improvement initiatives and this is generating ideas, enthusiasm and heightened staff engagement.
  • The pre-operative joint clinic for patients is recognised as enhancing patient outcomes.

CQC has told the trust it must make improvements in nine areas, including:

  • Ensuring the hospital has sufficient capacity to cope with the number of women in labour and newborn babies on a day-to-day basis.
  • Making arrangements for the replacement of the Liverpool Care Pathway and ensuring that appropriate national audit is undertaken.
  • Ensuring that medicines and intravenous fluids are stored safely and securely.
  • Ensuring that suitable arrangements are made for patients with mental health issues awaiting assessment.
  • Ensuring that the environment and facilities in which patients are cared for are safe, well maintained, fit for purpose and meet with current best practice standards.

The trust was previously inspected in March 2014. The overall rating following that inspection was Inadequate. The trust was rated Inadequate for safety and leadership, Requires Improvement for effectiveness and responsiveness, while caring was rated as Good. The trust was placed in special measures.

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

Last updated:
29 May 2017

Notes to editors

We have published our report on East Kent Hospitals University NHS Foundation Trust which is available at http://www.cqc.org.uk/provider/RVV.


About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.


We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.


We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.