The Care Quality Commission (CQC) has re-rated the emergency department at Medway Maritime Hospital in Kent as requires improvement following an inspection in April 2025.
Medway Maritime Hospital provides a range of NHS hospital services and is run by Medway NHS Foundation Trust.
CQC carried out the inspection to follow up on a warning notice issued in April 2024. The requirements of this warning notice have now been met, but concerns remained about people’s safety, dignity, and how care was managed during busy periods.
CQC has re-rated the emergency department as requires improvement for being effective, caring, and responsive. Safe has been upgraded from inadequate to requires improvement. Well-led has been re-rated as good.
The service remains in breach of two legal regulations relating to safe care and treatment, and dignity and respect. CQC has asked Medway NHS Foundation Trust for an action plan in response to the concerns found at this inspection.
Roger James, CQC deputy director of operations in Kent and Medway, said:
“When we inspected the emergency department at Medway Maritime Hospital, we found a service under significant pressure, with staff who weren’t always able to provide patients with timely support, treatment, dignity and respect. Staff told us this was due to persistent flow and capacity challenges.
“The department faced serious challenges managing flow to the wider hospital. During busy periods, this meant some people received care in temporary escalation areas that didn’t protect their privacy and dignity. We spoke with over 50 people during our inspection, and some told us their experience had been deeply unsatisfactory due to excessive noise, limited access to staff, and being cared for in unsuitable spaces.
“Staff couldn’t always complete essential risk assessments or respond promptly to people’s needs because they were overwhelmed. People often waited more than 12 hours for treatment, and some didn’t have their pain managed effectively. Medicine administration wasn’t always safe, and the department relied on nurses from other wards and varying levels of bank and agency staff to support patients in temporary escalation areas, which staff told us sometimes led to poor care for patients.
“However, we did see some improvements since our last inspection. Leaders were working hard to improve the department’s culture. Staff demonstrated dedication and worked well together across teams. Where staff had time to provide care properly, people felt well supported and informed. Staff and managers felt the department had made progress but acknowledged there was still a lot to do to ensure safe, high-quality care.
“We’ve told leaders at Medway NHS Foundation Trust where they must make improvements to keep people safe and maintain their dignity. We’ll continue monitoring the service closely to make sure people are safe while this happens.”
Inspectors found:
- Staff did not consistently complete risk assessments for falls or pressure ulcers, increasing the risk of avoidable harm.
- The department lacked sufficient senior consultant cover, falling short of national staffing guidance.
- Staff did not consistently record or review people’s pain levels, resulting in some individuals remaining in discomfort.
- Between May 2024 and April 2025, the department saw 13% of people waiting more than 12 hours for treatment, exceeding safe waiting time standards.
- The service only assessed 55% of people within 15 minutes of arrival, falling below national guidance.
However, inspectors also found:
- The department performed strongly in ambulance handovers, keeping delays over 30 minutes to a minimum and allowing ambulances to return to the community more quickly.
- Staff consistently administered medicines to treat sepsis in line with national guidelines and met targets.
- The department was clean and well maintained, with infection control audits showing 98% compliance.
- Leaders had introduced a cultural transformation programme to address aggression and improve staff wellbeing.
- Staff worked effectively with mental health services, discharge teams, and palliative care specialists to support people’s needs.