Medway Community Healthcare C.I.C

Updated 7 October 2022

Medway Community Healthcare is a community interest company (CIC) and provider of NHS funded adult and children’s community healthcare in Medway and Swale. Their services include community health services for adults, children and young people, a care home and hospice services, adult inpatient services, specialist dental and urgent care. Medway Community Healthcare (MCH) was established in 2011 and is a not-for-profit social enterprise committed to serving its communities and funded by the NHS and local authorities. MCH employs over 1300 staff. All staff have the option to become shareholders and any surplus money is re-invested back into the community.

Services span across all ages from birth to end of life and range from preventative and pro-active support to keep people as well and independent as possible through to complex care and support in individuals’ own homes to prevent admission to hospital or to support people following discharge. MCH provides 40 different services across 31 different locations as well as in individual’s homes and in schools.

MCH provide the following core services:

• Community health services for adults
• Community health inpatient services
• Community health services for children, young people and families
• Urgent care services
• Community dental services
• Hospice services
• Care home

MCH are registered for the following regulated activities:

• Diagnostic and screening procedures
• Family planning
• Maternity and midwifery services
• Nursing care
• Personal care
• Surgical procedures
• Transport services, triage and medical advice provided remotely
• Treatment of disease, disorder or injury
• Accommodation for persons who require nursing or personal care

We carried out inspections of four core services provided by Medway Community Healthcare C.I.C. followed by a well led inspection.

We inspected the community health services for adults, community health services for children, young people and families and community health services for inpatients core services. We also inspected the community dental service, and the findings are included in this report, however we do not rate this core service.

The community health services for adults and the community health services for children and young people were last inspected in March 2017 and both had a rating of good. The urgent care core service was inspected separately in February 2022 as part of an inspection of the urgent care pathway in Kent and Medway and was rated requires improvement.

We did not inspect the Wisdom Hospice or Darland House care home. The Wisdom Hospice was inspected in August 2021 and is rated Good. Darland House care home was inspected in February 2021 and has a rating of good.

This was the first time we had undertaken a well led inspection of this provider.

Although Medway Community Healthcare is not an NHS trust, the word trust is used erroneously in several places in the report as the word cannot be removed from the standardised inspection report template.

We rated Medway Community Healthcare as good because:

• We rated safe as requires improvement, responsive as good, caring as good, and effective as good. We rated well-led for Medway Community Healthcare as good.
• We rated three of the four MCH core services we inspected as good. We do not rate community dental services. In rating the trust overall, we included the existing ratings of the three previously inspected services.
• The non-executive directors provided high quality, effective leadership and delivered appropriate challenge to the senior executives. They all had experience as senior leaders in a range of organisations and brought skills from other sectors including NHS acute care, health organisation directorships, social care, education and local government.
• The board was well supported by five sub-board committees which met every six weeks: audit and risk committee, integrated quality and performance committee, remuneration committee, finance committee and people committee. Each sub-committee was chaired by a non-executive director and also had an executive lead.
• The MCH senior leadership team demonstrated a high level of awareness of the priorities and challenges facing the organisation and the local health environment, and how they could address these and influence change in the system. The senior leaders had demonstrated an ability to adapt at a fast-changing pace during the COVID-19 pandemic.
• The organisation had a clear vision and a set of values which staff understood. These were underpinned by a set of clear strategic priorities running from 2019-2025 and progress was regularly reviewed. Leaders were well sighted on the ambition of the strategy and there was a focus on aligning the strategy with both local priorities in the Medway and Swale primary care networks and within the emerging Kent and Medway integrated care system.
• Staff described an open, transparent and supportive culture that centred on what was best for patients and the wider healthcare system. Staff across the organisation worked hand in hand with partners working in the wider healthcare system, with other providers and with external agencies including the voluntary sector.
• The provider’s governance system effectively provided assurance and helped keep patients safe. It helped the organisation deliver its key transformation programmes and priorities outlined in the annual business plan.
• During the core services inspections we saw that staff treated people with compassion and kindness, respected their privacy and dignity and understood people’s individual needs. Services were inclusive, took account of patients’ preferences and their individual needs. People had their communication needs met and information was shared in a way that could be understood.
• The provider was a research active organisation and had a research team of 2.4 full time staff and a research strategy. We saw that awareness of research, and its value to staff and patients, was embedded in the operational teams during the core services inspection. Research was part of the organisational culture and research activities were beyond what could be expected in an organisation of this size.

However:

• The provider needed to strengthen its work on Equality, Diversity and Human Rights (EDHR). The provider had produced a Staff Equalities Action Plan in 2021 and had an up to date Workforce Racial Equality Standard (WRES) report. It was clear that the experience of staff with disability, black and minority ethnic staff and the gender pay gap was being considered by the organisation. However, the responses in relation to targeting actions and delivering improvements were not fully formed in any substantial detail across all the groups with protected characteristics.
• Whilst the role and remit of the elected members forum (EMF) was well described, it was not evident from the inspection that the forum was playing the central role envisaged in conveying the views of the shareholders to the board and playing an active part in the development of the organisation’s strategy and governance.
• The scale of the organisation meant that succession planning and ensuring that skilled leaders were being developed presented a risk as the departure of key people could have a larger impact on service delivery. Senior leaders recognised that succession planning was an issue that presented a challenge to the organisation.
• Within the community adults core service the process around maintaining and reviewing patient risk assessments needed improving. The provider also needed to strengthen the palliative care pathway so that staff could effectively escalate the needs of deteriorating patients and ensure communication pathways were effective at these times.
• Within the community inpatients core service we told the provider that it must deploy the right number of staff with the right skills on every shift. The provider also needed to ensure that equipment needed to care for patients is available, fit for purpose and stored appropriately.

How we carried out the inspection

To fully understand the experience of people who use services, we always ask the following five questions of every service and provider:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

Before the inspection visit, we reviewed information that we held about the services and reviewed a range of information. During the inspection visit to Medway Community Healthcare services, the inspection team:

Community Health Services for adults

• visited two Medway Community Healthcare CIC bases and three satellite clinic locations
• spoke with 16 senior leaders including heads of service, operational and clinical leads
• spoke with 46 other members of staff including advanced practitioner physiotherapists, physio assistants, dieticians, speech and language therapists, podiatrists, phlebotomists, registered nurses, nursing assistants, tissue viability nurses, occupational therapists, an induction facilitator and administrative staff
• spoke with 19 patients and families who were using services or their carers/relatives
• reviewed 18 patient care and treatment records
• observed three shift handover meetings for community nursing teams
• observed five schedules of care in patients’ homes
• observed staff providing care to patients in clinic settings
• held six focus groups to capture staff who were unavailable on the days of the inspection
• looked at a range of policies, procedures and other documents related to the running of the services.

Community health services for children, young people and families

• visited the main base of the service and two other locations to observe clinics and reviews
• looked at the quality of the service environment
• observed a number of clinics, assessments and reviews, such as well-baby clinics, developmental reviews, health and continence assessments
• observed three home visits
• observed a virtual multidisciplinary team meeting
• observed a virtual meeting between staff members and a special educational needs coordinator
• spoke with 25 parents who were using the service; we spoke to 18 of these parents remotely following the inspection
• spoke with five team managers, two medical staff and 17 other staff including nurses, health visitors, admin staff and therapy staff
• we ran three focus groups virtually for additional staff to join and give feedback on the service
• looked at 18 patient records
• reviewed a range of documents relating to the running of the service
• looked at medicines management.

Community health inpatient services

• visited Amherst Court, Britannia and Endeavour wards on 17 May
• visited Harmony House on 28 May. This visit was delayed due to COVID-19 within the inspection team
• toured all the wards and had an introduction by staff
• observed clinic rooms and medical equipment
• attended a MDT meeting
• spoke with sixteen patients and two relatives face to face
• spoke with 16 staff face to face and six more via an online focus group, and four senior leaders
• looked at seven patient care records and prescription charts
• observed care in communal areas and therapy groups
• looked at charts recording food and hydration intake for eight patients
• looked at records including complaint records and incident reports, workforce data and training information

Community dental services

• toured the unit at Lordswood Healthy living centre
• looked at systems and processes such as observation of the decontamination process
• spoke with four members of staff, 1 dentist, two nurses and the receptionist
• looked at maintenance documents and schedules for the decontamination and radiography equipment
• looked at policies, recruitment processes, complaints, risk policies, and safeguarding
• checked that clinical staff had a current registration with the general dental council and were up to date with their mandatory continuing professional development
• checked the processes, equipment maintenance, training of staff and medicines management with regard to the provision of inhalation sedation
• looked at auditing processes for infection prevention and control, radiographic image quality, disability access, patient records, appointment waiting times and antimicrobial prescribing
• looked at the process for consent, how capacity assessments were carried out and what these entailed.

The well led inspection team comprised one executive reviewer who was an executive of an NHS community health provider, two specialist advisors with professional experience in board-level governance, one CQC head of hospital inspection, one CQC inspection manager and two CQC inspectors.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 11 August 2025

Medway Community Healthcare C.I.C Community urgent care service (UTC) is run by Medway Community Healthcare (MCH). MCH is a Community Interest Company (CIC) and a social enterprise that provides NHS-funded community services and is owned and controlled by its staff. As a social enterprise they are not-for-profit organisation and reinvest any surplus back into health and care services and the local community.

The UTC is located on the ground floor close to the emergency department at Medway Maritime hospital. Staff at the service provide care and treatment to people 11 hours a day, 7 days a week.

Medway Community Healthcare C.I.C also provides an out of hours service run at Sheppey Community Hospital. The site at Medway Maritime Hospital is a communication hub for district nurses, rapid response teams and other community and specialist teams which forms part of the urgent response team.
The service provides treatment for minor illnesses only. Services provided by the UTC include, but not limited to self-limiting conditions or infections such as ear, nose and throat infections, high temperature, fever and pains. The out of hours service is commissioned to assess and manage patients with symptoms of cellulitis or deep vein thrombosis.

Cellulitis and DVT pathways is contracted under Out of Hours provision and not UTC.

Patients attending the service are either referred by the NHS 111 service or streamed via the emergency department (ED) at Medway Maritime Hospital. ED Streaming is a clinical triage process used primarily in NHS hospitals to direct patients arriving at urgent care to the most appropriate service. The urgent treatment centre does not accept walk-in patients.
The service is registered to provide the following regulated activities:
• Treatment of diseases, disorder or injury and
• Transport services, triage and medical advice provided remotely.

There are two registered managers.

We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to local communities that most people take for granted.

We carried out an unannounced assessment of Medway Community Healthcare CIC Urgent Treatment Centre on 7 and 8 October 2025. The service was last inspected on 22 February 2022. Following the inspection in 2022, the service was rated as requires improvement overall. We rated safe as inadequate, effective, responsive and well led as requires improvement and caring as good.

We carried out this assessment as a routine assessment using CQC’s new assessment methodology to determine whether the provider had made improvements since the last inspection, and that people were receiving safe care and treatment that met their needs. During this assessment we found that while the service had made some improvements, there were still areas of concern from the last inspection which had not been addressed.

We rated the service as Requires Improvement overall. We found 3 breaches of the regulations in relation to premises and equipment, infection prevention and control and governance.

• The provider did not ensure that the environment was safely managed and, that they were always aware of people present at the service to ensure that vulnerable people were always protected.
• The provider did not take all practicable steps to ensure that infection control risks were managed well. We saw that the environment including one of the consultation rooms were visibly dirty.
• The provider did not ensure that information on how to complain about the service was readily available to people visiting the service.
• The provider did not ensure that medicines were always stored properly and free from clutter.
• The providers governance processes were not robust enough to manage and remove all risks. There were risks on the providers risk register, with no clear action on how these would be addressed.
However,
• The service had enough staff with the right skills and experience to meet people’s needs. The service learned lessons from incidents.
• Staff worked hard to provide care and treatment that is person centred and, met people’s needs that met national best practice and standards.
• People reported that staff were generally kind and compassionate.
• Staff felt the culture was inclusive and leaders cared for their wellbeing. Leaders understood the service and the challenges they faced.

At the time of our inspection we raised our concerns with the local integrated care board (ICB) who informed us that they had arranged a meeting with both the acute hospital provider and Medway Community Healthcare CIC. The ICB told us that they were providing support to both providers so that our concerns could be addressed promptly. We also asked the provider for an action plan in response to the concerns found at this assessment.

Updated 7 October 2022

Updated 7 October 2022

Updated 7 October 2022

Updated 7 October 2022