Medway Maritime Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed a limited number of quality statements in the effective key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Some patients and staff told us the service did not always meet national guidance. However, managers did audit and monitor staff compliance to national guidance. Some patients experienced teams and staff not communicating effectively, with patients having to answer the same questions multiple times to different staff. However, the service had documented clinical pathways which followed national guidance and had good working relationships with system partners, which supported some of the patient pathways.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Feedback from patients prior to and during the on-site assessment, did not express any concerns about whether they were being provided with evidence-based care and treatment. However, some did express concerns with lengthy waits and being accommodated in the corridor, which was not in line with best practice guidance.

Staff who contacted us between 31 August 2023 and 4 April 2024 told us about the practice of using non-designated care areas to accommodate patients, including patients accommodated on trolleys in the corridor for lengthy periods of time. During our on-site assessment on 21 February 2024, we observed patients accommodated in non-designated care areas, including the corridor. This practice was not in line with best practice guidance. The Royal College of Emergency Medicine detailed in November 2021 and January 2024 that “waiting on trolleys or in corridors can lead to suboptimal standards of care, putting patients at risk” and that crowding can result in “patients often situated on trolleys in corridors or in other inappropriate settings can lead to increased morbidity and mortality.” Staff also expressed concerns about management of patients undergoing chemotherapy who self-presented at the emergency department. However, senior leaders told us that ambulatory patients who presented to the department with suspected sepsis would have a full assessment by a triage nurse, including sepsis screen. Leaders spoke about the work they were doing to introduce new systems, processes and pathways, following national guidance, to improve the flow of patients, reduce attendances at the emergency department and improve the patient experience. This included working with system partners to implement guidance from the NHS England Getting it Right First Time programme to improve patient safety and experience in the emergency department.

Most documented processes and pathways used in the service followed national guidance, however the use of undesignated care areas to accommodate patients was not in line with best practice guidance. Staff used recognised national triage systems and tools to triage patients on their arrival to the department. The service had clinical care pathways that included reference to national guidance, for staff to follow to support them to deliver evidence-based care. The service had considered and was working with national programmes to improve the effectiveness of the service. This had resulted in improvement with the time taken for patient care to be transferred from ambulance crews to the emergency department staff. Monthly governance meetings provided opportunity for review of National Institute for Health and Care Excellence (NICE) guidance, review of policies for approval and review of overdue standard operating procedures. However, the records for the meeting of the Divisional Governance and Management Board for January and February 2024 did not give any detail about any scheduled reviews. The service informed us, that due to operational pressures, these meetings were not held. The service monitored compliance with some national standards and guidance. This included auditing of patient observations, compliance with the sepsis pathway, compliance with infection prevention and control (IPC) guidance, compliance with medicine management practices and monitoring of ED performance. The service also had schedule of local audits to support monitoring of effectiveness and support quality improvement within the department. However, although the service did audit and monitor staff compliance with national guidance, feedback from some patients and from some staff indicated this did not always result in the delivery of a service that met national guidance.

There was feedback from patients in the Friends and Family Test about how teams worked together. The main negative was about communication. This included lack of communication between hospital departments and patients having to answer the same questions multiple times to different members of staff. However, there were also positive comments about how well the team worked together and how they worked with other services, such as the hospice services.

Some staff felt the senior leadership team and the department team were not working together on a shared purpose. They felt the senior leadership was focused on performance, targets and finance above patients and safe care. However, many staff said there was good team working within the department with everyone working together to do their best for patients. Staff also commented about the good working relationships they had with the local NHS Ambulance Trust. They were proud about how working together, they had improved ambulance turnaround times. Staff commented that the executive team, including the Chief Executive Officer, were visible in the department. Senior leaders described effective working practices with system partners with all working towards improving patient flow to release capacity in the emergency department.

System partners including the local NHS ambulance trust, the local mental health NHS trust, stakeholders and the ICB all described good working relationships with the emergency department leadership team. They described how they were working together to implement and improve systems and processes to reduce pressure on the emergency department. Areas of improvement supported by system partners included working with the mental health NHS Trust to improve the experience of patients presenting to the emergency department with mental health conditions.

The service had processes to support staff and teams work together effectively. Processes were in place to ensure effective and timely handover of patient information when patients were admitted to inpatient areas from the emergency department. To ensure patients received the specialist treatment required while waiting for an inpatient bed, there was a recognised process where admitting teams reviewed and arranged treatment plans for patients in the department.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.