Medway Maritime Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed a limited number of quality statements in the responsive 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 requires improvement. People could not always access care and treatment in the department in a timely manner to meet their individual needs. Patients who attended the emergency department who needed admitting as an inpatient, experienced long waiting times in the department.

This service scored 46 (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 Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Patients who attended the emergency department who needed admitting as an inpatient, experienced long waiting times in the department. Between 31 August 2023 and 4 April 2024 we received information from 21 patients about their experience of attending the emergency department. Feedback included: “Elderly patient with complex needs waited four days in emergency department corridor”, “Elderly patient with Huntington's disease, left in corridor for two days”, “Patient in the corridor 2 days due to lack of beds” and “Patient waiting for 2 days in the corridor before transfer to a ward.” Our review of the Friends and Family Test (FFT) results provided by the trust for the ED between 1 December 2023 to 28 February 2024 included 13 comments that detailed patients had spent days in the department waiting for inpatients beds (range 2 to 4 days), 9 commented they had waited over 12 hours and 1 commented they had waited over 4 hours for an inpatient bed. During our on-site assessment on 21 February 2024, we attended a site meeting at 1.30 pm. At that time there were 113 patients in the department, with 43 of them waiting for an inpatient bed. The longest wait for a bed at that time was 55 hours (2.2 days). Staff said that corridor waiting times for an inpatient bed were an average of 40 hours 1.6 days.

Between 31 August 2023 and 4 April 2024, we received information of concern from 15 members of staff about the excessive length of time patients spent in the department. They told us patients were “stuck” in ED for 2 to 3 days at a time. Patients stayed more than 50 – 60 hours in ED. They said the management team moved patients who had been there 30-40 hours from trolleys to sitting in the waiting room, despite not being well and being frail. Elderly patients were accommodated in the corridor on trolleys for 2 days. During the on-site assessment staff said patients experienced long waits in the department before admission to an inpatient bed, some patients waited up to 40 hours for an inpatient bed. Senior leaders told us that due to the demand in ED some patients that were clinically stable and awaiting discharge (not patients lodged in the corridor with a decision to admit) were moved from trolley spaces on to chairs to enable space to be provided for new higher acuity patients. This is a widely used and established clinical assessment process embedded across the NHS known as ‘fit to sit’.

Processes did not support all patients to access care and treatment from the emergency department when they needed it. Between February 2023 and February 2024, the service performed consistently below (worse than) the national target of 95% of all patients being admitted, discharged or transferred within 4 hours of arrival at ED. In January and February 2024, the trust achieved 70.6%, which was below target but consistent with national average performance of 71% and 70.4% retrospectively. In March 2024, the national target for patients being admitted, discharged or transferred within 4 hours of arrival at ED was reduced to 76%. Trust Board reports for March, April and May 2024 showed that the service did not meet this 76% target, (March 69%, April 69% and May 71%). The trust had a target of zero 12-hour breaches. This is a measure of the time taken from the decision made to admit a patient to an inpatient bed to the time they were admitted. The number of 12-hour breaches had increased from February 2023 to January 2024. In February 2023, the trust reported 428 12-hour breaches, this decreased to under 200 breaches in April, May and June 2023. The figure then started to steadily increase (worsen) and in January 2024, the figure was 958. The average time patients spent in the department also steadily increased over the same period. The trust target of 200 minutes (3 hours) was not achieved in any month. In January 2024, the average time a patient spent in the department was 424.67 minutes (7 hours). However, the trust had consistently achieved the national average ambulance handover time of 15 minutes since January 2023. This was significantly better than regional and national performance and meant that most patients were handed over from ambulance crews to emergency department staff within 15 minutes.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.