Agenda item

The Care Quality Commission published a report on Wednesday 5 March 2025, following an unannounced inspection of the Emergency Department at Medway Maritime Hospital (Medway NHS Foundation Trust – MFT) on 21 February 2024. The attached report provides detail on the findings of that inspection and the actions taken and progress made by MFT.

Discussion:

The Chief Executive Officer (CEO) and the Chief Nursing Officer of Medway NHS Foundation Trust (MFT) introduced the report which provided the outcome of an unannounced inspection by the Care Quality Commission (CQC) on the Emergency Department (ED) of the hospital. The inspection had taken place in February 2024, at a time when the hospital had been under great pressure and had been in communication with CQC about actions to address the challenges.  The CEO confirmed she had not been notified of any issues until late April 2024. The hospital remained under great pressure, in ED in particular, but many actions had been made to avoid corridor care. She referred to the strong partnership working with SECAmb to ensure efficient hand over from ambulances and with other partners to help address difficulties with delayed discharges, which continued to be a challenge. Since February 2024, waiting times in ED had reduced and patient feedback as well as staff survey results had both been more positive. There had been additional matron posts put in place to provide stronger operational leadership and there was a whole hospital response to support ED.

Members then raised a number of questions and comments, which included:

• Leadership changes – reference was made to the CEO’s forthcoming departure. Members were reassured that the Executive Team at MFT was strong, stable and provided consistency in driving forward and embedding improvements throughout the organisation. She also emphasised that there was an effective and strong Chair of the Trust’s Board.
• System wide working – reference was made to the importance of working collaboratively with partners to deliver care in different ways and avoid pushing demand through ED. For example, a number of frailty patients being brought into ED could have been cared for in a different way, and also patients at end of life care should be cared for appropriately in their place of choosing. The hospital also ran a Virtual Ward which had approximately 80-100 patients being monitored remotely and cared for at home.
• Life support standards – reference was made to the percentages of compliances for life support standards, set out at section 5.4 of the appendix, and reassurance was given that improved monitoring of patients had made a huge difference in reducing resuscitation support calls as patients were identified early as at risk of deteriorating, and patient’s observations were taken as they checked in to ED.
• Staff morale and support – reference was made to how staff were being supported, including in relation to some racists comments that had been made in social media in response to articles about the inspection.  It was explained that staff were being supported and there were various listening activities underway to hear from staff on how they were feeling.  The pressure staff were working under was recognised and it was confirmed that there was zero tolerance in relation to racial abuse against staff.
• Readmittance – in response to a question about whether the hospital monitored incidents of readmittance to ED to highlight any patterns of early discharge, it was confirmed it did and levels were within the normal range and not a concern.
• Workforce levels – it was confirmed that levels of staff were correct but that there were gaps within rotas and there had been an over-reliance on bank staff. Work had been undertaken to recruit to permanent positions, as well as creating two additional matron positions within ED.  A collaboration with the mental health trust had also been underway to recruit substantive mental health nurses to work within ED. The vacancy rate at the hospital had significantly dropped and where appropriate, staff were being supported with flexible working options to encourage them to move from bank staff to permanent positions.
• Delays by CQC – reference was made to the delay by CQC in informing the Trust about its findings and in publishing its report which took over a year from the unannounced inspection. The Committee considered this to be unacceptable due to the negative impact it had on staff and equally, was difficult for patients to understand that the findings related to an unannounced inspection a year ago, rather than more recently. It was suggested that the Committee should write to the CQC to convey its disappointment in this delay.
• Hospital capacity – reference was made that the hospital was no longer sufficient to manage the demands and meet the needs of the population of Medway and its surrounding areas, particularly in light of forthcoming growth.

Decision:

The Committee noted the report and requested that the Chairperson, in consultation with the opposition spokespersons, write to the Care Quality Commission in relation to the unacceptable delay in its reporting of the unannounced inspection.