Published: 00:01, 13 August 2014
A damning report into hospitals in east Kent has rated two as inadequate and recommended the trust that runs them be put into special measures.
The Care Quality Commission (CQC) rated the William Harvey Hospital in Ashford as inadequate overall, particularly for A&E, surgery, and children’s care.
Kent and Canterbury Hospital was also rated as inadequate overall by inspectors following a visit in March - with surgery identified particularly as inadequate.
Meanwhile, the QEQM at Margate was listed as requiring improvement, with A&E rated inadequate.
Now England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has recommended that East Kent Hospitals University NHS Foundation Trust be placed into special measures following his first report on the quality of care provided.
Overall, he found there was a disconnect between those running the trust and frontline staff.
A recent staff survey found long-standing issues such as bullying and harassment.
The CQC report also found risks to patients were not always identified; some clinical services across the trust were poorly led and there were staffing concerns in a number of areas.
Inspectors rated William Harvey Hospital as inadequate for Accident and Emergency, surgery, and children’s care.
The hospital was rated as requires improvement for medical care, maternity and family planning, end of life care and outpatient services. Intensive and critical care was rated as Good. The hospital was rated as Inadequate overall.
Inspectors found that staff there were caring and responsive to people’s needs, but that there were not always enough appropriately skilled staff on duty to make sure that people got the care they needed.
Records of waiting times in A&E at William Harvey Hospital did not accurately reflect how long people had waited to be seen.
Children’s care needs were not always appropriately met.
Some outpatient clinics were routinely overbooked, which led to long waiting times, and follow-up appointments were often cancelled and rescheduled leading to delays.
CQC ordered the trust to take action in key areas at the hospital to ensure there were adequate staffing levels particularly among paediatric staff; the patient areas were clean, and staff were better informed of end-of-life care arrangements.
Kent and Canterbury Hospital was also rated as inadequate overall by inspectors.
Surgery at the hospital was rated as inadequate, while critical care was rated as good.
Emergency care, medical care, children's care, end of life care and outpatient services were all rated as requires improvement.
Inspectors found that staffing levels were also a problem at Kent and Canterbury Hospital, especially in paediatrics.
Inspectors saw an example of good practice in the critical care unit, where patient diaries were used to support patients with memory loss or poor recollection.
CQC recommended there was a lead person at board level to take responsibility for services to youngsters; that adequate admin support was given to outpatient services, and arrangements for end-of-life car be clarified to staff.
Inspectors rated Queen Elizabeth the Queen Mother Hospital (QEQM) as requires improvement overall.
A&E was rated as inadequate, while critical care was rated as good.
Medical care, surgery, maternity and family planning, children’s care, end of life care and outpatient services were all rated as requires improvement.
CQC identified issues with staffing levels in A&E at QEQM.
The department was very reliant on temporary staff, which was creating a risk to patient safety.
Many patients were experiencing delays in leaving hospital due to their medication not being ready.
The hospital was poorly led, and services for children and young people were not effective, the report said.
CQC told the trust it must take action in a number of areas at QEQM, including ensuring that safety is made a priority in A&E; Discharge planning and flow through the hospital is responsive to people's needs. and patients don't experience unnecessary delays for outpatient appointments.
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: "When we inspected all three hospitals run by East Kent Hospitals University NHS Foundation Trust, we were extremely concerned at the disconnect we identified between the senior team and the staff working on the frontline.
"We saw ineffective leadership in action across a number of clinical services, and that the board was at times receiving false assurance through governance procedures.
"This will allow the trust to receive the additional support that I believe it needs to deliver safe, caring, effective and responsive services to the local populations it serves."
“We, alongside our partners in the wider healthcare system, will continue to keep a close eye on the trust and will inspect again in due course to assess whether or not adequate progress is being made.”
CQC inspectors will return to the hospital to check the required improvements have been made.
"It is a lack of effective leadership, alongside care failings across the majority of services we inspected, which has led me to recommend... that the trust be placed in special measures" - Prof Sir Mike Richards
Speaking after the report, Ashford MP Damian Green described the findings as "alarming".
He added: "There are clearly serious problems which need to be addressed urgently by the senior management at the Trust.
"I will want to see a recovery plan which deals with the problems the CQC identifies, and which builds on the strengths in patient care and the hard work of the staff which the report identifies."
Trust chief executive Stuart Bain - who is due to leave the trust at the end of the year - said staff were working to address much of what was contained in the report.
He said: "Following a staffing review, we have invested an additional £2.9 million to recruit 69 nurses where shortages exist (55 of these have been recruited already).
"We have also recently appointed an additional four general surgeons and will be recruiting a further three surgeons very shortly.
"We identified the need to improve our appointment system some time ago and have just completed a public consultation on our outpatient services that will allow us to make improvements to the services we offer patients.
"New appointment booking systems, more flexible appointments, and an investment of £28 million in improved facilities including a new hospital in Dover will start to address these issues."
He added: “The report does recognise the committed and caring nature of our staff of which we can be very proud.
"Our task as leaders of the organisation is now to work with our staff and our partners including the Clinical Commissioning Groups to address the issues that have been raised and ensure we provide the residents of east Kent with high quality health care."
North Thanet MP Roger Gale said: "Yesterday, the majority of the people that I represent in East Kent will have felt that they have good hospitals with caring staff generating acceptable outcomes. Today, they are being told that the services that they have trusted are 'unsafe'.
"In spite of an ageing population, East Kent has one of the lowest mortality rates in the country. Its staff are recognised by CQC as caring, the standard of care in dementia cases is high, critical care is good and East Kent is the first Trust ever to have been recommended for special measures while not in breach of its Monitor licence."
He added: "Of course there are issues of management and staffing that need to be addressed and in particular there is a problem of A&E services being overwhelmed by people using A&E unnecessarily as a GP service. As a result of increased patient demand there have also been times when the ration of nurses to staff has been too low and that is not acceptable.
"The fact is that East Kent has had about £12million stripped out of its budget to help to fund Community preventative services - money that has yet to reach those services - and some difficult decisions have had to be taken.
"The inspection, which has been described to me as disorganised and chaotic, took place at a time when staff were understandably unsettled by change and during a period when, at the behest of the Royal College of Surgeons, there were serious reorganisation issues in respect of acute surgery."
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