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Medway Maritime Hospital has been slammed today for providing poor emergency care in a damning report from the Care Quality Commission.
The report lists multiple failings uncovered when inspectors visited the troubled Gillingham hospital in December after anonymous concerns were reported about its A&E department.
It concluded the department is failing to meet national standards of care, cleanliness and infection control - and the Medway NHS Foundation Trust has been issued with warning notices to make urgent improvements.
"It is absolutely horrific," said one manager quizzed over cleanliness at Kent's largest hospital. "The system doesn't work because no one has overall control."
Overcrowding, excessive waiting times, dirty surfaces and overflowing clinical waste bins were all cited as concerns in a report that makes grim reading for prospective patients.
The hospital has apologised for "letting our patients down" and said it has started work on a major revamp of the emergency department.
When the inspectors arrived on December 31, they found 20 patients who had been in the department for more than four hours - seven of whom had been there for more than 11 hours and one who had been there more than 19 hours.
They heard how the previous night, 17 people had been left on trolleys in corridors waiting to be seen, while 16 ambulances queued up outside to bring in more patients.
Staff said they felt "under siege" and in "a constant battle" and told inspectors those working other wards "had no concept of what it's like down here".
Although patients said nurses and doctors were "excellent" when they eventually saw them, they reported a lack of basic care while they waited.
"It is absolutely horrific. The system doesn't work because no one has overall control..." - hospital manager
One patient waited four hours for a blanket and another was not offered food or drink for 18 hours, while another was left on a trolley in the clinical decision unit for more than 22 hours.
Nursing staff were unsure of their responsibilities in keeping cubicles and equipment clean.
There were several examples of poor hygiene and cleanliness - among them a blood-spattered wall in the Vanguard unit, stained floors and dirty hand basins, and an overflowing clinical waste bin next to a new supply of intravenous fluids.
Public toilets inside the walk-in area were also "visibly dirty and unpleasant".
Adrian Hughes, regional director of CQC in the south, said: "We know that the trust is taking steps to improve its services – but during our inspection one member of staff told us that they felt 'under siege', while another said that they did not feel supported. There were too many patients for the capacity in the department.
"It is clear that the work taking place to make improvements has not yet translated to better patient care in the emergency department. We have referred our findings here to local commissioners, Monitor and NHS England.
"Patients are entitled to be treated in services which are safe, effective, caring, well run, and responsive to their needs. We will be going back into the trust shortly as part of our in depth hospital inspection programme to check that this is the case – and will report further in due course."
The report follows the announcement earlier this year that the chairman and chief executive of Medway Maritime Hospital - Denise Harker and Mark Devlin - were both to leave.
A Medway NHS Foundation Trust spokesman said at the time they have "decided that the time is right for them to move on and hand over the leadership of the trust to a new team".
- which branded the hospital's A&E unit "completely inadequate".was placed in special measures last year following the Keogh report into high death ratesThe hospital
Waiting times, which have since improved, were said to be the worst in England several times over the summer and levels of under-staffing were said to be dangerous.
Chief nurse Steve Hams said: "We are sorry that the emergency department failed to live up to the high standards of care we want to provide for our patients and which they have a right to expect. I want to apologise personally for letting our patients down.
"The emergency department was designed to treat 50,000 patients a year, but now it is treating 90,000 and rising. We know it is not suitable for emergency and critical care in the modern world and are working hard to put it right.
"We are sorry that the emergency department failed to live up to the high standards of care we want to provide for our patients and which they have a right to expect..." - chief nurse Steve Hams
"On 31 December 2013 at 7am – the morning after one of the busiest evenings in recent times – there were unprecedented levels of ambulance activity, seriously ill patients presenting with complex conditions, local floods and a norovirus outbreak.
"We took immediate action. We introduced a daily executive director-led review of the department; implemented a new executive director rota providing an on-site presence seven days a week and during bank holidays, carry out patient safety rounds by the matron and consultant three times a day focussing on nutrition, hydration, pain relief, good documentation, talking to patients and a clean, safe environment.
"We have recruited more clinical and non-clinical staff, and the infection prevention and control team carry out weekly unannounced visits.
"The emergency department is a much cleaner, safer and more efficient environment than when the CQC visited and we will carry on improving. This week we started work on a complete redevelopment of the emergency department, the first phase of which will be ready for next winter."
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