Health chiefs in east Kent have been told they need to do more to improve services after a visit by independent inspectors.

A report into standards at hospitals run by the East Kent Hospitals University NHS Foundation Trust says that while some areas have improved and there was outstanding practice in some, shortcomings remain - including waiting times and staff shortages.

And health bosses have been urged not to let the development of a five-year masterplan for health care in Kent distract them.

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That is a reference to the on-going development of the Sustainability and Transformation Plan (STP) setting out how patient care will be provided into the next decade in Kent and Medway.

As a result of the Care Quality Commission (CQC) findings, the three hospitals run by the trust were rated as requiring improvement - the same as in the last inspection.

The inspection was carried out in May and involved visits to Ashford’s William Harvey Hospital, Queen Elizabeth the Queen Mother Hospital in Thanet and Kent and Canterbury Hospital.

It focused on four core areas. These were emergency and urgent care, surgery, maternity and end of life care. It also examined how well led the trust was.

The report said the trust needed to improve safety, effectiveness and its responsiveness but that caring was good at all three hospitals.

Among areas of concern raised about safety was that staffing rates in some departments were below what was planned and the trust had some times failed to find agency staff to cover shifts.

The trust said it was investing £13.5m to address staffing issues.

The 115-page report also referred to “visibly unclean” areas, broken and out-dated equipment. At two hospitals - Ashford and Thanet - emergency departments for children were closed at night and had to be dealt with in departments for adults.

Inspectors were concerned the emergency department at William Harvey Hospital did not always enhance patient safety with the major treatment area and children’s treatment area too small for the numbers of patients.

“This meant staff had to constantly move patients from one space to another.”

It also found that the recommended one hour time time for patients to receive treatment was not met for 10 months between February 2017 and January 2018.

But there was praise for the trust for the way staff cared for patients, which was the one area rated ‘good’ at all three hospitals.

Inspectors highlighted how staff provided emotional support to patients and treated them with compassion.

However, the inspectors were concerned the trust had suspended some decisions about how hospitals were managed while discussions went on about the re-organisation of NHS in Kent.

At the same time, it concluded the trust’s leaders were in a position to build on improvements that resulted in it being taken out of special measures in 2017.

The report singled out some areas as outstanding, including communications and the use of technology. It said a mobile phone app for patients was one example of how the trust was innovating.

The CQC also praised maternity services saying: “It was notable that the maternity department had made great strides to drive learning, improve patient outcomes and inspire innovation”.

Amanda Stanford, CQC’s deputy chief inspector of hospitals, said: “I am pleased to report that East Kent Hospitals University NHS Foundation Trust has continued to make improvement since our last comprehensive inspection.

“The trust has been working with local stakeholders to develop a new clinical strategy that meets regional needs.

"Although it is important, this work must not be allowed to distract from support to the trust to drive forward improvements.

“The board must concentrate on the strategic direction of the trust and allow staff to continue to embed the operational improvements that are required. We will return in due course to check their progress.”

It is the fourth inspection since the trust, which deals with 200,000 emergencies each year and has one million out-patient appointments, was placed in special measures in 2014. That was lifted in 2017.

Meanwhile, health chiefs said they recognised more work was needed to improve patient care but were confident the trust could tackle the challenges.

"The board must allow staff to continue to embed the operational improvements that are required... we will return in due course to check their progress" - Amanda Stanford

Chief executive Susan Acott said: “We welcome both the outstanding practice highlighted by the CQC and the honest appraisal of the significant challenges we are working to overcome in east Kent.

“I am pleased the CQC has again recognised the incredible dedication and compassion of our staff who work tirelessly to provide the best possible service they can to patients.

“As a trust, we pride ourselves on our use of technology and have high ambitions to be an excellent training provider, so to have these two areas highlighted amongst our areas of outstanding practice is very encouraging."

The CQC highlights further areas for improvement, including safeguarding training of staff caring for children and young people and vulnerable adults; the levels of nurse staffing on surgical wards; referral to treatment times for surgical patients; and capacity within our emergency departments and receiving wards.

The extra £13.5m would create more beds for patients needing admission from the emergency departments at William Harvey and Queen Elizabeth The Queen Mother hospitals, reducing waiting times and creating more room in the emergency departments.

The money was also being used to increase the number of patients who could be treated on the same day, as well as additional radiology services to provide a seven-day CT scanning service for quicker diagnosis.