We take the feedback from CQC very seriously and have made some progress in addressing the issues raised. The current high demand for many of our services does put extra pressure on our staff in A&E and in our medical and surgical wards. Each year we employ more staff. However, we acknowledge that we are carrying a number of vacancies in key areas where there is a national shortage of staff.
We are doing all we can for our patients, the public, and our staff.
Patient Safety
Is it safe to be treated at our hospitals?
- We have had a good track record in patient safety and continue to have a much lower than expected rates for mortality, infection and complications following surgery
- Patients can be reassured that the current services are safe in terms of the outcomes we provide. For example, our hospitals have lower than expected rates of mortality, infection and surgical complications. We do not believe that any patients have been harmed as a result of what the CQC have highlighted to us.
- We are addressing staffing levels in some key wards and departments where we have had to put up extra beds to accommodate increasing admissions to hospital or where there have been delays in transferring patients to other services outside of our hospitals (for example specialist hospitals in London, community hospitals or community teams, residential and nursing homes).
- Too many of our staff have to undertake extra hours to compensate for vacancies or when someone goes off sick. We are working hard to cover these gaps and to recruit to vacancies, however this is not easy when there is a local, and sometimes national, shortage of some staff groups.
- We have looked at alternatives to recruit nursing staff, for example recruiting from outside of the UK. This has only worked in part as some only want to stay for a relatively short period of time (approximately 12 months) and in the meantime it creates more work for our staff in providing the support that overseas staff need when getting used to working in the NHS.
- We have invested £2.9 million recruiting 55 extra nurses, with funding to recruit an additional 14 nurses. This September we are also welcoming 55 newly qualified nurses.
What are you doing about unsafe, out of date equipment?
- All equipment is accounted for on an equipment register and is regularly reviewed for maintenance and replacement. The Trust spends £2 million each year on equipment replacement, and this is prioritised with clinical input. The equipment they saw was on the list for replacement this year, and the equipment identified has now been replaced.
- Equipment that the CQC highlighted to us as unsafe for use with children we know are used in many other specialist hospitals for children. We have, however, now moved to the equipment the CQC recommended and will be letting the specialist hospitals know about the CQC's views.
Is it safe to be treated at the William Harvey Hospital?
- The care, medical and surgical outcomes are very good at the William Harvey Hospital. The main difficulty we have faced there is the growth of patients wehave seen over the past year or so. This has led to many of the clinical environments being cramped as they are not designed for the volume of patients, causing difficulty for both staff and patients.
- We are working to lower the volume of patients as we have found that a large proportion could have their care provided at home, in a community hospital, or in an extended outpatient setting rather than being admitted to hospital.
- We are working with our commissioners and other health and social care providers to see how together we can ensure patients can be cared for safely outside of hospital when appropriate. This would free up hospital beds and staff to care for those patients that really do need to be in hospital.
Trust Management
How are you helping to reduce the reported divide between frontline staff and senior managers?
- This is one of the areas we must improve on because this is the clear perception of our staff. Although the members of the Board, senior medical & nursing staff and managers do visit wards and departments as often as they can across the 3 sites quite clearly we need to find ways of improving this even further and will endeavour to do so.
How are you working to improve how staff are led?
- Our staff take great pride in caring for patients, and we will continue to support them in caring for patients well. The rating for leadership relates directly to the impact of vacancies on services and on staff and the perceived impact on patient safety.
How are you looking to support your staff more effectively?
- We will be looking at ways to improve how we meet and listen to staff, and together support each other in resolving the many difficult challenges faced by our staff and by the hospital system. Our staff are very important to us and have many good ideas. The vast majority of staff do talk to their clinical and managerial leads to raise concerns or to have problems resolved. However, we do recognise that some staff felt the need to raise their concerns via the CQC.
- We are looking at ways we can further encourage our staff to be always vigilant to patient safety and care, and to report all safety incidents no matter how insignificant they may seem.
Are members of the Trust's Board of Directors planning to resign?
- It is important for our efforts to be focused on working together to address the issues raised in the report.
How then can the public have faith they will get safe care in the Trust?
- We too are disappointed with the reports and are focussed on the improvements required. We think the public can have confidence in the care and compassion of our staff and the good clinical outcomes they achieve. We have lower than expected rates of mortality, infection and complications following surgery.
- We would like to continue working with our patients and the public to regain their faith in us. We will be interested in any help and support that the publiccan provide so that together we have services that we can all be proud of.
Accident, Emergency and Urgent Care
How is the Trust working to improve A&E?
- We agree that we do need to improve our A&E services. The A&E departments are seeing up to 100 more patients each day now than they did this time last year, especially in the evenings and at weekends. We have added in some more staff, however, we do have significant vacancies in both medical and nursing staff, and so patients are not seen as quickly as we would like. We are working with our commissioners to try to understand the growth in the numbers and to see if we can pool resources across other providers (community, social services, and the ambulance service) to support us in caring for our patients safely and quickly.
Is the Emergency Care Centre (ECC) at Kent & Canterbury Hospital confusing for patients?
- Our evidence suggests that the ambulance service and many of our local residents do understand how the ECC at Kent & Canterbury Hospital fits into how we provide safe emergency care.
- Some of the improvements we have made include adding an additional doctor to the service, and have arranged the rota’s for junior medical staff in a different way which has helped to ease the work-load for doctors.
- The CQC were also concerned about children with minor illness or injury being treated by general nurses in the ECC. These nurses are specifically trained to provide minor injury and minor illness services and so we are happy that the service is safe. We will, however, be looking to include specific children’s nurses at Kent & Canterbury's ECC as well to ensure children and young people receive the best possible care.
Is the report an indication that services are being run down at QEQM as rumoured?
- We are seeing more patients than ever at QEQM, both emergency patients requiring urgent care, and also patients requiring planned operations. The truth is that the needs of the population are growing, people are often older and sicker when they reach hospital. However, we also have a difficulty in discharging patients from hospital, it often takes many days and weeks to organise complex discharges. This puts pressure on our wards and in general terms our hospitals much of the time are too full. We are working with our commissioners, social services and community NHS partners to speed up discharges and reduce avoidable admissions.
Are there any areas rated as good by the CQC?
- We are pleased that the CQC recognised that critical care is providing a good service, these patients are amongst the most vulnerable in our hospitals and so it is good to see. Our ambition is to continue to improve all our services so that they are ranked as good or outstanding. The CQC did say that they saw good and outstanding care in other services but felt that the gaps in staffing meant that they could not give it a good rating.
Surgery
I'm concerned about the surgery I'm due to have - is it safe?
- We have been pro-actively looking at how we can ensure surgery is safe and sustainable in the Trust and we were particularly concerned about how we could sustain emergency surgery on three hospital sites. This led us to explore whether we could temporarily provide emergency surgery from one hospital site. Since then we have we have recruited four additional general surgeons who will start in September and October which will enable us to maintain emergency surgery on all three sites. We are continuing to recruit to a further three general surgeon posts.
- All through this situation we have been monitoring surgical outcomes (mortality, infection rates and surgical complications) at all 3 hospital sites. None of the services are rated as unsafe in terms of these surgical outcomes. The CQC acknowledged that we have plans for additional staff but these staff were not in post at the time of the inspection.
- Patients who may be concerned about their operation should speak with their consultant or with a senior nurse.
