CQC recognises examples of outstanding practice at East Kent Hospitals, but there’s more work to do

The CQC inspected the Trust’s hospitals in Ashford, Canterbury and Margate in May and June this year.

The Trust’s rating remains at Requires Improvement after the CQC looked in detail at four areas at three of the Trust’s five hospitals – urgent and emergency services, surgery, maternity and end of life care – as well as the ‘well-led’ aspect of the Trust. 

This is the fourth inspection for the Trust since 2014 and the first since it was taken out of quality special measures in February2017.

In its report, the CQC recognises that the Trust is on a journey of improvement, aiming to build on the progress which raised the Trust out of special measures in 2017. 

It found areas of outstanding practice, including:

• How the Trust uses technology to improve the patient experience. For instance, patients can use mobile phone applications to access information about pregnancy and the maternity department, and to get additional support and guidance about surgery before and after their operation
  

• An specialist intravenous access team takes blood samples and inserts cannulas under ultrasound guidance – this gives patients a better patient experience as it minimises the number of attempts that need to be made to ‘find a vein’. The Trust is the first in the country to implement this innovative service in emergency departments.
  

• Also within the emergency departments, equipment in the resuscitation area is very well organised with colour coded drawers and clearly labelled equipment in glass-fronted cabinets, which means staff can quickly find the correct equipment they need.
  

• The maternity service has ‘a unique and ambitious approach to education’ and the faculty of multi-professional learning provides training that ‘exceeded that of other maternity units’. The service has top of the range simulators for staff training and is the only maternity unit in England to have undertaken quality assurance in clinicians’ essential life support skills.

The CQC commented “it was notable that the maternity department had made great strides to drive learning, improve patient outcomes and inspire innovation”. Since the last CQC inspection, the Trust had introduced the maternity transformation programme, called ‘birthing excellence success through teamwork’ (BESTT), to reduce the number of stillbirths, admissions to neonatal intensive care, and skin tears during delivery by the end of next year. 

The report also reflects significant challenges that the Trust is addressing, including waiting times for surgery and for emergency admissions, and the significant impact that high numbers of patients can have on the Trust’s ability to deliver some services, for example, in the Trust’s emergency departments.                                                                                          

The Trust is addressing these issues. In total it has invested £13.5m to increase staffing and services ahead of this winter. This includes creating more beds for patients needing admission from the emergency departments at William Harvey and Queen Elizabeth The Queen Mother hospitals, reducing waits and creating more room in the emergency departments.

The investment includes extended ambulatory care so that more people can be seen, treated and discharged on the same day, without needing to be admitted to hospital; additional radiology services to provide a seven-day CT scanning service for rapid diagnostics and investment in new technology.

The Trust has recently announced plans to improve surgery waiting times and protect planned orthopaedic operations by moving some orthopaedic services to Kent and Canterbury Hospital this year to avoid having to cancel patients’ surgery in the busy winter months.

This also gives the Trust an opportunity to carry out more general and gynaecology surgery at the Ashford and Margate hospitals, to further reduce the number of people waiting over a year for an operation.

The Trust has also asked for national funding to extend the emergency departments at Margate and Ashford in the New Year by building new observation areas. This will create more space in the emergency departments during very busy periods and ensure patients needing observation can be cared for in a more appropriate environment than a busy emergency department.

Key findings of the report include:

• All hospitals rated ‘good’ for ‘caring’, with staff providing emotional support to patients and caring for patients with compassion, and ensuring patients’ privacy and dignity by using discreet symbols to communicate personal or sensitive information about medical history, disabilities or end of life status;

• Outstanding practice in a number of areas, including use of technology, maternity, specialist IV access teams, resuscitation areas, post-discharge checks for surgical patients and communications practice;

• Commitment to improving staff experience at the Trust, with Board members ‘recognising the need to focus on and improve the culture of the organisation and developing processes to support staff and promote their positive well-being’;

• A need to improve staffing levels in some areas, particularly surgical ward nursing teams and emergency care doctors;

• A need to embed quality monitoring, systems and processes, including ensuring the Trust consistently learns from mistakes and makes more use of data to improve the quality of care;

• Delays to public consultation regarding the provision of health services across the system has ‘impacted many aspects of running the Trust including investment, staffing and culture’.

“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,” said Chief Executive Susan Acott.

“I am pleased that 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 improving 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.

“These are things we are already addressing as priorities. For example, by investing in extra operating theatres, hundreds of patients who would not normally be able to have their planned orthopaedic operation over the winter will see their operations go ahead this year.

“We are pressing ahead with much-needed investment in our hospital sites to make sure east Kent patients are served well in the period before long-term decisions about the future organisation of health services in the county are made and implemented.

“We have asked for national funding to extend the emergency departments at Margate and Ashford in the New Year by building new observation areas. This will create more space in the emergency departments and prevent patients needing to wait in open areas for a bed in extremely busy periods.

“We are recruiting additional nurses, doctors and consultants in our emergency departments, as well as paediatric nurses to provide 24/7 cover to care for children in the emergency department.

“We are all determined to continue to improve services for patients and resolve our challenges as quickly as possible.”

As well as the overall Trust rating, the CQC gives an individual rating to each of the Trust’s three hospitals inspected this year.

• William Harvey Hospital, Ashford – remains rated ‘requires improvement’ overall, with surgical services at William Harvey Hospital upgraded to ‘good’ overall and critical care and outpatients diagnostic imaging rated ‘good’ overall.

• Queen Elizabeth The Queen Mother (QEQM) Hospital, Margate - rated ‘requires improvement’ overall, with medical care, critical care and outpatient and diagnostic imaging all ‘good’.

• Kent and Canterbury Hospital (K&C), Canterbury – remains rated ‘requires improvement’ overall, with services for children and young people, critical care and end of life care rated ‘good’ overall.

• The ratings for the Trust’s two hospitals in Dover, Buckland Hospital, and Folkestone, Royal Victoria Hospital, were rated ‘good’ in 2015 and not re-inspected this year.