CQC inspection of East Kent Hospitals' emergency departments

Published on 14 July 2020

The CQC has today published reports into East Kent Hospitals’ emergency departments following an inspection of urgent and emergency care at both hospitals on 3 and 4 March this year.

The CQC upgraded the service at the William Harvey Hospital in Ashford to ‘good’ for caring, it remains requires Improvement for being safe, effective, responsive and well led.

The Queen Elizabeth The Queen Mother Hospital in Margate was also rated ‘good’ for caring and was upgraded to ‘good’ for well-led. It remains requires improvement for being safe, effective and responsive. 

The service remains as requires improvement overall.

William Harvey Hospital

At William Harvey Hospital, inspectors found staff “treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs”. They also recognised improvements to the children’s emergency department. 

However, the Trust has taken immediate action to address issues raised in the CQC’s report, including creating more space in the department, continuing to recruit more nurses, and ensuring risk assessments are consistently carried out.

East Kent Hospitals Chief Executive Susan Acott said: “Staff in the emergency department have worked hard to improve, particularly on the issues raised by the CQC in its 2018 inspection around the privacy and dignity of patients in the department, and compassion. This work has been recognised by the CQC in improving its rating to ‘good’ for caring.

“The CQC has also recognised the huge amount of work undertaken to improve emergency services for children since its last inspection.

“We fully accept that we still have a lot of work to do to achieve the consistently high standards we want for all our patients in this very complex service.

“We recognise the improvements the CQC requires us to make, and we will continue to implement changes to the emergency department to enable staff to provide the highest standards of care.”

The CQC has issued two requirement notices, relating to governance and safe care of patients, as well as other actions the Trust must take to improve.

Since the inspection, we have:

  • continued to recruit nurses, with assistance from the Trust’s aspirant nurses programme and those who returned to practice. Managers increased their review of nursing and medical staffing to every two hours so that staff can be relocated from within the department or from other areas in the hospital. There is also an additional daily staffing call of medical and nursing staff across the emergency floor on both sites to identify and address any gaps.
  • begun the planned building work to expand the department to provide more space to care for patients, including providing an additional 15 cubicle spaces to improve privacy and dignity, and creating a room specifically for patients with mental health needs that replaces those used at the time of the inspection.
  • promoted the role of the nurse in charge and ensured they are checking every two hours to make sure patients are receiving the correct level of care. This includes nutrition, hydration, pain relief and pressure area care, and that their privacy and dignity is respected. This is supported by regular matrons’ rounds at least every four hours to review cleanliness and other patient safety checklists and ensure any delays to treatment are escalated.
  • given staff additional training on the newly-installed Vitalpac system, which records patients’ clinical observations, to help staff monitor patients and record their care more effectively.
  • worked with the team on auditing incidents to ensure everyone can learn from them, and promoting the Freedom to Speak Up programme for staff to raise concerns.
  • continued to encourage all patients to complete a Friends and Family questionnaire to give feedback on their care.

We are also trialling an emergency department app that will allow patients to access discharge information and advice electronically. It also allows staff to sharing guidelines and education material.

The CQC identified two areas of outstanding practice: that there were mental health support workers on every shift, and that the service had an arrangement with Kent County Council to fund five care packages each day, allowing patients who needed support to be discharged without having to wait for arrangements to be made.

Queen Elizabeth The Queen Mother Hospital

At QEQM, inspectors found “staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs”, “supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment” and focussed on the needs of patients receiving care.

The report also found staff kept detailed records of patients’ care and treatment, swiftly completed risk assessments, and acted on their findings quickly. They acted on and shared learning from incidents and complaints. Staff had the right mix of skills and experience and more staff had been recruited.

They said “leaders understood and managed the priorities and issues the service faced”, and staff “felt respected, supported and valued. They were focussed on the needs of patients receiving care”.

But they also found areas that required improvement, including the need to improve waiting times, ensure all staff had completed training and improve the way medication is prescribed and reviewed. 

The Trust has taken immediate action to address these issues, including reviewing pharmacy support in the emergency department, and providing more training. There is now a pharmacy team dedicated to supporting the emergency floor.

The CQC issued two requirement notices, relating to mandatory training, reducing the unplanned reattendance rate and waiting times, and monitoring improvements on patient outcomes.

Inspectors identified having mental health support workers on every shift to care for patients with mental health needs as outstanding practice during their visit. 

Their report also praised the way doctors, nurses and other healthcare professionals worked together for the good of patients, and noted the compassionate way all staff dealt with patients, including porters and receptionists. 

The report added: “We observed episodes of care during which patients were truly respected and valued as individuals.

“Patients were empowered as partners in their care both practically and emotionally. This was especially the case for those patients who presented with mental health conditions or those patients who were recognised as vulnerable.”