Strict conditions imposed on Medway following multiple inspections

The regulator imposed the conditions on Medway Foundation Trust immediately after it inspected its A&E department at the end of August and found a lack of improvement, it has been revealed.

The CQC has previously refused to reveal the details of these conditions for “legal reasons”.

The inspection report published today reveals that under the new rules all patients arriving at A&E must be assessed by a clinician within 15 minutes.

The department has also been told to establish a system to record each patient’s arrival, registration and time of first clinical assessment.

The trust must also inform the CQC on a weekly basis every time this standard is failed; and provide details about the patients affected, how long each one waited for an initial assessment, the reason why they waited longer than 15 minutes, and if there were consequences.

A monthly report must also be submitted that identifies the “root causes” for failing the 15 minute assessment standard and an action plan put in place to tackle any failures.

The actions follows the CQC’s latest inspection of the beleaguered department at the end of August, which found examples of poor care including an elderly lady who was assigned a ward bed after waiting for over 12 hours, only to be told that the bed was no longer available.

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Despite being at high risk of developing pressure sores, the patient was left waiting on a trolley for nine hours.

Inspectors also found that one elderly patient had presented with a “potentially life threatening gastrointestinal disorder” but had been waiting for two hours in the holding bay without intravenous fluids or an initial clinical assessment being carried out.

A senior ambulance staff member told the inspectors that a patient with a known arrhythmia had suffered a cardiac arrest in a corridor while awaiting their first clinical assessment.

The performance of the A&E was “markedly worse” between July and September compared to between April and July despite there being fewer attendances, the team found.

In the latest three monthly figures the department only managed to see, treat, admit or discharge 83 per cent of patients within four hours, against the 95 per cent target.

Six patients waited more than 12 hours to be seen and 724 patients were left waiting between four and 12 hours.

A trust spokeswoman said it has employed an emergency consultant lead from Homerton University Hospital for a year to help improve Medway’s A&E.

Two new emergency consultants have also joined the trust and there is a new head of nursing in the department. Three emergency care matrons will be in post by December.

The trust has replaced its referral system and the spokeswoman claims that over 95 per cent of patients who arrive at the department by ambulance now have an initial assessment completed within 15 minutes of arrival.

Phillip Barnes, acting chief executive, said: “We realise the challenges before us and are fully committed to providing the high quality of care our patients deserve. With the direction now being provided by the new board of directors, work is taking place across the organisation in a number of areas to ensure we can provide high quality and efficient healthcare in a sustainable way.”