A&E promoted from ‘inadequate’ to ‘good’

Medway Foundation Trust’s accident and emergency had made significant improvements, the CQC said in a report today, praising leaders who were having a positive impact on the department and worked well with the executive team. Changes made to the A&E in the last two years have created more space and helped staff provide better care, it said.

But the regulator also pointed out that there were not always enough nursing staff on duty, patients waited up to 40 minutes outside before getting access to the department, and were not always assessed during this time. Five patients were being cared for in a corridor when inspectors visited.

The trust also had problems with patient flow through the hospital – on the day of the inspection 108 patients were medically fit to leave but needed social care support, leading to other patients waiting for extended times to be reviewed by specialist teams.

Interim chief executive Jayne Black said: “I would like to thank colleagues for their hard work and commitment to delivering these improvements despite a very challenging backdrop of increased demand for services and the covid-19 pandemic.

“Thanks to their efforts we are now providing more timely and consistent care for patients coming into the emergency department.

 “We know there is still more that we can do to improve, and we remain committed to providing the outstanding service that the people of Medway and Swale expect and deserve.”

The inspection – which does not change Medway FT’s overall “requires improvement” rating  – was part of a larger inspection of urgent and emergency care services across Kent and Medway, which also saw the rating for Dartford and Gravesham Trust’s A&E improve from “requires improvement” to “good”.

The “system” inspections included a community healthcare provider GP surgeries and social care, as well as the two hospital trusts but did not include some key providers such as Maidstone and Tunbridge Wells Trust, East Kent Hospitals University FT and Kent Community Health FT.

Inspectors said they had also stepped in, as part of their system inspection, to ensure patients were able to access particular GP practices.

CQC director of operations for the south Deanna Westwood said: “A number of GP practices in the area have a sizeable number of patients and demand for appointments is increasing. We saw that in the majority of cases this demand was well managed.

“However, we did find some access issues in primary care, as some GP practices weren’t allowing patients to enter the building without permission from staff. Since our inspections, we have taken action to ensure patients can access their GP freely.”

The report also highlighted staffing problems and called for further work across the Kent and Medway integrated care system to ensure people were not facing long delays for assessment and treatment. Social care staff were having to look after patients waiting for ambulances, it added. South East Coast Ambulance Service FT was put into “special measures” following a critical report earlier this week.

But the use of other healthcare professionals in GP surgeries and support for interpretation services for people from diverse communities and Ukrainian refugees was praised.

Kent and Medway integrated care board chief executive-designate Paul Bentley said: “Despite an incredibly busy winter and rising Covid-19 infections – nearly 900 people with covid were cared for in our hospitals in February - the CQC snapshot on some of our services shows areas of good work and highlights where we have further improvements to make. We are investing in more than 150 new projects to reduce waiting times, for example.

“How we work together to consistently offer our communities the best possible care is critical and we understand this. We look forward to seeing it reflected in future inspections.”

 Cambridgeshire and Peterborough

Meanwhile, a similar “system” report into urgent and emergency care services in Cambridgeshire and Peterborough found staffing shortages in health and social care left services struggling to meet patient needs and called on leaders to minimise this through smarter ways of working, recruitment and retention and collaboration.

CQC director of integrated care, inequalities and improvement Mandy Williams said: “Without further management there is a risk the quality and safety of care people receive could be undermined.”

The report found a high number of 999 calls involved people who could have received more appropriate assessment elsewhere, ambulance handover delays and some GP surgeries had not acted to reduce unnecessary A&E attendances.

Updated 24 June with comment from Medway FT at 8.11am and from Kent and Medway ICB at 10.03am