PERFORMANCE: Ambulances will be temporarily diverted from the accident and emergency department at Medway Foundation Trust two mornings this week under a plan from NHS England.

  • Ambulances to be diverted from Medway FT’s A&E twice this week
  • Maidstone and Tunbridge Wells Trust and Dartford and Gravesham Trust to receive extra patients
  • Neighbouring trusts have been asked to provide A&E staff to Medway
  • CQC inspection found “lack of active leadership” in Medway’s A&E department

This follows a recent Care Quality Commission inspection that found a “lack of active leadership” in the department which created a “subsequent risk to patient safety”.

Under the plan, the emergency department at Medway will be temporarily closed to ambulances on Wednesday and Thursday between 7am and 12pm this week and ambulances will be diverted to Darent Valley, Maidstone or Kent and Canterbury Hospitals.

Walk-in patients and paediatric, cardiac, maternity and abdominal aortic aneurysm patients arriving by ambulance will all be seen at Medway.

In the weeks following the ambulance divert neighbouring trusts will be asked to supply staff to the struggling A&E department to allow Medway staff to attend training. This will include staff from East Kent Hospitals University Foundation Trust, Dartford and Gravesham Trust and Maidstone and Tunbridge Wells Trust.

Some of these trusts are already struggling with poor A&E performance. Only 81.3 per cent of East Kent’s A&E patients were seen, treated, admitted or discharged within four hours throughout July and Maidstone and Tunbridge Wells Trust saw 91.2 per cent of patients.

NHS England was considering closing the A&E to ambulances overnight but this was met with concern by figures in the local health economy, HSJ understands.

It is not clear if the neighbouring trusts will receive extra funding for the increased number of patients or if penalties for breaching the four hour target will be waived.

This follows an inspection of the emergency department last month which found that at the busiest times patients were waiting too long to see a doctor or were left unattended.

Medway Maritime hospital

The closure at Medway FT could be repeated in subsequent weeks

This is the fourth inspection of the trust’s A&E department in the past two years that has caused the CQC concern. An inspection in July last year concluded the department “remained in a state of crisis”.

An NHS England spokesman said: “Following a recent inspection of Medway Foundation Trust by the Care Quality Commission the trust has asked for support from across the local healthcare system to help them in making the improvements needed.

“In order to provide this support ambulances will be diverted from Medway Maritime Hospital between 7am and midday on Wednesday 16th and Thursday 17th September. Walk-in patients to the A&E department will continue to be seen at the hospital.

“Ambulance patients will instead be taken, according to clinical need, to either Maidstone Hospital, Darent Valley Hospital or the Kent and Canterbury Hospital. Some patients will continue to be taken to the Medway Maritime Hospital.

“We are also working with partners across the healthcare system to put in place further measures to support staff at the hospital. This includes additional training for clinical staff in the emergency department and bringing in experienced clinical staff which will allow staff time to attend training. Ensuring the delivery of safe care to patients and the public in Kent and Medway is our absolute priority.”

Guy’s and St Thomas’ FT was buddied with Medway in March to help the trust improve its clinical leadership and care standards.

Following an inspection last August, strict conditions were placed on the trust’s licence.

All patients arriving at A&E had to be assessed by a clinician within 15 minutes and the trust had to inform the CQC on a weekly basis every time this standard was failed and why.

There have previously been plans for neighbouring trusts to take on work from the trust. In November last year Maidstone and Tunbridge Wells Trust was considering taking on outpatient work from patients in Swale in respiratory, cardiology and elderly care.

A GP and nurse led urgent care community service, MedOCC, which already works in the A&E during the day, was also introduced onsite open 24 hours a day.

Sir Mike Richards, CQC chief inspector of hospitals, said: “We were concerned by the lack of active clinical leadership in the accident and emergency department and the subsequent risk to patient safety. In the busiest times, the emergency department was not able to cope with the numbers of patients attending: patients in need of treatment were waiting too long to see a doctor, or were being left unattended while they waited.  

“We raised our immediate concerns with the trust and local commissioners.

“We will publish the detailed findings of our inspection in due course. In the meantime, we will continue to monitor the trust closely.”

A trust spokeswoman said: “We are aware of the CQC’s interim findings and are working with our healthcare partners in NHS England and within Kent to address the issues that they have been raised. We share the CQC’s commitment to the delivery of excellent patient care and are doing our utmost to deliver this.”

Updated: This story was updated to include a new statement from NHS England and information on neighbouring trusts being asked to supply staff to Medway.

Quarter of patients waiting over 18 weeks

More than a quarter of patients waiting for elective treatment at Medway Foundation Trust have waited over 18 weeks, according to the latest data published by NHS England.

This is the highest proportion of any trust in the country. There were 9,094 patients waiting over 18 weeks to start treatment in July out of a total waiting list of 35,157 patients – 25.9 per cent of the trust’s total waiting list.

The target is for no more than 8 per cent of a trust’s waiting list to be waiting over 18 weeks.

NHS England recently announced it would be cracking down on breaches of the incomplete target and doubling the penalty.

From the beginning of October the fine will be £300 for each breach of the 92 per cent target.

The specialty with the largest backlog of patients was dermatology. There were 2,424 patients waiting at the end of July.

There were 229,606 patients nation-wide waiting over 18 weeks in July. This does not include 10 trusts which did not report their waiting lists.

A spokeswoman from Medway Clinical Commissioning Group said: “Solutions are being identified that seek to rapidly improve the situation, making sure that in the meantime patients are able to choose alternative providers if appropriate for them, and that people with longer waits are being treated at the earliest opportunity.”

“A remedial action plan has been agreed with Medway FT which seeks to address immediate capacity issues, as well as actions to put the trust on a better footing to deliver acceptable waiting times sustainably in the future.”

A spokeswoman for Medway FT said: “[The trust] has seen a significant increase in demand for services in specific specialist areas. We are currently working with our partners at the Medway CCG to address this increase, through the use of capacity and demand modelling solutions. Further, we have successfully co-sourced from other providers to increase our capacity for our patient referral to treatment pathway, thereby enabling patients to be seen in a timelier manner.”