• CQC report expected to be critical of aspects of trust’s care
  • Changes “essential for quality and safety priorities,” says trust
  • Director of nursing on long-term sick leave

A trust has made changes to its nursing strategy ahead of a Care Quality Commission report which is expected to be highly critical of aspects of its care.

The CQC’s report on Medway Foundation Trust is due to be published imminently, but it is understood its visit in early December highlighted concerns about nursing leadership, staffing numbers and senior nursing oversight in some areas. 

A paper discussed at the trust’s board meeting last week said the changed approach laid out in its strategic plan for nursing for the rest of this year “is essential to ensuring the delivery of our local strategic quality and safety priorities and in turn regaining the confidence in nursing both internally and externally to the trust”.

It added delivering “the scale and depth of priorities at pace will, at times, require a more transactional leadership approach to be taken”.

In December, interim chief nurse, Jane Murkin, was appointed alongside director of nursing quality and professional standards, Kary White. 

The trust’s substantive director of nursing, Karen Rule, is on long-term sick leave, with no date set for her return. The trust declined to share when Ms Rule went on sick leave, although this month’s board papers referred to her sick leave being “anticipated” on 13 December. 

Ms Murkin and Ms White have identified the following priorities for change, some of which are already in progress:

  • A focus on developing the role of matrons and ward managers with investment in their leadership development and support. Revised job descriptions for pivotal nursing roles are being developed;
  • A new nursing and midwifery standards, accountability and governance framework to be implemented this month;
  • Commissioning an external review of maternity services by the chief nurse which will be undertaken in partnership with the clinical commissioning group. It will look at reporting, investigating and learning from incidents; and
  • A review of establishment and training and education, which needs to be undertaken in April. The trust says any subsequent role or people changes will be made in keeping with its organisational change policy.

The CQC’s visit also highlighted the need for regular reviews of nursing care plans on the trust’s Dickens Ward, which was used for patients who no longer require acute hospital care but might require other services. The trust shut the ward in January

In addition to the CQC’s concerns, trust chief executive James Devine commissioned a report from NHS England/Improvement in February last year, which made recommendations for improving nursing at the trust.

Mr Devine then appointed a quality adviser for three months and, in October, sought assurance from two senior experienced nurses. Their concerns — some of which the CQC also identified during its visit — included:

  • A lack of clarity and consistency in job roles such as ward manager, senior sister, charge nurse and matron;
  • Senior leaders not always being sighted on ward safety risks even when they had been reported or were visible on wards;
  • Little or no oversight of “fundamental care outcomes such as nutrition and infection prevention and control”. Most patients were in bed, even at mealtimes; and
  • A lack of clarity around how nursing indicators and outcomes were linked to performance management and how senior nurses were held to account.

The trust declined to comment further on the board paper, other than saying it was a positive story about strengthening nursing and midwifery leadership.