• Trust says it made decision to shut ward and closure not requested by CQC
  • Closure may increase trust’s problems with patient flow
  • Trust currently rated “requires improvement”

A trust has closed an escalation ward “following discussions with the Care Quality Commission”, after a visit by the regulator which HSJ understands was critical of some services.

Eight patients on Medway Foundation Trust’s 15-bed Dickens Ward — which is mainly used for patients who no longer require acute hospital care but might require other services — were moved to acute beds and the other seven were discharged. 

It is understood the trust’s ability to provide an appropriate level of care for the patients is behind the abrupt closure. The trust said it reviewed use of the ward “following discussions with the CQC”, but that the decision was its alone, and not requested by the regulator. The visit took place in December and January.

However, the trust like many is facing problems with patient flow — and therefore its ability to meet the four-hour accident and emergency target — and the loss of beds will likely exacerbate this problem. It has upwards of 100 so-called “stranded patients” who would be better suited to another setting, and leaving such patients in an acute environment for too long can lead to deconditioning and increased chance of acquiring infections.

According to the trust’s January board papers, it is also battling “exit block” — causing a knock-on problem of major A&E delays for admitted patients — and its bed occupancy rate is regularly higher than 100 per cent. Medway also has no community hospital beds, although there are some in neighbouring Swale. 

It is likely the Dickens ward would have been closed later in the year, as escalation wards are typically used during the the winter months, then closed at some point in the spring, although NHS England has recently asked trusts to keep beds open through the year.

Chief executive James Devine said: “Following discussions with the CQC as part of their recent visit we reviewed the use of the ward. This week we took the decision to bring forward the closure so that patients are cared for in the most appropriate care setting which may be in another hospital ward or in the community with a care plan.

“We have worked together with the support of our partners in the community and our commissioners to ensure patients who were fit to go home or to a community setting were able to do so in a timely way. High quality safe patient care is our priority at all times, to ensure our patients receive the right care in the right place.”

The trust is currently rated “requires improvement” following a July 2018 inspection, with “good” ratings for effectiveness and caring, and “requires improvement” ratings for safety, responsiveness and leadership. Its medical care is also rated “good”. 

Medway FT came out of special measures after four years in March 2017, at which point its rating was also upgraded from “inadequate” to “requires improvement”. 

The CQC report from the most recent inspection is expected to be published next month. However, the trust has confirmed initial feedback warned it needed to comply with Control of Substances Hazardous to Health Regulations, particularly around locking away hazardous substances. It added it had “raised awareness of this with [its] staff” and had also implemented checks to make sure all staff were compliant with infection prevention and control measures, including hand hygiene.


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