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Special measures trust gets formal warning from CQC over A&E failings

A hospital trust that is already in special measures and has been warned over maternity has been told to improve after inspectors found “blood spatters”, people waiting on trolleys for hours and A&E staff saying they were “under siege”.

The Care Quality Commission issued a formal warning to Medway Foundation Trust after an unannounced A&E inspection in December in response to “anonymous concerns” raised directly with the regulator.

During the inspection, CQC chiefs found a “crisis situation”, with blood-stained walls, serious overcrowding, problems with ambulances queuing outside, not enough staff and unsafe practices which could be life-threatening.

The problems at the Medway Maritime Hospital in Gillingham, Kent, come after the troubled trust was forced by the health regulator Monitor last month to appoint a new interim chief executive and chairman.

Medway hospital

Medway hospital

A major report in December from health firm Dr Foster said the trust had significantly higher than expected death rates while in October the CQC issued three formal warnings over poor maternity care.

During the maternity inspection, experts found an “almost constant demand for extra midwives to staff the delivery suite”, a lack of equipment for monitoring blood pressure in women who had undergone caesareans and problems with emergency equipment.

In the latest CQC review, inspectors said they could not judge the A&E care at the Medway Maritime Hospital to be safe.

They said patients arriving by ambulance were the worst hit, with not enough cubicles and trolley bays in A&E to provide assessment.

Instead, a mobile unit had been set up outside the hospital and was being used as an “overflow area” where patients brought in by ambulance could be assessed.

Despite the fact patients should only stay there for 30 minutes, many were staying longer due to there being no bays or beds in the main unit and a lack of staff.

In the main unit, inspectors found patients waiting for hours on trolleys. Patients were also not near resuscitation or other vital equipment.

“I personally don’t think we are being supported; it’s a constant battle”

Member of trust staff

The report said: “On our arrival in the department there were 20 patients who had been in there for more than four hours, waiting to be seen by doctors. Seven of these had been in the unit for over 11 hours and one patient had been there in excess of 19 hours.

“Staff and a person’s relative reported that during the preceding night there had been up to 17 people on trolleys in the corridors waiting to be seen and 16 ambulances waiting for spaces to bring in more patients.

“A staff member said that there had not been a free cubicle for five consecutive days.”

One patient who was cold had asked for a blanket at 4am but had still not been given one at 8am.

Another patient “had not been offered any food or drink for 18 hours, although this person had no medical reason to prevent or restrict them from eating or drinking.”

One patient who wanted pain relief had not been given any while one elderly person had been on a trolley for over 20 hours. Other patients were left in cold rooms with only short-sleeved nightwear.

“Single use resuscitation equipment was open and not covered or protected from cross contamination”

CQC inspectors

Inspectors also looked at cleanliness and saw “cubicles with visibly dirty radiators and paintwork, stained floors and dirty wash hand basins; and blood spatters on a wall in the (mobile) unit.

“The resuscitation area was cluttered with boxes and equipment on the floors including sharps bins. Single use resuscitation equipment was open and not covered or protected from cross contamination.”

Inspectors said records showed cubicles had not been cleaned for several days or weeks before the inspection, which was carried out on New Year’s Eve.

Furthermore, many curtains between cubicles were “visibly stained or dirty”. There were also problems with men and women being treated together, which breached their right to privacy and dignity.

The inspectors said the emergency department was “effectively in a crisis situation”.

“More than one member of staff described the situation as ‘under siege’, and another said, ‘I personally don’t think we are being supported; it’s a constant battle’.

“A relative stated ‘The staff have been nice; they couldn’t work any quicker’ and we saw that medical and nursing staff were working very hard to try and treat people appropriately.

“However, there were too many patients for the capacity of the department, and too few staff to meet their needs.”

Even when inspectors told nurses an older person was at risk of pressure sores, nothing was done to move them to a bed until 22 hours after arrival.

The report went on: “We found that there were times when seriously-ill patients were left unattended. The resuscitation area had an allocation of two nurses at all times.”

However, nurses said this did not happen in practice and admitted there were sometimes no nurses present. There was also a lack of doctors on duty and emergency suction equipment was not assembled.

Inspectors said: “We assessed that care and treatment in the emergency department could not be considered as safe.

“Staff told us that moving people to the wards was difficult. One member of staff told us that staff on the wards had ‘No concept of what it’s like down here… they don’t understand what it’s like to have 12 ambulances stacking outside’.”

“It is clear that the work taking place to make improvements has not yet translated to better patient care”

Adrian Hughes

Adrian Hughes, regional director of CQC in the South, said the trust was taking steps to improve its services but there were too many patients for the capacity of the department.

“It is clear that the work taking place to make improvements has not yet translated to better patient care in the emergency department,” he said. “We have referred our findings here to local commissioners, Monitor and NHS England.”

In January, the trust announced that plans had been agreed for a major redevelopment of Medway Maritime Hospital’s Emergency Department. The developments will cost up to an estimated £5m and key sections are due to be completed in time for winter 2014-15.

Both its chief executive, Mark Devlin, and chair, Denise Harker, also announced their intention to step down last month.

“I want to apologise personally for letting our patients down”

Steve Hams

In response to the CQC report today, trust chief nurse Steve Hams apologised that the A&E department failed to “live up to the high standards of care” that staff wanted to provide for patients.

“I want to apologise personally for letting our patients down,” he said.

Mr Hams highlighted that the emergency department was designed to treat 50,000 patients a year, but was treating 90,000 “and rising”.

Steve HamsSteve Hams

“We know it is not suitable for emergency and critical care in the modern world and are working hard to put it right,” he said.

He added: “We have recruited more clinical and non-clinical staff, and the infection prevention and control team carry out weekly unannounced visits.

“The emergency department is a much cleaner, safer and more efficient environment than when the CQC visited and we will carry on improving. This week we started  work on a complete redevelopment of the emergency department.”

Readers' comments (7)

  • Poor management: never mind spending £5M on a new A&E, the money needs to be spent on more staff, more senior Doctors and a team to take patients home from A&E who ought not be there. It is right that those two have decided to go

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  • The recently appointed "chief nurse" was recently featured in NT bragging about how he was going to improve the "standards" !

    He was also making a big noise about all the additional staff the Trust was recruiting !

    Seems Steve Hams days are numbered -----another failed "senior nurse" !

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  • Wonder where the Chief Exec and Chair have moved to?

    As for Mr Hams, his apologies aren't worth a carrot, just a meaningless platitude. At least he has introduced more non-clinical staff

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  • Its is amazing to me that "senior nurses" such as Mr Hams need the CQC to point out the filth, the lack of care, overcrowding and the poor staffing levels.

    Guess it must be very difficult for a "senior nurse" to extract themselves from the comfortable, clean, office to enter the real world occupied by patients and "junior" nurses !

    Perhaps Mr Hams will come here and explain why he not only failed to notice the problems but did nothing about them until the CQC lashed out.

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  • I have decided to help Mr Hams !

    Here Mr Hams are some potential hot spots in the organisation where if things go wrong will come back and bite !

    1. A/E
    2. Maternity
    3 Wards with high % of elderly patients.

    You need to be making regular non announced visits to these areas during the day , at night and the weekends !

    Simple observation should tell you if the clinical areas are clean and if the staffing is matched with the workload.

    A "senior nurse" should be able to ensure that emergency equipment is available and well maintained. Ask the "junior colleagues if they feel supported in their roles , ask if there an adequate number of B/P monitors or cardiotocography machines ( Hint the midwives know about cardiotocography! )

    I have no doubt you will need to construct a check list/tick box form to assist in this onerous task !------If that is the case then so be it

    But

    Get out there man and never allow the CQC to find a failures of "nurse management" again !

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  • tinkerbell

    when you upgrade medway A&E could you also address the dimly lit areas of the A&E waiting room, I could barely see my hand in front of my face. The whole waiting area is very grim indeed. Also could you address the receptionists sitting talking to each other and trying to ignore me until I had to say 'excuse me', also could you address the length of time it takes to answer a phone when trying to get through to Medway, I'm sure a lot of people eventually put the phone down. Also could you address the telephonist who answers the phone at medway and sounds as though she couldn't give a toss, she is the first point of contact. Also could you address .................................oh never mind.
    There are some really good areas of care at medway with cheerful staff but A&E is pretty dire and has been for many, many years.

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  • After reading the report about the failures one would be forgiven to think that Health Care in England is worse than in some 3rd world countries.
    Is it such a difficult thingh to care?
    Do we have the most foolish people taking up managerial positions in nursing?
    Sometimes I feel ashamed to belong to a profession that cannot pull themselves up.
    Every other profession is just getting on with their job without so much horror stories.

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