Medway Foundation Trust has insufficient staffing levels and employees there feel unable to raise concerns, according to the Keogh review.
The north Kent trust’s board has been told it needs “greater pace and clarity of focus” on improving the overall safety and experience of patients.
The NHS England medical director’s review, published today, looked at 14 hospitals with higher than expected mortality rates. Its specific report on Medway identified six areas of concern.
The review report said: “The trust urgently needs a single visible strategy and action plan based on a recognised patient safety improvement model and underpinned by systematic staff training and roll out.”
In addition – like other trusts investigated by Sir Bruce Keogh – the review observed that in some areas it was clear that staffing levels and skill mix are “potentially unsafe”. The trust’s recent proposal for additional nursing staff was a “good start”, the review report noted.
Poor accident and emergency admission processes and a lack of early senior review meant the trust was also failing to do enough to prevent admissions, the review said.
This “failure to properly manage admissions” in A&E was leading to frequent use of escalation wards, overstretched staff and a failure systematically manage patients on the correct care pathway.
“The review team recognise the totally unsuitable layout of the A&E department and the constant work arounds staff are using to try and cope with working in an environment unfit for purpose,” the report stated.
It added that there was a need to improve senior clinical assessment and timely investigations, and to “galvanise” and spread the good work that was going on in wards.
The report said: “The medical and nursing director must urgently agree a single model to assess the deteriorating patient and a clear protocol for escalating concerns which is rapidly implemented on every ward.”
It added: “Junior Doctors must be trained in the system so when they are called by nursing staff they understand how to respond, including asking for consultant help, and that the single model is part of the induction process for all staff.”
The review team said they met a large number of “committed and concerned” staff who reported they feel unable to raise patient safety concerns and when they did, little or no action was taken.
“Staff feedback on patient safety must be taken seriously,” the report warned.
The trust has yet to respond to the review’s findings.
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