Critical care services at Maidstone and Tunbridge Wells NHS Trust have been labelled “inadequate” by the healthcare regulator, which has told the organisation to make significant improvements in this area.
Overall, the Care Quality Commission said the trust required improvement, but highlighted the critical care services in particular at both Tunbridge Wells and Maidstone hospitals as needing changes to ensure patient safety.
In October inspectors found several incidents of delayed discharge from both hospitals’ intensive care units – sometimes up to a week – due to a lack of ward beds and in many instances were discharged home directly from the ICU.
“Senior staff told us they continued to escalate delays [from the ICU] to the matron during the daily bed meetings, but the practice continued”
At Maidstone Hospital, the CQC found that after a high number of discharges being delayed by more than 24 hours in January 2014, a member of the senior management team had asked staff to stop recording these incidents.
Inspectors were told by staff that they had been asked to do this because there were no financial penalties to the trust for breaching these best practice guidelines.
“Senior staff told us they continued to escalate delays to the matron during the daily bed meetings, but the practice continued,” said the CQC in its report on the trust.
Other issues included the large remit of the matron – who covered both hospitals’ ICUs, operating departments and contamination – and their lack of previous experience working in critical care.
“We have come a long way as a trust and are committed to going a great deal further ”
Across all services, staff were caring and patients and relatives were satisfied with how they were looked after, the report added.
At both hospitals, inspectors found nursing staff levels were “generally good” and that the trust was taking steps to recruit from abroad to fill vacancies and reduce its current “significant reliance” on bank and agency workers.
However, there were some concerns about the “unco-ordinated” nursing leadership within urgent and emergency services at Maidstone Hospital.
Inspectors also noted the hospitals were visibly clean and had falling infection rates. In 2007 a series of deaths relating to an outbreak of Clostridium difficult were exposed following an inspection by the Healthcare Commission, the CQC’s predecessor.
CQC chief inspector of hospitals Professor Sir Mike Richards, said: “We saw that quick work was needed to improve the governance of the trust and of a number of the core services we inspected.
“There was a great deal of variation, both in the ability of the senior directorate level management teams to run their services effectively, and in the level of robust clinical oversight of services,” he said.
Trust chief executive Glenn Douglas said that following the inspection, the trust was “driving through further improvements for our patients”.
He added: “We have come a long way as a trust and are committed to going a great deal further and see the CQC inspections as an important part of our journey.”