The Care Quality Commission has recommended that Medway NHS Foundation Trust should exit the “special measures” regime after nearly four years, following significant improvements.
The CQC recommended the Kent trust should leave the support scheme for struggling providers after its inspectors found significant improvements at its main site Medway Maritime Hospital.
“I want to pay tribute to the outstanding staff there who have always sought to put patients first”
Despite the improvements, the CQC noted there are still areas where further progress was required to ensure that patients received consistently safe care, including staffing levels.
The trust had originally been placed in special measures in July 2013 following Sir Bruce Keogh’s review of hospitals with higher than average mortality rates. Subsequent CQC inspections had seen the trust rated as “inadequate”.
- Eleven trusts put in ‘special measures’ following Keogh review
- Staff feel unable to raise concerns at Medway FT
- Regulators consider ‘next steps’ for struggling Kent trust
- CQC imposes strict conditions on Medway following multiple inspections
- Failure to improve leaves Medway facing more action
Following the latest inspection carried out during November and December 2016, the CQC informed its fellow regulator NHS Improvement that the trust has made enough progress to come out of special measures.
The trust’s overall CQC rating is now “requires improvement”. All of trust’s individual services are now rated as either “good” or “requires improvement” overall, with no areas still rated as inadequate. Meanwhile, maternity and gynaecology was rated as “outstanding” for being caring.
Inspectors found that all of the core services had made improvement. The executive team, although fairly new, was performing as an effective unit and staff spoke of a significantly better culture.
There had been improvements made to the triaging and management of patients in the accident and emergency department, and patients were no longer treated in a corridor.
“This is a great tribute to our dedicated staff and the fantastic job they do day in, day out”
The handovers and safety briefings in A&E were effective and ensured staff managed risks to people, noted the CQC in its latest report on the trust, published today.
In addition, the CQC said a programme of training, along with enhanced risk assessment tools had led to an improved incident reporting culture.
The trust had significantly improved its mortality rate and was no longer an outlier for the hospital standardised mortality rate – the original reason for it being placed in special measures.
Support to vulnerable patients such as those living with dementia and those with learning disabilities had been significantly improved, noted the CQC, with new pathways and services introduced to deliver enhanced care for patients.
However, although assessment of risks to emergency patients had improved, there were still concerns over staffing levels in the emergency care and maternity departments, said the CQC.
The inspection also identified a number of other areas for further improvement. For example, the trust was told it must ensure all staff had appropriate mandatory training and received an annual appraisal.
“We have found good evidence that the trust is making steady progress”
In addition, the trust was told to ensure patients should not have to share sleeping accommodation with others of the opposite sex. All staff must be trained to have an understanding of the regulation regarding same sex accommodation, said the CQC.
The trust must also ensure clinical areas are maintained in a clean and hygienic state, and the monitoring of cleaning standards falls in line with national guidance, said the CQC, and must take action to ensure emergency equipment, including drugs, are appropriately checked and maintained.
The CQC’s chief inspector of hospitals Professor Sir Mike Richards said: “We have found good evidence that the trust is making steady progress.
“Two years ago, we rated the trust as ‘inadequate’ overall because of concerns relating to patient safety, the organisational culture and governance throughout the trust. Since that time we have been keeping a close watch,” he said.
“There is no doubt that substantial improvements have been made,” he said. “There is a strong sense of forward momentum. Strong leadership and clear communication are leading to a workforce who are now much better engaged and whose morale is now much higher.”
He added: “I have no doubt that the additional support from Guys’ and St Thomas’ NHS Foundation Trust has helped the trust to address the shortcomings that have been identified, but much of the credit must go to the new leadership team at the Medway Hospital and to the commitment and hard work of the staff.”
Trust chief executive Lesley Dwyer said: “It is wonderful news that a decision has been made by NHS Improvement to remove the trust from special measures. I am so pleased that the improvements that we are all so proud of have been recognised.
“This is a great tribute to our dedicated staff and the fantastic job they do day in, day out,” she said. “They really are the best of people, working hard to deliver the best of care.
“We would also like to thank our colleagues at Guy’s and St Thomas’ NHS Foundation Trust with whom we have had a special relationship through our successful buddying arrangement,” she added.
However, she said she acknowledged there was more to do, as set out in the report. “The areas highlighted by the CQC where we need to improve such as staffing levels, condition of the estate, the use of mixed sex accommodation and training rates, come as no surprise to us,” she said.
“This trust has come a long way in the past year, and we have always said that we wouldn’t get to where we want to be overnight,” she added.
Interim trust chair Dr Peter Carter, former chief executive of the Royal College of Nursing, said: “While we know there is much still to do, I want to pay tribute to the dedication of our staff – from our support staff, porters, receptionists, domestics and volunteers through to our doctors, nurses and midwives.
“I’m feeling really optimistic about what lies ahead for Medway,” he said. “This is a significant milestone and signals a brighter future for the trust.”
Health secretary Jeremy Hunt said: “I’m absolutely delighted that Medway has exited special measures – and I want to pay tribute to the outstanding staff there who have always sought to put patients first.
“Their journey hasn’t been an easy one – some of the problems at Medway were deeply entrenched, and the trust was part of the first group to go into special measures – which makes the achievement all the greater,” he added.