Medway Maritime Hospital is still giving cause for serious concerns for the health, safety and welfare of its patients, 16 months after being put into special measures.
Medway Maritime Hospital provides acute services to a population of 400,000 people across Medway and Swale. The hospital was put into special measures in July 2013 following a Keogh review. The CQC inspected the A&E department in December 2013, on an unannounced visit, in response to anonymous concerns. Enforcement action was taken following this visit in respect of the care and welfare of patients, cleanliness and infection control.
The Trust was inspected again by the CQC in April 2014, with an unannounced visit in May 2014. The hospital was rated as inadequate overall by the CQC, with safety, responsiveness, A&E and surgery specifically being identified as inadequate. Identified as requiring improvement were effectiveness, leadership, medical care, maternity and gynaecology, end of life care, and outpatients. The only areas rated as good were caring, intensive and critical care, and services for children and young people.
A few months later in July 2014 there was an unannounced inspection of Accident and Emergency, which identified that the department was in a state of crisis with poor clinical leadership. There was no evidence that nursing, medical and other allied health professionals were working in a joined up manner. Policies were not being used properly within the department, resulting in patients being ‘stacked’ (even though the department was not extremely busy at the time of the inspection), and whilst they were being ‘stacked’ they were not undergoing regular nursing observations, and were not being seen in a timely manner by medical staff. Patients were not being prioritised appropriately and there was poor organisation of staff. Also identified was a continued failure to perform adequate initial assessment of children.
An assessment in August 2014 by the CQC, assisted by independent specialists in emergency and general medicine, identified continuing concerns over leadership and cohesive working in A&E, and flaws in the timely assessment of patients, resulting in delays of more than 2 hours before treatment was started. This report was published on 26 November 2014, and the Trust’s response to this has been published on its website. The Trust states it has made a number of organisational changes and put in place a number of actions since this visit to begin to address the issues raised in the report. These include attempts to stabilise the Board of Directors, reviewing the managerial structure within the A&E department, taking steps to improve initial patient assessment and patient flow, and the planned opening of a new emergency department for children next month.
The effectiveness of the Trust’s actions, some 16 months after being put in special measures, remains to be seen. NHS England published data for the week ending 16 November 2014 for A&E activity at Medway hospital showed only 79.1% of patients were treated within 4 hours of arrival, against the government target of 95%; one fifth of all patients had to wait over 4 hours for treatment.
We can only hope that the changes made will improve care without further delay, to provide reassurance and safe care to those patients using the Trust’s services. Solicitors in our specialist clinical negligence team are already advising a number of clients in relation to bringing claims for clinical negligence against the Trust.
Dawn Treloar is a Senior Associate in our Clinical Negligence team. Hodge Jones & Allen is working with Medway CAB and run specialist medical negligence free advice clinics at the CAB. If you need specialist advice and would like a free appointment contact Medway CAB telephone number 01634 373760 or Hodge Jones & Allen direct on 020 7874 8524.