Maidstone Hospital

Updated 16 February 2024

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Maidstone Birthing Centre.

We inspected the maternity service at Maidstone Birthing Centre as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The Maidstone Birthing Centre provides maternity services to the population of Maidstone and Tunbridge Wells and the surrounding areas.

Between May 2023 and September 2023, 155 babies were born at Maidstone Birthing Centre.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

This location was last inspected under the maternity and gynaecology framework in 2015. Following a consultation process CQC split the assessment of maternity and gynaecology in 2018. As such the historical maternity and gynaecology rating is not comparable to the current maternity inspection and is therefore retired. This means that the resulting rating for safe and well-led from this inspection will be the first rating of maternity services for the location. This does not affect the overall trust level rating.

Our rating of this hospital stayed the same. The hospital is rated Requires Improvement.

Our rating of Requires Improvement for maternity services did not change ratings for the hospital overall. We rated safe as requires improvement and well-led as requires improvement.

There are two other maternity services run by Maidstone and Tunbridge Wells NHS Trust.

Our reports are here:

Crowborough Birthing Centre – https://www.cqc.org.uk/location/RWFX1

The Tunbridge Wells Hospital at Pembury - https://www.cqc.org.uk/location/RWFTW

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited the midwifery led birthing centre.

We spoke with 5 midwives and 1 support worker. There were no women and birthing people admitted into the birthing centre during the inspection. Therefore, we were not able to speak to any women and birthing people.

We reviewed 6 patient care records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 9 March 2018

• Since our last inspection in 2015, we saw a number of changes.
• There was an improved culture of incident reporting. Incidents were recorded on electronic systems that incorporated fail-safes about aspects such as duty of candour.
• Patients and relatives we spoke with gave positive feedback about the care they received on the unit.
• Staff showed compassion when dealing with patients and protected their privacy and dignity.

However:

• Although medicines were better managed and more available, some aspects of medicines management still needed improvement.

Updated 9 March 2018

• Staff recognised incidents and reported them. Managers investigated incidents and shared lessons learn with the paediatric directorate.
• There was comprehensive assessment of children, including a history of any past or current mental health problems alongside the assessment of their physical health needs. This included age-related pain assessments and children’s pain levels were regularly assessed and acted upon.
• Children had individualised care pathways for their care and risk assessments were completed for all patients including National Paediatric Early Warning Scores in order to rapidly detect any child whose health was of deteriorating.
• Staff had training in the assessment and management of sepsis antibiotics were given in line with guidance. Reports on antimicrobial prescribing and sepsis management were escalated to the board through the trusts governance framework.
• Staff demonstrated an understanding of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005, with regard to children over 16 years and the Children Acts 1989 and 2004.
• There was evidence of good multidisciplinary working both within the trust and with external stakeholders.
• The service was responsive to children, young people and their family’s needs. They delivered personalised care and took into account needs and choices of different people.
• There was a children’s strategy in place that staff we spoke to knew about and were committed to improving child health experiences and outcomes. There was a clear governance framework in place that was led by the chief nurse.
• Staff told us they were supported and felt valued; they thought highly of the matron who they said was very visible supportive and kept them well informed.

However:

• Although it was evident that lessons learned in the children’s services was shared within the directorate and practice changed as a result, it was less clear how learning was systematically identified, disseminated or audited across the trust.
• There were no safeguarding level 3 trained staff on adult wards where 16-18-year-old patients were cared for.

Updated 9 March 2018

Since our last inspection in 2015, we saw a vast number of improvements in critical care.

• There was a good culture of incident reporting and learning, and all incidents were recorded on the trust wide electronic reporting system.
• Medicines were well managed.
• Patient outcomes were mostly in line with or better than other similar critical care units.
• Compliance with national guidelines had improved.
• Patients and relatives we spoke to gave positive feedback about the care they received on the unit.
• Staff showed compassion when dealing with patients.

However:

• The environment did not promote privacy and dignity for patients.
• It was not clear of all intensive care unit deaths were discussed at the morbidity and mortality meetings.
• Delayed discharges from the unit stayed an issue.

Updated 31 August 2023

Updated 16 February 2024

Updated 3 February 2015

All the patients we spoke with told us they had been treated with dignity and their privacy protected. They spoke highly of the staff in outpatients and radiology. Patients found staff polite and caring. However, many patients complained to us about waiting times in outpatient clinics.

Staff were reporting incidents, and these were discussed at the clinical governance meetings within the directorates. Systems were in place to reduce the risk and spread of infection. Medicines were stored and administered safely. The department held its own training records, which were up to date and demonstrated that most staff had attended mandatory training.

The trust had met its national targets and consistently performed higher than the national average with regard to radiology waiting times. There had been a backlog in reporting computerised tomography (CT) and magnetic resonance imaging (MRI) scans for several months, but there was evidence at the visit that these were being resolved. An ongoing backlog in clinic letters being sent out had not been resolved. There was a risk of patients receiving delayed or inappropriate treatment, and considerable stress caused to staff.

Staff demonstrated a commitment to patient-centred care, and we found many examples of such care and attention to patients’ conditions and preferences.

Updated 9 March 2018

• The hospital improved in safety, effectiveness and leadership.
• Safeguarding training levels for nursing staff met or exceeded targets and staff demonstrated good knowledge of safeguarding principles.
• Records keeping systems had improved. Records we reviewed in the hospital were complete legible and organised.
• Patient pain levels were closely monitored, staff were proactive about pain management and patients reported good pain management.
• The trust exceeded its target for Mental Capacity Act (MCA) mandatory training, staff demonstrated a thorough understanding of the MCA and records reflected that capacity was being assessed in line with guidance and consent was gained prior to care being provided.
• Patients told us they felt they were treated with dignity and respect. They noted that staff were caring, genuine, friendly and kind.

Updated 9 March 2018

• Between October 2016 and September 2017 there was an upward trend in the monthly percentage of ambulance journeys with turnaround times over 30 minutes at Maidstone Hospital.
• Over the period an average of 42% of ambulance journeys had a turnaround time over 30 minutes.
• From August 2016 to July 2017 the trust reported 364 “black breaches”, with an upward trend over the period. A black breach occurs when a patient spends more than 60 minutes on an ambulance waiting to be seen in the emergency department.
• A significant backlog of incident investigations and limited evidence of learning from incidents meant we were not assured safety improved as a result.
• Triage processes were inconsistent and did not always keep people safe. In addition, the results of triage records indicated a need for improved quality.
• Audits identified a need for improvement in the quality of patient records.
• There was very limited evidence of health promotion work or intervention despite a significant number of patients presenting with alcohol or drug overdoses, or with suicidal intent.

However:

• The Royal College of Emergency Medicine recommends that the time patients should wait from time of arrival to receiving treatment is no more than one hour. The trust met the standard for all months over the 12-month period between September 2016 and August 2017 although this did not include patients who arrived by ambulance.
• The unit performed consistently well in the national patient-led assessment of the care environment (PLACE) and in weekly environmental audits. In the previous 12 months, the unit performed better than national and trust averages in all categories.
• From September 2016 to August 2017, the trust reported no incidents classified as never events for urgent and emergency care.
• The recruitment of practice development nurses had significantly improved the training and professional development opportunities for staff. This improved tracking and assessment of staff competencies and enabled individuals in different roles to work and develop together.
• There was a demonstrable track record of well-coordinated multidisciplinary working that contributed to patient outcomes.
• From January 2017 the trust showed a general trend of improvement in performance against Department of Health access and flow metrics, including the national standard to be seen, discharged or admitted within four hours.
• There were clear and demonstrable improvements in clinical governance and leadership, and this was reflected in the morale of staff and initiatives to improve performance and risk management.