A crisis-hit hospital trust has been ordered to make “immediate improvements” with staff shortages and “overcrowded” emergency departments leading to serious safety concerns.

The Care Quality Commission (CQC) has made the recommendations to the East Kent Hospitals Trust following visits to William Harvey Hospital in Ashford and QEQM in Margate.

The health watchdog carried out an unannounced inspection of the urgent care and emergency department, medical care services, and children and young people services at both hospitals in July.

Inspectors also looked at the management and leadership of the trust overall.

Following the visits, services for children and young people, and medical care, at the William Harvey were rated as requiring improvement.

At the QEQM, the children and young people’s service’s overall rating improved from required improvement to good.

However the rating for medical care services dropped overall from good to requires improvement.

Urgent and emergency care in both services were inspected but not rated and remain as requires improvement overall from previous inspections.

Earlier this week, KentOnline showed how patients are facing huge waits in A&E as East Kent Hospitals accounted for more than half of the 2,266 12-hour corridor waits in the county in November.

Following the inspection in the summer, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to how they were managing each department.

Neil Cox, CQC deputy director of operations south, said: “During our inspection of East Kent Hospitals University NHS Foundation Trust, we were aware there had been several changes in membership of the board over recent years, which had made it difficult for the trust to adopt and take forward previous plans that had been in place.

“We saw this reflected in the differences we found between services and hospitals, and the leadership in some services.

“We found that while leaders understood the priorities and issues the trust had, they didn’t always take the appropriate action needed to resolve them.

“Some executives were visible and approachable in the service, but most staff we spoke to also told us of a disconnect between the board and frontline staff.

“Staff told us there was a lack of trust-wide ownership of the pressures faced by the emergency department.

“Speciality teams didn’t always collaborate effectively with the emergency department teams.

“This caused problems with the flow of people coming in and out of the department.

“This meant people sometimes waited too long to receive treatment.

“We saw there was a plan in place to manage the overcrowding, but the implementation wasn’t as effective as it could have been.”

At the William Harvey, it was found there were not enough emergency department or paediatric emergency medicine consultants to safely meet the Royal College of emergency medicine or the Royal College of paediatrics and child health guidelines which was a risk to children’s health.

Mr Cox continued: “We have issued a warning notice to ensure the trust concentrates on the areas where we have concerns and will return to check that the required improvements have been made.

“If further improvements are not implemented and embedded, we will not hesitate to take further action to ensure we are confident people are receiving the safe, consistent care they deserve.”

The trust was again rated as requiring improvement for how well-led it is overall across the organisation.

These rating changes have not affected the overall rating for the trust which stays as requires improvement.

The report says at the William Harvey, inspectors found the privacy and dignity of people in the emergency department could not always be respected because the department was overcrowded.

The lack of flow between the emergency department, and the wider hospital, had a significant impact on both people needing treatment and staff.

There was a disconnect between the emergency department and services within the hospital and a lack of trust-wide ownership of the challenges faced by the emergency department.

The report also says the service did not have enough staff to care for people and keep them safe and incidents or near misses were not always reported in line with trust policy.

However, it did find staff felt respected, supported and valued, and were focused on the needs of people receiving care.

In terms of medical care, the report says there were not always enough staff to care for people.

Communication was not always effective when making decisions about their care and safe systems were not always in place to manage risk including fire safety, infection prevention and control, and privacy and dignity.

Not all leaders ran services well and information systems were not always reliable or effective in supporting staff to develop their skills.

People were treated with compassion and kindness and staff provided emotional support to people, families, and carers.

In services for children and young people, the individual needs of children and young people receiving treatment and care were not always taken into consideration.

Concerns were not always recognised and escalated by leaders.

Key services such as education facilities, paediatric physiotherapy were not available and there was no plan to address this at the time of inspection. However, staff treated children and young people with compassion and kindness.

“While improvements have been made, there is more for us to do…”

At the QEQM, inspectors found that in urgent and emergency care, an effective handover process for people who had been in the emergency department for more than 24 hours was not in place.

This led to a delay in treatment and lack of continuity of care for some people.

People were not always treated with dignity and respect however, the needs of local people were met and it was easy for people to give feedback.

In medical care, there were not always enough staff to care for people.

Staff did not always make sure equipment, such as resuscitation trolleys, were checked regularly and accurately and were safe to use.

Near-misses or potential harm were not always reported by staff.

Staff did not always ensure they followed their standard operating procedure when placing people in escalation areas, however staff did understand how to protect people from abuse and treated people with compassion and kindness.

Children and young people were receiving good care and treatment with enough to eat and drink and access to pain relief when they needed it.

However key services such as education facilities, paediatric physiotherapy were not available seven days a week.

There was also not always enough medical staff to care for children and young people and keep them safe and the service did not always have reliable information systems to help manage risk.

In response to the findings, Tracey Fletcher, chief executive, East Kent Hospitals, said: “We are working hard to improve services across East Kent Hospitals and I want to thank our staff for their commitment during what has been a period of significant change.

“We welcome the CQC’s report, which highlights a number of issues that we have been working hard to address.

“I would like to assure our local communities that we are fully committed to delivering improvements...”

“There is, and will continue to be, a strong focus on the work required to put the trust on a more sustainable footing.

“We are building a substantive leadership team and are embedding an organisational structure designed to ensure staff and services have the stability and the right level of support to meet the needs of our local population going forward.

“Since these inspections in May and July, we have improved how we work across the hospitals to support our emergency departments and the safety and experience of our patients.

“The building programmes at our emergency departments, which have extended and reconfigured both departments to provide better facilities, have also progressed and are near completion.

“While improvements have been made, there is more for us to do and we must ensure that positive changes are truly sustained.

“At the same time, it is important that we recognise the excellent examples of care in our trust, some of which have been described as outstanding practice by the CQC today.

“I would like to assure our local communities that we are fully committed to delivering improvements for patients and demonstrating further progress to the CQC next time they visit.”

Earlier this month, the trust was described as among the “most challenged” in the country, as it faces a deficit of almost £70m.

The trust’s board of directors were told during a meeting that at the end of October it had recorded a black hole of £68.2 million. That is £22.7 million more than planned by this point in the year.

In November, worrying pictures showed how exhausted patient Steven Wells resorted to sleeping on the floor in Ashford’s A&E amid soaring demand.