Patients at Medway hospital are waiting up to 35 hours to be treated in A&E, as another damning report into the troubled NHS trust is published.

The latest inspection by the health watchdog Care Quality Commission found patients were waiting up to two hours just to be initially be assessed in the emergency department - despite being set a target time of 15 minutes.

The hospital in Gillingham has been branded the worst in the country as it remains in special measures following the Keogh report into high death rates.

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Medway Maritime was placed in special measures in July 2013. Since then it has been closely monitored by the CQC.

In April inspectors found the hospital had not made enough improvements and ruled that it must stay in special measures indefinitely.

The CQC made an unannounced inspection at the end of July and raised continuing concerns.

This was followed by another visit at the end of August and the report into that visit, published today, found patients are not getting safe and appropriate care.

In July, the Trust was told it must urgently change the way patients are assessed when they arrive in A&E to ensure they are initially seen in 15 minutes.

Despite urgent action taking place within the department, inspectors have found patients are still waiting too long.

Between September 3 and September 24, of the 6,525 patients who attended A&E, 300 patients experienced delays of more than 15 minutes to get an initial assessment.

Inspectors said the delays were down to poor management, confusion and a lack of any formal pathway.

The performance of the emergency department during quarter two (July-September) was markedly worse than that of quarter one (April-July) despite there being fewer attendances.

Between April and July, 25,277 patients attended the emergency department. This was compared with 24,344 patients attending between July and September.

During quarter one, 86% of patients were admitted, transferred or discharged within four hours of arrival (the national target is 95%).

During quarter two, 83.7% of patients were admitted, transferred or discharged within four hours.

The longest wait in A&E during October was 34 hours and 54 minutes - the longest wait in the last 12 months.

Medway hospital also performed badly on the Friends and Family Test (FFT). This is a single question survey which asks patients whether they would recommend the service they have received to friends and family who need similar treatment or care.

The England FFT average score in August was as 57. Medway Maritime Hospital scored eight for the same month. It scored four for July compared with 53 nationally.

During their visit inspectors found:

• Five patients had been waiting more than an hour and 14 minutes to be initially assessed
• One elderly patient with a potentially life-threatening gastric disorder had been waiting two hours in a holding bay without intravenous fluids or an initial assessment
• A patient with a known heart condition had a heart attack in the corridor while waiting for their first assessment
• A patient with a fractured hip, who arrived by ambulance, was not given any kind of physical examination for three hours.

In conclusion, the CQC report states: “In terms of the emergency department at Medway Maritime hospital we found little evidence of improvement following our inspections in April and July.

"Whilst the trust had provided us with an action plan to address the plethora of issues we had identified, the pace of change remained slow; the ability to introduce change was hindered by the continued lack of leadership within the department however we were reassured that the trust was in the process of appointing experienced nurses to lead the workforce as well as commissioning external specialists in emergency medicine to help improve the safety of the department.

"We have judged that the trust continues to fail to ensure that patients are protected from the risks of receiving care or treatment that is inappropriate or unsafe because they are failing to plan and delivery care which meets the individual needs of people whilst also ensuring their safety and welfare."

Video: What the people of Medway think of the hospital

Following the visit on August 26, the CQC has imposed urgent conditions which the trust must meet in order to to be allowed to keep running.

The trust must:

• Ensure patients attending A&E have an initial assessment within 15 minutes of arrival
• Ensure there are sufficient numbers of appropriately qualified clinical staff
• Provide records which show the arrival time of each patient, the time the patient is given an initial clinical assessment and by whom.
• Each week the trust must report to the CQC on how many occasions it did not meet the 15 minute target time and why
• Each month the trust must submit a report to the CQC which identifies the root causes for failure to meet the standards and explains its action plan.
• It's believed the findings could lead to recommendations to restrict the patients coming into A&E, or even the eventual closure of the trust.

The CQC has the power to restrict the patients coming into A&E or even close the trust.

In response, the Medway NHS Foundation Trust said it took patient safety and patient experience very seriously.

It added: "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."

Read its full statement here.