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Inspectors say one of Kent's biggest hospitals still has "a lot of work to do" despite finding improvements are taking place.
The team from the Care Quality Commission (CQC) visited the Medway Maritime Hospital in Gillingham between April and June noting progress is being made.
The health watchdog rated the Medway NHS Foundation Trust as requiring improvement overall – the same level achieved at its previous visit – but said generally services had improved.
It retained its good rating for being caring and safe, effective and responsive still require improvement, said a report published today.
But question marks were still raised by inspectors about the trust's leadership despite seeing its rating improve from inadequate to the requires improvement grading.
The report said patients were treated in a caring manner and with dignity and taking account of individuals' needs, planned care to meet local needs.
It also noted the trust had a "vision for what it wanted to achieve and each care group had developed individual strategies to achieve this" and praised the improvements taking place amid the backdrop of the Covid pandemic.
The unannounced inspection came three weeks after new trust chief executive George Findlay started at Medway.
Inspectors noted Dr Findlay's own assessment of the trust leadership had "demonstrated clear understanding and awareness of the issues" identified by the CQC.
The report said inspectors wanted to assess the trust's leadership due to "concerns about a lack of cohesion within the trust’s executive team and the culture within this team".
It states the trust was struggling to monitor its own performance against its strategic aims and staff satisfaction was "mixed" with improving staff culture "not shown to be a high priority".
Inspectors said staff they spoke to "did not always feel actively engaged or empowered" with the report highlighting the trust had a "limited approach to sharing information with and obtaining the views" from staff, patients and external organisations.
The report said: "The trust had plans to increase engagement but needs to demonstrate evidence in support of this work.
"There was a greater understanding of how to effectively manage risk since our last inspection and systems and processes had improved. However, risks, issues and poor performance were not always dealt with appropriately or quickly enough.
"The trust recognised though that it needed to do more to embed risk management and to make sure that it filtered through to all levels.
"There were significant cultural issues with the use of incident reporting with numerous examples highlighted to us of where behaviour had resulted in staff being discouraged to report.
"The information used in reporting, performance management and delivering quality care is not always accurate, valid, reliable, timely or relevant.
"Leaders and staff do not always receive information to enable them to challenge and improve performance.
"The organisation has not always reacted sufficiently to risks identified through internal processes and has often relied on external parties to identify key risks before they start to be addressed.
"Improvements are not always identified, or action is not always taken. There is minimal evidence of learning and reflective practice.
"However, there is an appetite to improve and the early stages of developing a framework to deliver necessary improvements."
But despite finding areas which must get better, the head of the CQC's hospital inspection team said it was a "fairly positive" inspection.
Catherine Campbell said: "Following our inspection of Medway NHS Foundation Trust, we were pleased to find some improvements have taken place and were embedded. However, the trust leadership team knows there is a lot more work to do.
"Throughout the trust we found a workforce who were doing their utmost to deliver high quality patient centred care, treating people with compassion, dignity and respect.
"However, not all staff felt supported or listened to. There were mixed views about the openness of the culture and not all staff felt they could raise concerns without fear.
"We were pleased to find some improvements however the trust leadership team knows there is a lot more work to do."
"Although there were still a number of areas for improvement which we have advised the trust to look at, overall, this is a fairly positive report and we want to congratulate staff for ensuring these improvements were addressed and thoroughly embedded, particularly in times of high pressure during the Covid-19 pandemic."
The trust says it is already taking action to address points raised by the CQC which include issues around cleanliness, equipment storage, infection control and social distancing in the coronary care unit.
It has also improved safe medicine storage, a review to focus on learning from incidents and new system to manage patient complaints while also reducing the backlog of incidents which require investigation.
Dr Findlay, who previously said he was encouraged by the recent inspections and involvement with the CQC, said: “Our staff have worked incredibly hard throughout the pandemic to deliver safe and compassionate care to our community, and we are pleased that the CQC has recognised some of the improvements the trust has made since its last inspection.
“We know we still have more to do to consistently deliver the safe, high quality care that our patients expect and we are working closely with clinicians to implement our improvement plan and achieve this aim.”
CQC inspectors have visited the hospital on several occasions over the past 12 months raising concern about infection control measures and also handing out a formal warning notice relating to A&E services which led to criticism from Rochester and Strood MP Kelly Tolhurst.
