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A hospital has received a warning from the health watchdog following concerns about risks to patients arriving at A&E.
Inspectors visited Medway Maritime Hospital following concerns about safety in the emergency department and delays to treatment and ambulance handover times.
A full report into the unannounced inspection is due to be published later this month.
The Care Quality Commission (CQC) team has not revealed the full findings following the visit on December 14 but placed an official warning notice on the department.
Catherine Campbell, CQC's head of hospital inspection for the South East, said: "Inspectors undertook a focused, unannounced inspection of the emergency department at Medway Maritime Hospital on December 14, 2020.
"This was in response to risks around patient flow and concerns regarding ambulance handover delays.
"We recognise the tremendous pressures that hospitals are facing but where we have significant concerns about safety we have a responsibility to follow these up.
"We continue to support services in their efforts to provide the best possible care in these challenging times while monitoring any risk closely.
"The report from our recent inspection of the trust will be published in the coming weeks.”
James Devine, chief executive of Medway NHS Foundation Trust, said: “The safety of our patients and staff is our overriding priority and while our staff have worked incredibly hard throughout the pandemic, the CQC’s notices show that there is more we need to do.
“Since the CQC’s visit we have taken immediate steps to reduce lengthy waits in our Emergency Department and continue to act to ensure we are consistently providing safe, high quality care for our patients.”
High numbers of Covid patients being admitted to hospital sparked emergency meetings with trust executives and ambulance service chiefs discussing plans to redirect paramedics and their patients elsewhere.
During the most busy spell, hospital sources told KentOnline there were up to 18 ambulances queuing outside the emergency department doors leading to six-hour waits for crews to hand over.
Another source said difficulties separating Covid patients, suspected Covid patients and non-Covid patients along with wards already at capacity was leading to severe issues.
The inspection came at the height of the second wave when the more infectious Kent variant of the coronavirus was rapidly increasing through the community.
Covid case rates in Medway and Sheppey – the two areas served by Medway Maritime Hospital – at the time were among the highest in the country.
Pressure on the hospital continued during the Christmas and New Year period when high numbers of patients were brought into hospital as images showed ambulances waiting outside.
The hospital also had to transfer some patients to other hospitals as far afield as Bristol, Leeds and Portsmouth due to capacity.
Numbers have since dropped but in early January, more than 300 patients at the 500-bed capacity hospital were either confirmed to have Covid on the ward or in critical care with dozens more suspected.
Medway Maritime Hospital was inspected by CQC teams in December 2019 with the Gillingham site rated as requiring improvement – the same rating as its previous inspection in 2018 – as inspectors warned about slow progress being made.
Critical care is now listed as outstanding and end of life care was upgraded to good, following the latest report published last April.
Mr Devine said in September the hospital's improvement plan has put them on the "right track" towards improving to a good overall rating.