- CQC finds `significant and sustained improvement’ at MTW
- Two-thirds of scores for five key services are now rated `good’
- Trust leadership rating jumps from `inadequate’ to `good’
- Trust closes in on overall ‘Good’ rating, but stays as ‘Requires Improvement’ for now
The Care Quality Commission (CQC) has published a report today (9 March 2018) showing that Maidstone and Tunbridge Wells NHS Trust (MTW) has made significant improvements since its last inspection three years ago. While the CQC has rated MTW as ‘Requires Improvement’ for now, the Trust is closing in on a ‘Good’ rating. In fact, the Trust has been rated ‘good’ in over two thirds of the CQC standards across the five core services that were inspected – a significant increase from less than a third in 2015. Moreover, this report saw no individual standards rated Inadequate, compared to six in 2015 (*see tables at the end of this press release).
The report emphasises ‘significant and sustained improvement throughout the trust’, with noted improvements in the well-led domain, resulting in a ‘Good’ rating (compared to a rating of ‘Inadequate’ for the well led domain in the last CQC report).
Every service at MTW was rated ‘Good’ in the caring domain, with inspectors recognising that quality has been put at the heart of everything that the Trust does, and that numerous areas of patient care have been improved at a time of unprecedented operational and financial pressure across the NHS as a whole.
The report also highlights that MTW has made improvements in several service areas since the last inspection, in particular in the areas of critical care, medical care and services for children and young people.
During the course of 12 separate visits, carried out collectively by 81 inspectors, five core services at Maidstone and Tunbridge Wells Hospitals were inspected between 18 October 2017 and 1 February 2018. Inspectors noted examples of outstanding practice in urgent and emergency care, surgery, critical care services and services for children and young people.
The Trust has received 17 specific recommendations from the CQC, such as ensuring that overnight discharges are reduced within critical care, and that within surgery, a system should be put in place to address paperwork issues which delay patient discharges. Work is already underway to ensure these actions are completed as soon as possible.
Maidstone and Tunbridge Wells NHS Trust’s Chairman, David Highton, said: “This CQC report clearly shows marked improvements across all areas, which is excellent news for the Trust. What is particularly encouraging is the major progress in the well-led CQC standard, which has moved from inadequate to good. The Trust will move forward with confidence to continue its journey of improvement into the future.”
Maidstone and Tunbridge Wells NHS Trust Chief Executive, Miles Scott, said: “We are pleased that the CQC noted a number of significant improvements at the Trust, as well as some outstanding practice. We are hugely encouraged that the inspectors recognised that we put quality at the heart of everything we do, and that we have improved numerous areas of patient care while managing a difficult operational and financial positon, and also at a time of unprecedented demand across the NHS as a whole.
“We know we have come a long way since our last inspection and I’d like to thank our staff for their unwavering commitment to their patients and the Trust. During their visits, the CQC inspectors praised staff on numerous occasions for their friendly and welcoming attitudes, and their shared vision and engagement.
“We are looking forward to moving confidently towards a ‘Good’ rating, and looking further ahead, towards ‘Outstanding’.
“Our top priority will always be to provide best possible service to our patients and we look forward to working with the CQC in the future to build on the strong foundations already in place, to continually strive for improvement across all areas.”
- CQC rates over two thirds of standards as `good’ in five key services – a significant increase from less than one third in 2015
- MTW has no inadequate ratings in its service standards noted in the 2018 report, compared to six in 2015
- MTW has 17 `should do’ actions to complete (down from 52 in 2015) and no must do actions (compared to 18 in 2015)
Further information taken directly from the CQC report
Outstanding practice included:
Urgent and emergency services
- Staff had opportunities for training and development including joining network training days, taking part in simulated exercises and engaging with emergency care nurses in other trusts as part of facilitated multi-professional learning events.
- The Trust promoted training, research and innovation which staff took pride in.
- The department had a simulation machine which provided staff the opportunity to practice scenarios in a realistic setting with no risk to patients.
- The Maidstone Hospital critical care unit had set up a memory keepsake service for relatives of patients who passed away on the unit. Relatives could choose a hand print, a hand cast or a lock of hair; all in presentation keep sake boxes, to take home with them.
Services for children and young people
- The service used play specialists through the whole of the child’s inpatient journey, from outpatients’ right through to theatres applying distraction techniques.
- The matron had initiated and led on bringing together a children services matron’s professional group across the region. The group was also used as supervision with peers and benchmarking how services could be improved in all areas.
Notable comments regarding the well-led domain:
The rating for well-led in this report is ‘good’. This has improved dramatically from a rating of ‘inadequate’ in the last CQC report three years ago. Comments from the CQC around this include:
- The Trust had made improvements in several service areas since the last inspection, despite being put in financial special measures.
- The Trust board had been through a period of significant change since the last inspection, which had not affected patient care or the delivery of improvement.
- The Trust had a leadership team with the skills, abilities, and commitment to provide high-quality services. They recognised the training needs of managers at all levels, including themselves, and worked to provide development opportunities for the future of the organisation.
- The board and senior leadership team had a clear vision and values that were at the heart of all the work within the organisation. They worked hard to make sure staff at all levels understood them in relation to their daily roles.
- The Trust’s strategy had been developed in line with the National Health Service Five Year Forward View and was aligned to local plans in the wider health and social care economy.
- Senior leaders made sure they visited all parts of the trust and fed back to the board to discuss challenges staff and the services faced.
- We found an open and honest culture throughout the organisation. Staff felt able to raise concerns amongst their peers and with leaders. Leaders and staff understood the importance of staff being able to raise concerns.
- The Trust had a clear structure for overseeing performance, quality and risk, with board members represented across the divisions. This gave them greater oversight of issues facing the service and they responded when services needed more support.
- The Trust used information from a variety of data sources to gain assurance and measured improvement in the quality of its services. The board reviewed performance reports regularly.
- Processes were in place to ensure the Trust included and communicated effectively with patients, staff, the public, local organisations and local health and care services.
Areas for improvement:
Action a Trust MUST take is necessary to comply with its legal obligations. Action a Trust SHOULD take is to comply with a minor breach that did not justify regulatory action, to prevent it failing to comply with legal requirements in future, or to improve services.
The Trust received no MUST do actions (compared to 18 in the last report) and no improvement notices (compared to 1 in the last report).
The Trust received 17 SHOULD do actions (compared to 52 in the last report).
Action the Trust SHOULD take to improve
We told the Trust it should take action to either comply with a minor breach that did not justify regulatory action, to avoid breaching a legal requirement in future or to improve services. This action related to four core services:
Urgent and emergency services
- The service should ensure significant and sustained improvements in the quality of patient records, including in relation to: risk assessments; triage assessments and observations; documentation of patient outcomes at the triage stage; use of the early warning score tools; pain relief; overall compliance with trust standards
- The Trust should implement systems to ensure that learning from incidents and complaints is shared and embedded.
- The Trust should embed a system of prioritisation to ensure holes in theatres department walls and doors are addressed in a timely fashion to minimise infection risk.
- The Trust should embed a system to ensure all staff meet mandatory training targets.
- The Trust should take steps to ensure all shifts are staffed in line with staffing requirements.
- The Trust should implement a system to respond to patient complaints in compliance with timelines set out in the trust’s complaint policy.
- The Tunbridge Wells Hospital at Pembury should put a system and policy in place to ensure only clinically suitable patients are cared for on the escalated short stay surgery unit.
- The Tunbridge Wells Hospital at Pembury should put a system in place to ensure all patients on the short stay surgery unit, including medical patients, have regular access to consultant care and consultants respond to requests for care on that ward.
- The Tunbridge Wells Hospital at Pembury should work to retain and recruit staff members to address the vacancy rate of 26.6%, more than three times the hospital’s target.
- The Tunbridge Wells Hospital at Pembury should ensure patient starvation times are not longer than clinically necessary, and actively manage starvation times when there are delays.
- The Tunbridge Wells Hospital at Pembury should implement systems to ensure patient’s pain levels are pro-actively assessed and treated.
- The Tunbridge Wells Hospital at Pembury should put a system in place to address paperwork issues which delay patient discharges.
- The Trust should ensure that there is a standard operating procedure in place for children who may be treated on the unit.
- The Trust should ensure all patient deaths are discussed at morbidity and mortality meetings.
- The Trust should ensure that overnight discharges are reduced.
- The Trust should ensure that all staff receive an appraisal.
Services for children and young people
- The Trust should ensure children admitted to adult wards are cared for by staff with level 3 safeguarding training.
Overview of ratings from our 2018 report
Overview of ratings from our 2015 report