East Kent NHS trust fails in attempt to overturn CQC warning notice

East Kent Hospitals University NHS Foundation Trust unsuccessfully challenged a Care Quality Commission warning notice issued after inspectors raised serious concerns about the safety of urgent and emergency care at Queen Elizabeth The Queen Mother Hospital in Margate.

The warning notice followed an unannounced inspection of the hospital in January, when the emergency department was experiencing severe pressure and was close to declaring a critical incident.

The trust appealed against the warning notice, but its challenge was not upheld by the CQC. Two individual points relating to the monitoring of nutrition and hydration and inconsistent physical health monitoring within the mental health lounge were, however, removed from the actions the trust was required to take.

The CQC has now rated urgent and emergency care at the hospital as requires improvement overall, while its rating for safety has fallen to inadequate. The service remains rated as requires improvement for effectiveness, caring, responsiveness and leadership.

Inspectors found significant overcrowding within the emergency department, including 28 people being cared for in temporary areas that were not designed for ongoing care while another 50 people waited in the main waiting room.

Some patients had been waiting for more than 72 hours for a hospital bed, while inspectors also found the main waiting room was left without staff monitoring patients for a period of 40 minutes.

People being cared for on trolleys in corridors did not have access to emergency call bells, creating a risk that they would be unable to call for help if their condition deteriorated. Inspectors also raised concerns that staff did not always have sufficient time to support patients with nutrition, hydration, skin care and personalised communication.

In another incident, a patient who could not be accommodated within the mental health lounge because of capacity and safety concerns left the emergency department to wait elsewhere and later had to be located by police.

Amanda Williams, CQC deputy director of hospitals, secondary and specialist care for the South-East, said the emergency department had been under “serious and sustained pressure” and that systems intended to keep patients safe were not holding up under the strain.

The regulator acknowledged that staff were working extremely hard in difficult circumstances and that many patients said they had been treated with kindness despite lengthy waits. However, inspectors identified a disconnect between frontline teams and senior leadership which the CQC said needed to be addressed urgently.

There was more positive news elsewhere at the hospital. Medical care, including services for older people, improved from requires improvement to good overall, while its caring rating was upgraded to outstanding.

Inspectors praised staff for providing compassionate and individualised care, particularly for people living with dementia and those approaching the end of life.

East Kent Hospitals has since introduced a series of changes in response to the emergency department findings, including strengthening safety oversight, improving staffing and training, expanding virtual ward services and introducing digital nursing records.

The CQC returned to inspect urgent and emergency care in May. According to the trust, 61 of the 66 actions identified for improvement have now been completed and the regulator has ended the requirement for weekly progress reporting.

Dr Des Holden, acting chief executive of East Kent Hospitals, acknowledged that the care witnessed by inspectors in January was unacceptable for both patients and staff but said significant changes had since been made.

He said the trust now rarely cares for patients in corridors and is working with NHS England, NHS Kent and Medway and other partners towards eliminating waits for patients outside appropriate cubicles or bed spaces.

The overall rating for Queen Elizabeth The Queen Mother Hospital remains requires improvement, with the CQC saying it will continue to monitor progress to ensure patients receive safe care.

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