Updated 20 December 2023
East Kent Hospitals is one of the largest trusts in the country and covers a large geographical area of Kent. The trust became an NHS foundation trust in 2009. It has 5 hospitals and several community clinics serving around 720,500 people in east Kent.
The trust has approximately 1,030 inpatient beds across 49 wards. This includes 30 critical care beds, 58 children's beds and 49-day case beds. The trust receives over 200,000 emergency attendances, 158,000 inpatient spells and one million outpatient attendances.
The trust operates from 5 sites. It has 3 acute sites: William Harvey Hospital (WHH) in Ashford, Queen Elizabeth the Queen Mother (QEQM) Hospital in Margate and Kent and Canterbury Hospital in Canterbury. Across these sites they provide a range of services including urgent and emergency services, medical care (including older people’s care), surgery, critical care, gynaecology, services for children and young people, end of life care, and diagnostics. Both William Harvey Hospital and Queen Elizabeth the Queen Mother (QEQM) Hospital provide all core services while Kent and Canterbury Hospital does not have maternity beds and has a minor injuries unit with an emergency care centre rather than a full emergency department.
There are 2 community hospitals, the Buckland Hospital in Dover and the Royal Victoria Hospital in Folkestone. The trust also provides some specialist services for a wider population, including renal services in Medway and Maidstone and a cardiac service for the population of Kent at the William Harvey Hospital in Ashford.
The trust does not have a strong financial track record; formal financial undertakings have been in place since 2015, the trust entered into the Financial Special Measures (FSM) regime in 2017 and has been in the NHS England Recovery Support Programme (RSP) since 2021. The Trust has developed and updated financial recovery plans during this period, with the last formal refresh in 2022/23.
We carried out an unannounced inspection of the urgent and emergency, medical care (including older people’s services) and children and young people services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We also inspected the well-led key question for the trust overall.
We did not inspect maternity because the services had not had time to make the improvements necessary to meet legal requirements as set out in the action plan the trust provided after the last inspection. We are monitoring the progress of improvements to services and will re-inspect them as appropriate.
Our rating of services stayed the same. We rated them as requires improvement because:
- Leaders understood the priorities and issues the trust had but did not always take appropriate action to resolve them. Some executives were visible and approachable in the service, but most staff reported a disconnect between the board and the floor.
- The executive team had reviewed the vision, values and strategy. This was in its infancy and needed time to be developed fully. There were plans to ensure a structured planning process in collaboration with people who use the service, staff and external partners.
- There were systems and processes for managing risk; however, they were not always effective. Leaders and teams used systems to manage performance, but at times this was not effective. While known risks were identified and high-level risks escalated with identified actions to reduce their impact, there was variability and a lack of pace in the trust response to mitigate and manage these in some core services.
- Not all staff felt respected, supported and valued. Not all staff felt the service had an open culture where they could raise concerns without fear.
- Governance arrangements lacked clarity and were not always effective at all levels. The governance reporting needed streamlining and strengthening to be more effective.
- There was a process to deal with reported incidents. During our core service inspections, we found staff knew what incidents to report and how to report them. However, near misses, including those with potential for harm were not always reported.
- The trust did not always deal with complaints within expected timeframes.
However:
- There was a focus on continuous learning and improvement at all levels of the organisation, including through appropriate use of external accreditation and participation in research.
- The trust understood the negative impact of activities on the environment and strived to make a positive contribution in reducing it and supported staff to do the same.
- There had been improvements in how users of the service were involved in the business of the organisation.
- The trust board received and reviewed integrated performance reports for key local and national targets, monthly. This included those related to: patient waiting times, emergency care standards, quality, patient experience and cancer targets. Outcomes were RAG rated and trends were clearly stated. Trust board minutes demonstrated the report and data within was discussed along with the financial information.
- The trust had made improvements in how it included and communicated with users of the service and staff. It supported the divisions to develop engagement strategies and encouraged staff to get involved in projects affecting the future of the trust.
How we carried out the inspection
During the inspection we visited wards and departments across both William Harvey Hospital and Queen Elizabeth the Queen Mother Hospital where Urgent and Emergency Care, Medical Care (including older people’s services) and Children and Young People (CYP) services were provided. This included wards, emergency departments, Children’s Assessment unit, Neonatal Intensive Care Unit (NICU), Special Care Baby Unit (SCBU), operating theatres and recovery areas used by CYP.
We spoke with a range of staff including doctors, nurses, support staff, executive and non-executive directors, patients and relatives.
We observed ward handovers, daily staffing meetings, safety huddles and the day to day running of each of the services inspected. We reviewed patient records, drug charts and care plans.
We reviewed information received before the inspection from patients and staff. These included meeting minutes; policies; guidance; staff rotas; training figures; feedback from staff and patients, complaints and investigations.
We spoke with members of the trust board and executive team along with senior leaders, and those with key roles such as risk and quality leads. We reviewed meeting minutes, strategy documents, governance documents, performance reports and other documents provided by the trust. We reviewed the information we hold about the organisation.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.