Staff at under-fire hospital raised concerns about the delivery of therapy services with CQC team
Therapy services for patients receiving coronary care at Medway Maritime Hospital in Gillingham, Kent, deteriorated earlier this year after changes were introduced in response to the Covid-19 pandemic.
That is one of the findings outlined in a Care Quality Commission (CQC) report published yesterday (30 July) that focuses on the medical care – including older people’s care – at the hospital, which is run by Medway NHS Trust.
The CQC also published a report on 30 July on the trust as a whole after a team carried out an inspection earlier this year due to long-standing concerns about the quality of the trust's services. Its team found some improvements had been implemented since the last CQC inspection but that 'there is further work to be done', the CQC said in a press release.
The trust’s overall rating remains 'requires improvement'. It is rated as good for being caring while it requires improvement for being safe, effective, responsive and well-led. Previously the trust was rated inadequate for being well-led.
Cardiac care issues
'Staff told us the environment had affected the way they worked, and they were not able to give patients the appropriate level of care or therapy with limited resources,’ the 40-page report on the hospital notes.
Though the unit in question was equipped with piped oxygen, staff could not offer patients continuous positive airway pressure (CPAP) as it was an ‘aerosol generating procedure’.
As a consequence, patients needing CPAP were transferred to the high dependency unit, intensive care unit or the medical dependency unit, the report notes.
‘Staff told us it was difficult to get a bed for patients in these areas and therefore at times patients did not receive this treatment which had the potential to affect their recovery and increase their hospital stay.’
Turning to examine how safety issues were being dealt with at the trust, the report says that in response to Covid-19, online learning had been introduced and simulated training had been interrupted. But only allied health professionals (AHPs) were meeting trust targets on the completion of mandatory training modules, the inspectors found.
‘Among all staff groups, AHPs performed better, meeting the trust target of 85 per cent in eight out of the 10 modules.’
‘Leaders had the skills and abilities to run the service,’ the report states. ‘They were visible in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.’
However, staff expressed ‘mixed views’ on the support they received from local and executive leaders. Some staff told us leaders ‘make the right noise but nothing changes’.
The CQC inspection team found ‘significant improvements in the caring domain across medical care’.
‘During this inspection, we observed staff taking time to speak with patients, explaining their treatment, making sure they were comfortable or keeping them company. Staff we spoke with, spoke proudly of the care they were providing.
'Leaders of the therapies and older persons care group told us they wanted to be the centre of excellence for frailty in the community.’
Physiotherapy services, occupational therapists and assistant therapists were available from Mondays to Fridays. However, services were also available at weekends – either being provided by bank or substantive staff over shorter days.
‘Each speciality had its own arrangements for allied health professionals cover to suit its needs. Staff in the medical assessment unit told us patients were normally seen within 24 hours of referral.’
Health promotion: therapy staff win praise
Patients had access to physiotherapists and OTs [who] provided practical support and encouragement for patients ... who spoke highly of the therapy staff and told us of the help and support they received from them [CQC report]The report states that ‘staff gave patients practical support and advice to lead healthier lives’.
It notes: ‘Patients had access to physiotherapists and occupational therapists [who] provided practical support and encouragement for patients with both acute and long-term conditions. Patients spoke highly of the therapy staff and told us of the help and support they received from them.’
The CQC inspectors found many examples of wellbeing initiatives across the trust, such as staff having access to wellbeing and mindfulness support through the intranet. However, they heard that some staff were suffering from COVID-19 related issues, including sleep disturbance, depression, anxiety and post-traumatic stress disorder.
‘Managers told us the second wave of the pandemic had been very difficult and staff had cared for each other’s friends and relatives which had an impact on staff wellbeing.
‘The trust was working in partnership with other organisations to offer staff psychological therapy services including a six-week psychologist course delivered individually or to a group via video conferencing. Staff also had access to a sleep physiologist.’
The report spotlights a ‘wobble room’ in the respiratory ward, which allows staff to ‘step away from the stressful environment of the ward and have a moment of respite’.
Acknowledging that staff had opportunities to develop and progress, the report states that managers in the therapies and older persons care group recognised that staff needed to ‘hone their interview skills’.
‘They had introduced a robust feedback process for staff who were not successful at interview and supported then to gain the skills needed for progression’.
What did the CQC say?
Catherine Campbell, the CQC’s head of hospital inspection, said: '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.
'The new chief executive had been in post for a little over three weeks at the time of our inspection. They had carried out their own diagnosis of a well-led assessment and this demonstrated clear understanding and awareness of the issues identified during our inspection.
'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.'
What did the trust say?
Chief executive George Findlay 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.
Dr Findlay added: ‘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.’
The CQC inspected Medway Maritime Hospital in April and May. Its team looked at the trust's medical and older people’s services, and children and young people’s services. The team also reviewed leadership at the trust.
To see the report in full, visit: https://api.cqc.org.uk/public/v1/reports/86f1a4d0-54b2-4a56-a58b-8950f2e1f9c1?20210730135908
To see an earlier PhysioUpdate report on the trust, visit: https://www.physioupdate.co.uk/news/cluttered-nhs-rehabilitation-gym-posed-infection-prevention-and-control-risks-says-cqc-report/Author: Ian A McMillan