Monitor to cast East Kent verdict ‘soon’

Monitor will decide whether to put East Kent Hospitals University NHS Foundation Trust into special measures in the coming weeks, following a damning report by the Care Quality Commission.

The CQC report, published earlier this month, said there was a “disparity” between the board’s view of the trust and the reality of what was happening “on the ground.”

It found that the trust was failing to take part in a significant number of audits, that there were issues with its incident reporting, and that staff felt unable to speak up directly.

Overall, the CQC reported that while staff were caring, the trust was ‘inadequate’ at providing safe care for patients and not effective. It recommended that Monitor should put it into special measures.

A spokesman from Monitor told EHI that it normally follows the recommendations of the CQC, but that it will have to consider the report in detail before making a verdict. He added that a decision is due in “the next few weeks.”

The CQC reports that: “The comprehensive papers going to the board suggested strong governance within the trust” and that “when we spoke with the executives they did not recognise the issues that the staff were describing.”

It adds: “There was a disconnect between the risks and issues described by staff and those reported to, and understood by, leaders and the board.

“Risks and issues were not dealt with in a timely fashion and lessons were not being consistently learned across the whole trust.”

The inspectors also found that there was no culture of openness and transparency and that staff found it difficult to raise concerns.

 “The lack of openness discouraged the identification of risk. Issues and concerns were being discouraged and repressed, which meant that leaders were unaware of significant issues threatening the delivery of safe and effective care,” says the report.

In June this year, the Department of Health launched a website called ‘How Safe is My Hospital’, which includes indicators such as ward level staffing levels, incident reporting levels, pressure ulcers, falls and how the hospital is complying with patient safety alerts.

The website shows that Kent and Canterbury Hospital, which is part of the trust, is listed as “ok” for its “open and honest reporting.”

However, the CQC report highlights that the trust is known to be “a low reporter of incidents” and instead of using national standards for what qualifies as a never event or serious incident, the trust has “applied its own criteria.”

“The trust has had very few grade 3 or 4 hospital acquired pressure ulcers for a trust of its size, given the contingency beds, the staffing challenges and the shortage of equipment all identified on inspection,” says the report. 

The inspectors found that the trust published its own quality bulletin which says that it downgraded severe harm to moderate harm, depending on the time it would take for a patient to recover, which is not the national standard. This could explain the low reporting of incidents.

“We raised concerns that the trust could not determine this at the time of such incidents and by possibly downgrading incidents the opportunity to investigate and learn was being lost, and is the key to reporting,” says the report.

Responding to the report, the trust’s chief executive Stuart Bain said that “much of what is in the report we have already recognised and we are working to address.”

“Our task as leaders of the organisation is now to work with our staff and our partners including the clinical commissioning groups to address the issues that have been raised and ensure we provide the residents of east Kent with high quality health care.”

The report also found that patients had “excessively long waits” for follow-up appointments and “considerable delays” in clinics. Bain said that the trust had “identified the need to improve out appointment system some time ago.”

“New appointment booking systems, more flexible appointments, and an investment of £28m in improved facilities including a new hospital in Dover will start to address these issues,” he said.

Update: Monitor confirmed that it had decided to put East Kent Hospitals NHS Foundation Trust into special measures on 2 September.

The trust's chief executive, Stuart Bain, said it was already recruiting nurses and general surgeons and planning investment in a new appointment booking system and outpatient facilities to address the concerns raised by the CQC.