Bosses at Medway Maritime Hospital have again been told to make urgent improvements following another damning report today.

The Care Quality Commission has rated the hospital and the foundation trust as inadequate following a detailed inspection examining every department.

The new-style inspection by the health watchdog comes a year after the trust was placed in special measures.

England's chief inspector of hospitals, Prof Sir Mike Richards, has recommended Medway remains in special measures until urgent improvements are made.

He said: "Despite some areas of development, notably in maternity and children's care, overall Medway NHS Foundation Trust has made inadequate progress in the past year for me to recommend that it should leave special measures at this time.

"Significant improvement is still required here, and I have advised Monitor that the trust should continue to receive the additional scrutiny and support provided by special measures, while urgent attention is given to resolving the ongoing issues at the trust.

"People deserve to be treated in services which are safe, compassionate, effective, and responsive to their needs.

"We will continue to monitor the trust closely and will inspect again as soon as we are able to assess whether or not adequate progress is being made.

"At that stage, I will be in a position to advise Monitor again on whether the trust is ready to leave special measures or whether further action is needed."

Inspectors rated critical care and services for children as good, but rated end-of-life care, outpatients, medical, and maternity as requiring improvement. A&E and surgery were rated inadequate overall.

They noted that while the culture within the hospital demonstrated most staff were committed and took pride in their work, there was a clear reliance on "firefighting" and a tendency for staff to work locally in their own way.

Inspectors found too few nurses and junior doctors on duty. Despite recent recruitment, there is still a reliance on agency and locum staff, especially out of hours and consultants are not providing a seven-day service.

They also found insufficient progress has been made in A&E at Kent's largest hospital, in Gillingham, since the last inspection in February.

Patient flow throughout the hospital was inefficient, both in terms of delayed admissions from A&E and lack of proactive discharge, and this is one of the areas where staff have been told to make urgent changes.

But inspectors praised the improvements made on the maternity ward and also praised services for young patients, including the Oliver Fisher Neonatal Intensive Care Unit, and the recently opened Bernard Dementia Unit.

Steve Hams, chief Nurse at Medway NHS Foundation Trust said the hospital is working with staff, partners and patients to make rapid improvements.

He added: "Since the Keogh review last year, significant progress has and is being made in a number of areas to improve patient safety and experience.

"Significant improvement is still required here, and I have advised Monitor that the trust should continue to receive the additional scrutiny and support provided by special measures, while urgent attention is given to resolving the ongoing issues at the trust..." - Prof Sir Mike Richards

"Forty-one of the 50 improvement actions in the trust's Keogh plan have been delivered, in addition we have 160 more nurses caring for our patients than we did 12 months ago, however there is still more to be done.

"The board agreed earlier this year to focus on five priorities, around improving basic standards, patient flow, recruitment, control and clinical leadership, all of which align with the concerns highlighted in today’s report and work is already underway in each area.

"We have also implemented some urgent actions in response to the concerns raised by the CQC, which include improving staffing levels in emergency care and increasing the size of our short stay Acute Medical Unit, alleviating congestion in the emergency department.

"While we recognise the need for further improvements, the report rated our critical care services and services for children and young people as good, as well as caring throughout the hospital as good.

"In addition, the inspectors noted the significant improvements made in the overall care provided to women in our maternity and family planning services.

"This is testament to our excellent frontline staff who continue to deliver compassionate care to the thousands of patients who need our services each month - despite operational and financial challenges."

The inspection team - which included doctors, nurses, hospital managers, trained members of the public and CQC inspectors - made an announced visit over three days in April.

A one-day unannounced visit also took place in May.

Inspectors found continuing instability in the senior leadership of the trust was having a serious negative impact on the day to day running of the hospital.

In February the health regulator Monitor drafted in Nigel Beverley as interim chief executive and Christopher Langley as interim chairman.

It was announced last month that Dr Philip Barnes, Medway's medical director, will take up the post as acting chief executive when Mr Beverley's contract comes to an end in August, while Langley's contract runs until February next year.

It was revealed last weekthat the trust has hired more than 30 interim managers for six-figure sums in recent months.

CQC inspectors are due to return to the hospital in the next few months to check if the required improvements have been made.

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