Darent Valley Hospital

Updated 23 December 2022

We inspected the maternity service at Darent Valley Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

Dartford and Gravesham NHS Trust provide maternity services at Darent Valley Hospital and local community services. The maternity service supported 4,704 mothers to birth and 4,757 babies were born in 2021. This included 52 sets of twins.

Maternity services include:

• Antenatal Clinic
• Mixed antenatal and postnatal ward (Cedar ward)
• Postnatal ward (Aspen ward)
• Fetal Medicine Unit
• Home from Home Birth Centre
• Labour ward
• Triage (Tambootie ward)
• Community midwifery
• Special Care Baby Unit (Walnut ward)

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well led key questions.

We did not rate this hospital at this inspection. The previous rating of good remains.

How we carried out the inspection

We visited all areas within the hospital birth centre. We spoke with 13 mothers/partners and 41 members of staff. We reviewed performance information about this service before we visited. We reviewed 8 sets of maternity records and 4 prescription charts. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, incidents and audit results.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 22 August 2019

Our rating of this service improved. We rated it as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it. Staff we spoke with had a good understanding of who the safeguarding named lead was, and they could describe how to raise a concern or seek advice.
• The service-controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. All ward areas we visited were visibly clean and tidy. We saw staff following national guidance on infection control.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. Staff knew how to report incidents or near misses via the trust’s electronic reporting system. Staff we spoke with felt confident in raising an incident should they need to. They gave us examples of what they would report as an incident and how they would respond to the person involved.
• The service provided care and treatment based on national guidance and evidence-based practice. Policies and procedures were available and accessible to staff via the trust intranet. Policies we viewed as part of our inspection were in date and in line with best practice and national guidelines. Clinical guidance was also available on the trust intranet.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Managers used the appraisal process to identify staff learning and development needs. Staff told us they had regular one to one and team meetings and were supported with their continuous professional development.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. We saw all staff wearing name badges and we saw display boards informing patients and families of key staff on each ward. A poster displaying clinical staff grades and specialities by their uniforms was at the entrance to all wards we visited.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. We saw dementia friendly environments in all areas of the hospital. The dementia-friendly facilities on Ebony ward included a reminiscence room which provided a peaceful place for patients to spend time.
• Pets as therapy dogs visited some wards twice weekly. We were told that this was welcomed by many patients and had positive feedback from both staff and patients.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint. The Patient Liaison and Advice service was available for patients to access, who supported patients with concerns and complaints and gave information about NHS services.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Managers we spoke with were aware of the registers and knew the main risks and the actions needed to reduce the risks that had been found. We saw risk registers that had been reviewed with control measures in place and actions completed.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Staff told us there was an open and honest culture and were aware of how to raise concerns in the workplace but reported that they did not have any. All wards were described as friendly and welcoming. The trust had a Freedom to Speak Up Guardian and had developed a freedom to speak up policy in 2018. The Director of Nursing was the designated Board member, with whom concerns about raising concerns could also be addressed.
• Staff told us they were encouraged to learn. Nursing development opportunities were offered to staff throughout the wards and the practice development nurse supported staff with this.

However:

• The service did not achieve their trust completion rate targets for all mandatory training modules.
• Safeguarding and Mental Capacity act training rates did not achieve trust completion rate targets. We heard this was because training in these modules had been restructured and training rates were being monitored since these were introduced.
• There was no Mental Capacity Act specific training at the time of the reporting period. The trust advised that a new course was introduced on the 1st of April 2019 but staff we spoke with had not yet attended it.
• The service did not always develop and establish action plans and strategies in a timely way from their audits. As an example, the lung cancer audit did not identify any actions to improve or sustain their results.
• Not all staff received an appraisal. Appraisal rates were not meeting trust completion targets for several staffing groups.
• There was no formal action plan to minimise the number of night ward moves. This data was however discussed through senior members of the medicine clinical group and the executive team.

Updated 2 July 2014

In the main children’s department parents told us that staff were responsive to their needs and that they listened to them. They were included in decisions about the care and treatment of their children. They said staff responded quickly to requests for assistance. Patients received safe and effective care and treatment. The environment was well maintained and engaging for young people. There were sufficient numbers of staff on the wards and in the outpatient area, and there was a system for the management of staffing levels and skill mix to ensure children were cared for safely.

This was not the case in the A&E department where there was an insufficient number of nurses qualified in the care of children. We also found in the A&E department that national guidance was not being followed in relation to the management of pain in children.

The trust was monitoring the quality of the service and making changes were they were needed. The views of children and families were being used to inform the service provision in the main children’s department. There was a team in place to monitor and address any safeguarding concerns, and the trust had planned further developments.

Updated 2 July 2014

We found that the intensive care and critical care service was safe and effective, performing within expectations for a unit of its size according to the Intensive Care National Audit and Research Centre data. It was responsive to the needs of patients and had caring and attentive staff. We found that the unit was well led. Pressure was placed on the unit when transfer of patients was delayed due to bed occupancy challenges faced by the trust. Though the unit coped with the situation, these patients were cared for in a mixed sex environment and had to use the bathroom and toilet facilities in the adjacent ward.

Updated 2 July 2014

We found that end of life care provided at the trust was safe, effective, caring, responsive and well led. The trust no longer used the Liverpool Care Pathway and was in the process of reviewing its end of life pathway. The palliative care team worked closely with staff on wards to ensure that patients had individualised end of life care provided in a positive, supportive environment. The team also had close links to community services. Patients and their families were involved in decisions about care and treatment in a dignified, respectful manner. Staff spoke positively about the support they received from the team. They felt this improved the patient experience and ensured patients received choices regarding end of life care and treatment.

Updated 23 December 2022

Updated 2 July 2014

The main outpatients department was a large area, with good access and seating for patients. Patients received effective treatment and information and felt happy with the care they received. The trust was monitoring appointment targets for waiting times and clinic start and finish times. It had sought the views of patients, and we saw that it had listened and responded to patient feedback by changing the layout of the department. Clinics were well managed and organised. When unavoidable delays occurred and clinics ran late, staff kept patients informed and provided them with information. Staff told us that they received training and supervision to enable them to provide effective care. All staff we spoke with told us that outpatients was a positive environment to work in.

Updated 22 August 2019

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 24 June 2022