East Kent NHS trust upgraded but inspectors urge action
Inspectors remain concerned about A&E and end-of-life care at an NHS hospital trust previously rated inadequate.
East Kent Hospitals Trust was placed in special measures in 2014 due to serious concerns about patient safety.
In its latest inspection, the Care Quality Commission (CQC) said it was pleased with the trust's progress and upgraded its rating.
But hospital inspector Alan Thorne said: "We want to see that progress sustained."
The trust has been rated as "requires improvement" overall, with a rating of good for being caring.
Inspectors found William Harvey Hospital, Queen Elizabeth The Queen Mother Hospital and Kent and Canterbury Hospital all require improvement.
Both Buckland Hospital and Royal Victoria Hospital were rated as good.
Areas of concern
Alan Thorne of the Care Quality Commission (CQC) said inspectors were pleased with significant progress under the new executive team "particularly around the management and reporting of safety incidents".
He said staff were more engaged and inspectors were "exceptionally impressed" with the change seen in outpatient care.
But there were two major areas of concern inspectors want addressed urgently - the "deteriorating performance" of the emergency department and a lack of action over changes to end-of-life care.
Inspectors also found the escalation ward at Queen Elizabeth the Queen Mother was not fit for purpose, with a lack of equipment and staffing not managed effectively.
The trust has been told to make improvements in nine areas, including maternity and mental health.
Professor Sir Mike Richards, the Chief Inspector of Hospitals, said: "I feel optimistic that the trust will continue to improve but it will require continued support for the foreseeable future."
Trust chief executive Chris Bown said he was "pleased that we have made demonstrable progress... but we must not rest on our laurels. This is not the time for complacency."
The CQC will return to re-inspect in six months.
Analysis: BBC South East health correspondent Mark Norman
Trust managers say they are very pleased with the progress that has been made but need to avoid complacency and the CQC inspectors are also cautious too - there is further to go.
The inspectors are particularly concerned about the performance of the A&E at the William Harvey Hospital in Ashford.
This is ironic because the department has the best-performing trauma unit in England.
But high numbers of patients, problems over recruiting staff and issues with moving people through the hospital mean the trust has struggled to hit targets.
It is worth remembering this is one of the largest trusts in England, covering more than 700 sq miles of east Kent and running five hospitals, while serving some of the most deprived wards in the country.
That leads to complications which mean the journey the trust is on is slow.