The Care Quality Commission (CQC) has published a report following inspections at two maternity services at hospitals run by University Hospitals of Derby and Burton NHS Foundation Trust (the Trust) earlier this year, and the findings are damning.
CQC inspection of the maternity services at University Hospitals of Derby and Burton NHS Foundation Trust
Inadequate rating
Following the CQC’s inspection, both Royal Derby Hospital and Queens Hospital maternity service ratings have dropped from ‘good’ to ‘inadequate’ overall for being safe and well-led.
Breaches were found relating to the Trust not having up-to-date policies and procedures, and not learning from issues at Royal Derby Hospital. As a result, the CQC placed urgent conditions on the Trust’s registration due to concerns that people using the service may have been at risk of harm.
Inspection findings
Deputy Director of Secondary and Specialist Healthcare, Carolyn Jenkinson, at the CQC said:
“When we visited the maternity services at Queens Hospital and Royal Derby Hospital, it was disappointing to see such a significant lack of strong leadership. At both services, we found that leaders didn’t have the capacity to effectively manage them and they weren’t always visible or approachable for staff or people using them.
“We found staff didn’t always feel respected, supported, or valued by leaders at both hospitals, with staff at Royal Derby Hospital becoming visibly distressed when we spoke to them due to the overwhelming workloads and lack of clinical and emotional support from them. Some staff at Queens Hospital felt there weren’t equal job opportunities or safe working conditions, or that their hard work was recognised by management.
“When we visited Royal Derby Hospital, we found managers couldn’t be sure that people calling the pregnancy assessment line were receiving timely responses as they didn’t monitor this. This and the fact that staff didn’t always escalate concerns when there were signs that people’s health was deteriorating, was putting them at risk of harm.
“At Queens Hospital, leaders didn’t make sure staff were up to date with their mandatory training, meaning we couldn’t be certain that staff had the appropriate skills to keep women and people using the service safe.
“During the inspection, we also found the service didn’t have suitable facilities to meet the needs of people and their families. We found limited access to showers and on one ward, two showers being shared between 26 beds. Furthermore, staff told us people were encouraged to shower with the door slightly ajar due to ventilation issues but there were no privacy/shower curtains to protect their dignity.
“After the inspection, we informed the trust’s leadership team that they needed to make significant improvements. We will continue to monitor the service closely, including through future inspections, to determine whether the issues we identified are addressed so women and people using the service receive the care they have a right to expect.”
During the inspection at Royal Derby Hospital, CQC inspectors found:
- Staff did not always complete risk assessments at every antenatal contact.
- Staff were not always up to date with training in key skills.
- The service did not always assess risks concerning fetal monitoring and post-partum haemorrhage effectively.
- Leaders did not have access to reliable information systems to support monitoring of the service due to paper-based record-keeping systems.
- Clinical guidelines were not always in line with national guidelines.
- The service did not identify, manage, and investigate safety incidents in a timely way or effectively embed lessons learned from them.
- There was limited engagement with local people and stakeholders about improving services.
You can read the full report on Royal Derby Hospital here.
The findings – Queens Hospital:
- There was no stable leadership team, with high unplanned turnover and/or vacancies.
- Staff did not always complete risk assessments for each woman or person using the service in order to remove or minimise risks.
- Staff did not always recognise and report incidents, reducing the ability to identify learning from incidents.
- The service did not always control infection risk well.
- The approach to service delivery and improvement was reactive, and significant failures in audit systems and processes were impacting on the management of risks and issues.
- Staff did not always follow control measures to protect women, themselves, and others from infection and managers did not regularly complete cleaning audits.
- There were trends in feedback from people using the service where they were not treated with kindness or respect during interactions with staff or when they were receiving care and treatment.
You can read the full report on Queens Hospital here.
Comment
Unfortunately, this is becoming all too familiar to learn of maternity services which are so badly letting down the people using their services.
Maternity services across the UK are under intense scrutiny. This inspection was carried out as part of CQC’s national maternity services inspection programme, and it is devastating to read that yet more services have been rated ‘inadequate’ through this.
For how long have failures been allowed to go unnoticed? It is clear already through the investigations into Nottingham’s maternity services, for example, that significant harm has already been caused as a result of failures in maternity care. This cannot continue.
As Ms Jenkinson at the CQC rightly commented, urgent and vast improvements are required to ensure that the issues are addressed so that women and people using the service receive the care they have a right to expect.
How can we help?
Danielle Young is a Legal Director in our Medical Negligence team, which is ranked in Tier One by the independently researched publication, The Legal 500.
If you have any questions about the subjects discussed in this article, please contact Danielle or another team member in Derby, Leicester, or Nottingham on 0800 024 1976 or via our online form.
Contact us