Maternity services at two Nottingham hospitals rated 'inadequate'
A watchdog found 'serious' issues like basic risk assessments not being completed
Maternity services at two Nottingham hospitals have been downgraded to inadequate - after inspectors found "several serious concerns''.
The Care Quality Commission has taken urgent action after visiting City Hospital and Queen's Medical Centre (QMC) in October.
The short-notice visits were triggered "in response to concerns raised from serious incidents, external investigations... and coronial inquests'', said the watchdog.
The CQC says it has imposed conditions on the registration of maternity and midwifery services at both sites "to prevent patients being exposed to the risk of harm.''
"Imposing conditions means the trust must comply with the instructions set in order to drive improvements.''
A warning notice was also handed to Nottingham University Hospitals NHS Trust over concerns around the documentation for risk assessments and IT systems'.
The notice gives the trust three months to make the necessary improvements.
From January to December 2019, there were 8,265 deliveries at the trust, the report said.
Inspectors highlighted serious concerns including basic risk assessments for women and babies not being completed.
There were not always enough staff and while it was acknowledged managers regularly reviewed shift headcount and skill mix they were "limited to the resources available''.
Some staff had not completed training in key skills and "did not always understand how to keep women and babies safe''.
Inspectors also found records which were patch-work, "incidents were not always reported due to the demand on staff and the ineffective feedback and escalation'' and "lessons were not being learnt''.
The CQC found only "limited evidence'' of managers monitoring care and driving improvements, while leaders did not have all the skills and abilities `"to effectively lead the service''.
Inspectors also said: "The service did not have an open culture where staff felt confident raising concerns without fear.''
However, the inspection team also concluded maternity services at both hospitals "mostly'' had enough qualified staff to keep women and babies safe from avoidable harm.
Staff were also focused on the needs of women receiving care.
Following the inspections, maternity services were down-graded to inadequate overall, as well as being rated inadequate, the lowest possible grading, for being safe, effective and well-led.
Professor Ted Baker, chief inspector of hospitals, said: "We were disappointed to find some serious concerns which were impacting on women's care and safety.
"We found fundamental practice, like adequately risk assessing women and babies, was not always done.
"We also found staff did not always complete growth charts which enable staff to identify possible growth problems.
"Women's notes were not comprehensive and not all staff could access them easily.
"We found that there was a combination of paper and electronic records in use across the unit.''
Chief Executive at Nottingham University Hospitals, Tracy Taylor, said: “We want to provide the best maternity services for local people, and the priority of our maternity team is to provide safe care to the families they come into contact with every day but we know we haven’t always got this right, and we are very sorry.
“We accept the report from the CQC and have already made some immediate changes and will continue to make further improvements, and I would like to reassure local people that we are committed to working to make its maternity service one that we can all be proud of.”
The trust says some of the immediate actions taken include:
- Recruiting 17 extra midwives recently, and increasing use of temporary staff while recruiting further.
- Additional midwifery and consultant support in triage
- Introduction of a resident midwifery manager seven days a week and on-call overnight
- Extra training for Dawes Redman analysis for electronic fetal monitoring
- Using a ‘modified early warning score’ for all women attending triage
- More opportunities to feedback via a range of channels, including improved visibility of leadership
- IT improvements, including additional equipment