Another warning notice issued to Gloucestershire Hospitals maternity department
The Trust say they expect the Care Quality Commission to re-inspect services once again in the near future
Last updated 21st Jul 2024
People being treated in the maternity department looked after by the Gloucestershire Hospitals NHS Foundation Trust are potentially 'at risk of harm'.
That is one of the findings by the Care Quality Commission, following a fresh inspection, with the details released today.
The CQC carried out a 'focused inspection' back in April this year - as they were following up on two warning notices which were first issued to the Trust in April 2022 for surgical services and maternity.
A further warning notice has now been issued by inspectors to the maternity department because of 'further issues found'.
Particularly, they want to make sure that the right safeguarding training is provided for all staff, and to firm up how incidents are investigated - with the CQC wanting to make sure all incidents are 'investigated in a timely way so learning can be shared quickly to reduce the risk of them happening again'.
They did find, however, that improvements have now been made to the Trust's surgical services - with the precious warning notices having now been met.
Despite this latest inspection result, these services weren't re-rated - meaning surgery remains 'requires improvement', and maternity remains rated as 'inadequate'.
The overall rating of the trust remains requires improvement.
'We found a number of positive changes'
Cath Campbell, CQC deputy director of operations in the south, said: “During our inspection of Gloucestershire Hospitals NHS Foundation Trust, we found a number of positive changes since our last inspection, and we were pleased to find the culture had improved and it was more open and transparent.
“These positive changes had impacted on the quality of care. Also, staff were receiving the support they needed to manage their wellbeing.
“However, we did find areas where improvements still need to be made. For example, at the inspection last April, we issued a warning notice due to poor compliance with safeguarding training level 3 in maternity. Following this latest inspection, we found that this hadn’t been addressed fully and have re-issued the warning notice.
“We also found that incidents were still not being investigated in a timely way. At the end of March there were still 215 incidents due to be investigated. While this was an improvement from the last inspection, further improvements were required to make sure that any poor practice was identified, improvements were made, and staff learnt from these in a timely way to help prevent them from happening again.
“We also found in surgery that not all of the department was clean due to ongoing building work. Ceilings in the non-clinical areas were dirty with a significant amount of dust. However, staff did tell us that the infection prevention and control team had assessed these areas and only non-clinical areas were affected.
“We'll continue to monitor these services, including through further inspections, to ensure people are receiving safe care and support the trust to continue building on the improvements made so far.”
The main findings of the CQC report
In surgery, inspectors found:
- Positive - Staff felt there had been an improvement in staffing since last inspection
- Positive - There had been an improvement in the number of people nursed in areas that were outside of their intended purpose
- Positive - The surgical assessment unit had now been extended and the number of people who needed ward-based care being nursed in recovery had gone down
- Positive - A reduction in 'never events' across both sites with no reported never events since December 2021
- Negative - There were instances of children undergoing non-specialist emergency surgery at Cheltenham General Hospital, which was not in line with national guidance
In maternity inspectors found:
- Positive - Safety checks on emergency equipment was completed daily to make sure it was ready to use
- Positive - Waiting time for women in triage to meet the 15 minute standard had improved to reduce any delays in care and treatment
- Positive - Staff had worked hard to make sure the majority of women experienced 1 to 1 care in labour which is crucial to safe care
- Negative - Incidents were not always investigated in a timely way which delayed the outcome and learning being shared
- Negative - Not all medicines practices were safe and potentially they placed women and people using the service at risk of harm
- Negative - Safeguarding training level 3 was not provided for all staff
In its report, the CQC identified a number of positive changes since its last inspection in April 2022, which also included areas of outstanding practice in relation to patient safety and quality of care, alongside an acknowledgement of the pride and hard work shown by the teams.
'Overall, this is a positive outcome'
Deborah Lee, Chief Executive Officer, said: “Overall this is a positive outcome which indicates some of the progress we have made over the last year or so.
“In particular it recognises the hard work of staff and colleagues who have put so much into patient care and I’d like to personally thank them for all their effort. It also demonstrates the journey we are on and the trajectory that the team have put us on. That’s particularly important given the context of health and care provision over the last few years.”
Ms Margaret Coyle, Chief of Service for the Surgical Division and Consultant Oral and Maxillofacial Surgeon, said: “While we found some of the CQC findings last time round difficult, particularly given the context of the pandemic and the exceptional way we had responded, we are pleased to see the progress that’s been achieved since.
“Since the inspection team visited in April we’ve made good progress against the areas identified for improvement and continue to do so.
“We have always been confident about the level of care we’ve provided and it’s encouraging to see this reflected by the inspection team who’ve described some of our practice as outstanding. That’s testament to the hard work of the team.”
Lisa Stephens, interim Director of Midwifery, added: “The challenges across midwifery nationally are well documented and there is no doubt that these are difficult times across the profession. The areas identified by the regulators largely relate to training and processes and on occasions we’ve had to prioritise patient care over these.
“However, it’s important for expectant parents and those families accessing our services to hear about the good care we continue to deliver.
“In that regard we will continue to invest heavily in our service, to work closely with regulators and advisory teams, to ensure that we can continue to provide a service that we are all proud of.”
Deborah Lee, Chief Executive Officer, added: “Currently, our outcomes across surgery and maternity remain in line with other centres nationally and are better in some areas.
“We are determined that this report will provide further momentum and impetus to address the issues identified and are working harder than ever to engage and involve our frontline colleagues in finding solutions to our challenges.”