CQC orders Somerset NHS Foundation Trust to improve maternity services

Inspectors at the Care Quality Commission have told the Somerset NHS Foundation Trust to make improvements to all three of its maternity services, with the CQC saying it's 'taken action to protect people' after looking at the offering at Musgrove Park Hospital, Bridgwater Community Hospital, and Yeovil District Hospital - under a programme looking at the quality of hospital services up and down the country.

Following the inspection:

• The overall rating for Musgrove Park Hospital maternity services has decreased from good to inadequate, whilst the rating for how well-led it is has decreased from good to inadequate and how safe it is has declined from requires improvement to inadequate
• The overall rating for the Musgrove Park Hospital has also gone down from good to requires improvement
• Yeovil District Hospital maternity services have been rated as inadequate overall, as well as for being safe and well-led
• Bridgewater Community Hospital’s Mary Stanley Birth Centre has been rated as requires improvement overall, and for being safe and well-led

The CQC has issued a warning notice at Musgrove Park Hospital and Yeovil District Hospital to focus the trust’s attention to maintain rapid and sustained improvement in the care of people using the service.

'A deterioration in care'

Carolyn Jenkinson, CQC’s deputy director of secondary and specialist care said: “When we inspected maternity services at Somerset NHS Foundation Trust, we found a deterioration in the quality of care being provided across maternity services at all three of the locations they provide them from. We also had particularly significant concerns with the care being provided at Musgrove Park Hospital and Yeovil District Hospital.

“Leaders weren’t supporting staff to learn from incidents or make improvements when things went wrong. Incident data seen by inspectors also didn’t always match up with information provided to the trust’s board. Leaders also weren’t effectively monitoring how the services performed, or taking action when risks needed to be escalated.

“At Musgrove Park Hospital, we found poor systems and processes for assessing women and people using the service who needed medical attention. Staff weren’t using a standard method to assess and prioritise people based on clinical need when they arrived, which meant that people were being assessed differently based on the individual who saw them.

“At Yeovil District Hospital, we were concerned that staff weren’t always cleaning their hands when entering clinical areas to care for people, and they weren’t always following the trust’s uniform policy to help reduce spreading germs. Leaders also weren’t monitoring whether staff were complying with their hand hygiene policies.

“There were high rates of staff sickness at Bridgewater Community Hospital and poor staffing levels meant the birth centre and home birth service had to close for five months between February and July last year. However, the trust had taken steps to recruit more midwives. They should also review how to ensure the service is sustainable for local women and people.

“Despite these issues, across the trust we found staff were keen to improve the services and some of the problems were out of local leaders’ control. At Musgrove Park Hospital, inspectors noted the buildings were in poor condition and required regular maintenance which posed an ongoing challenge for the quality of maternity services they were able to provide.

“We have told the trust where we expect to see significant improvements and will continue to monitor them closely while these improvements are made. We will return to check on their progress and won’t hesitate to take action if women, people using the service and their babies are not receiving the care they have a right to expect.”

Musgrove Park Hospital

Inspectors found:

• Staff weren’t always completing mandatory training or meeting the trust’s targets for training, and leaders lacked good management of this issue
• The service did not control infection risk well and the environment was unsuitable
• There was a lack of emergency equipment across the service
• There wasn’t always enough midwifery staff to keep people safe
• Fridge temperatures weren’t always monitored, and the contents weren’t always checked
• Staff couldn’t access up-to-date policies and procedures to support them in their roles

However, inspectors did find some positives - including with how well the service engaged with the local community to make improvements and plan services - as well as staff having a positive work culture and were committed to improving the service.

Yeovil District Hospital

Inspectors found:

• There was not enough emergency equipment to safely care for babies - but leaders have ordered more equipment following the inspection
• The service did not always control infection risk well
• The service did not always have enough medical staff, such as consultants, to keep people safe
• Leaders didn’t have effective governance systems to manage risks, issues, and how the service performed.
• Staff hadn’t all completed necessary training to protect women and people using the service from abuse
• There was a lack of meaningful conversations and information regarding maternity services at executive board level

However, inspectors found some positives, including that staff worked well together as a team to cover areas where women and people using the service needed support, and the service engaged well with the local community to make improvements and plan services.

At Bridgwater Community Hospital

Inspectors found:

• Leaders weren’t monitoring waiting times to ensure people could access emergency services when needed and if they received treatment within national targets
• Equipment was not always maintained safely
• Leaders didn’t have effective governance systems to manage risk, issues, and how the service performed
• The birth centre did not have a vision or strategy and there was a limited approach to engagement with local people about their services

However, they also found staff had training in key skills and worked well together for the benefit of women, people using the service and their families - and staff understood how to protect people from abuse, and managed safety well.

'We are committed to improve'

Peter Lewis, Chief Executive of Somerset NHS Foundation Trust, said: “We have received three reports from the Care Quality Commission (CQC) regarding the maternity services we provide. These illustrate that we have fallen short of the standards we expected to be delivering, and we want to say sorry to our families that use these services and to our hard-working colleagues.

“We are committed to improve, so that we provide an excellent service that supports women, birthing people, and families in Somerset. We have made significant changes since the inspection and will continue to do so.

“We have strengthened our processes to provide ongoing review of quality, performance and governance, including developing a strong audit and policy programme to drive continual improvements in our services. All guidance and policies that were highlighted have been reviewed and updated, and we have increased scrutiny and governance around our policy processes, ensuring these are available to all colleagues. We have reviewed and mapped all mandatory training, strengthened our oversight, and significantly improved our compliance.

“At Musgrove Park Hospital’s maternity unit, we have put in place a new evidence-based, standardised triage process to risk assess and prioritise care based on clinical need, and have reconfigured the ward to facilitate safe and effective clinical oversight of our service users. We immediately sourced emergency equipment at Musgrove Park and Yeovil District Hospitals.

“The CQC report for Musgrove Park’s maternity service highlights issues that are as a result of the poor condition of the building. We are planning to replace this as part of the national New Hospitals Programme, but have already made improvements specifically around safety and security.

“The inspectors noted an open culture, good engagement with local communities to make improvements and plan services, good team working, and that colleagues felt valued and supported. We have a lot of work to do, but this does give us good foundations on which to build.

“We are here to support all those using our maternity services. If you have any questions, or concerns, would like more information, or to speak to someone about our service, please speak to your midwife. We are here to help and support you.”

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