Ipswich & Colchester Hospitals told to improve maternity services
The CQC has rated them 'requires improvement'
Last updated 16th Jun 2021
The NHS Trust running Ipswich and Colchester Hospitals has been told to improve its maternity services.
The Care Quality Commission (CQC) has published reports following an inspection of maternity services run by East Suffolk and North Essex NHS Foundation Trust.
CQC inspected maternity services at Colchester Hospital and Ipswich Hospital in March and April, after whistleblowers raised concerns about staffing levels, incident management, leadership and culture.
Following the inspection, maternity services at both hospitals were rated requires improvement. They were previously rated good.
The Trust's overall rating is unchanged by this inspection. It remains requires improvement.
Philippa Styles, CQC head of hospital inspection, said:
"Our inspection of maternity services run by East Suffolk and North Essex NHS Foundation Trust found a number of areas at Colchester Hospital and Ipswich Hospital where improvements were needed.
"Prior to the inspection, we received information from whistleblowers regarding staffing within maternity at Colchester Hospital. We are grateful to these whistleblowers as our inspection found the number of midwives and healthcare assistants were below levels required to keep women and babies safe.
"We also found a staff shortage at Ipswich Hospital.
"During the inspection, staff across both units told us they felt let down by a lack of oversight from the trust's board and senior leadership team, who were slow to act when issues were raised.
"Some staff told us morale was low and they did not always feel respected, supported or valued by senior leaders. This affected the care they delivered.
"It was also concerning that the trust was not ensuring all staff received important training, including to protect patients from harm and abuse.
"However, inspectors also found women were given support by committed staff despite staff shortages at both hospitals
"We spoke with the head of midwifery and the leadership team, who confirmed staffing was their main concern and a priority area for improvement. They also referred to an unsuitable environment and IT system, which affected the care they could offer.
"The trust knows where we expect to see improvements. We will return to determine whether progress has been made, and we continue to monitor it closely."
There was dependency on bank staff as well as a reliance on regular staff working extra hours. This led to burnout and high levels of sickness absence.
Lack of adequate staffing delayed treatment across several areas, including induction of labour, and patient appointments.
Some staff had not completed training in line with trust requirements, meaning managers could not be assured they were competent in key aspects of their roles.
Findings at Colchester Hospital included:
Staff relied on a handwritten book to manage inductions. It was amended frequently and regularly removed from the triage station, meaning staff did not always know how many women might arrive for induction. This affected the ability to organise staffing.
Shift changes and handovers were not always structured to ensure all necessary information was shared to keep women and babies safe.
The maternity triage system was overburdened, causing a risk to women's safety.
However, staff apologised when things went wrong. They gave women honest information and suitable support.
To help address staffing shortages, there had been a rolling recruitment drive and 16 new midwives were due to start work at the time of inspection.
Findings at Ipswich Hospital included:
Patient records were not always comprehensive and staff used handwritten notes, which were not always easy to navigate. Staff said current information management systems were time-consuming and inefficient, taking them away from their role caring for women and babies.
Healthcare professionals did not always work as a team to benefit women. Although staff held regular multidisciplinary meetings, these were unstructured and inconsistently attended.
However, staff felt supported by their peers. They focused on patient need and sought to provide the best possible care, despite staffing shortages.
Following the inspection, CQC identified improvements were needed at both hospitals, including:
Incidents must be robustly reviewed to ensure patient safety.
All steps must be taken to ensure safe staffing levels.
Leaders must have sufficient oversight of the risk register, manage all risks and ensure mitigations are in place.
The services must ensure a clear strategy and vision, with objectives, to provide direction for the service and its staff.
Nick Hulme, Chief Executive of East Suffolk and North Essex NHS Foundation Trust said:
"We accept the CQC's findings and have already taken action to improve our staffing levels, leadership and processes to ensure patient safety.
"We are investing in recruitment for our maternity services, and are pleased that a new expert senior midwife will be joining us shortly to lead our service, with an additional 30 midwives due to join us over the next few months."