CQC tells South Tees Hospitals NHS Foundation Trust to make improvements in maternity
The Care Quality Commission (CQC) has told South Tees Hospitals NHS Foundation Trust to make improvements in maternity services, following inspections carried out in August.
The services at The James Cook University Hospital and Friarage Hospital were inspected as part of CQC’s national maternity services inspection programme. This will provide an up-to-date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement locally and nationally.
This is the first time maternity services at both hospitals have been rated as a standalone core service. Previously, maternity and gynaecology services were inspected and rated together.
Following this inspection, maternity services at The James Cook University Hospital have been rated as requires improvement overall, and for being safe and well-led.
Maternity services at the Friarage Hospital were rated requires improvement overall and for being well-led. It was rated good for being safe.
Both hospitals and the trust remain rated as good overall.
Carolyn Jenkinson, CQC's deputy director of secondary and specialist care, said:
“When we visited maternity services at South Tees Hospitals NHS Foundation Trust, we found leaders were generally visible and approachable for staff, as well as women, people using the service and their babies. However they didn’t always understand and manage the priorities both maternity services faced in a timely way.
“At the Friarage Hospital, the maternity unit was sometimes closed for births as staff were required to work at The James Cook University Hospital instead, due to low staffing levels. This made it difficult for people to plan a birth there.
“We found areas of concern at The James Cook University Hospital. For example, there was no birthing pool on the delivery suite or on the midwifery led unit. Staff used a standard bath instead of a birthing pool, which was unsafe and was putting people at risk due to the design of the room and the bath. Once this was highlighted to the trust, they stopped immediately.
“Leaders were also highly responsive and engaging in relation to other concerns we raised with them during the inspection and acted promptly to improve the standard of care they were providing.
“We will continue to monitor both services, so the trust can build on where it’s providing good care and make improvements where they’re needed.”
Inspectors found at the Friarage Hospital:
• The service did not always have enough midwifery staff, or they were frequently redeployed to The James Cook University Hospital.
• Leaders did not operate effective governance systems. They did not consistently monitor the effectiveness of the service and did not always manage risk well.
However:
• Staff understood how to protect woman and people using the service from abuse, and managed safety well.
• Staff assessed risks to woman and people using the service, acted on them and kept good care records.
Inspectors found at The James Cook University Hospital:
• The service did not always have enough staff and staffing levels did not always match planned numbers, which could put safety of women, people using the service and their babies at risk.
• There were various aspects of the environment that were not fit for purpose. This had implications for safety, efficiency, privacy and dignity.
• Staff assessed risks to people but did not always act on them to remove or minimise risks.
However:
• The service generally managed infection risks well.
• The service engaged with people and the community to plan and manage services.
• Managers generally made sure staff were competent, and staff were focused on the needs of people receiving care.
The Friarage Hospital report will be published on CQC's website on Friday 19 January.
The James Cook University Hospital report will be published on CQC's website on Friday 19 January.
South Tees Response
In August, the Care Quality Commission (CQC) carried out a short-notice inspection of maternity services at The James Cook University Hospital and the Friarage Hospital as part of its National Maternity Inspection Programme.
The CQC reports (published on Friday 19 January 2024) acknowledge a number of areas of outstanding practice including the service’s transparency and accountability, and the special support it provides for birth parents and foster carers if a baby is placed into the care of the local authority.
Inspectors also identified some areas for improvement which are already being addressed through a comprehensive action plan. These include:
• Ongoing recruitment to support maternity services across James Cook and the Friarage – this is in addition to the successful recruitment of all newly qualified midwives who trained at the trust in 2023.
• Improvements to the building and environment at James Cook, including plans to install of a new birthing pool – the trust is continuing to seek investment to improve the environment in maternity services.
Inspectors found leaders were visible and approachable and engaged with people and the community to plan and manage services. Staff were also praised for the way they managed safety, infection prevention, safeguarding and care records.
Despite many positive findings in the report, maternity services at both hospitals have been rated as “Requires Improvement”. However, South Tees Hospitals NHS Foundation Trust’s overall CQC rating remains as “Good”.
Dr Deepika Meneni, clinical director for the trust’s maternity services said: “The safety of those in our care is always our top priority and every member of our maternity team is dedicated to providing the best possible care.
“We are pleased that the reports reflect areas of outstanding practice as well as highlighting those areas where we know we need to make further improvements. All of the areas identified by the CQC for improvement are being addressed through a comprehensive action plan and many of these have already been completed. This includes successfully recruiting midwives to all our vacancies.
“We are proud of our team for the hard work, professionalism and caring attitude that they show each day and that is reflected in our excellent patient feedback and in how closely we work with the parents and parents-to-be who make up our local Maternity Voices Partnership.”