Concerns were again raised with many aspects of maternity care at Nottingham's hospitals following a reinspection, documents have shown. The Care Quality Commission highlighted issues with an increase in stillbirths, staffing and its triage service after it visited Nottingham City Hospital and Queen's Medical Centre from March 1-4.
Improvements were also noted, in terms of the quality of care, CTG practice, record keeping and handovers. The health watchdog returned to inspect how Nottingham University Hospitals (NUH), the trust that runs the hospitals, had improved the services since they were rated 'inadequate' in October 2020.
A previous visit in April 2021 found, whilst improvements had been made, more work was needed "to ensure safe high quality maternity care for all". The full report of the CQC's latest inspection is yet to be published, however newly released NUH board papers show a letter from the watchdog giving an overview of its feedback.
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In the letter addressed to acting chief executive Rupert Egginton, the CQC said it had concerns with maternity staff levels in general, specifically within the triage service at City Hospital and post-natal ward at QMC. "Concerns escalated within the triage service were not always acted on promptly," it reads, adding; "Women attending triage were not consistently reviewed within 15 minutes."
At City Hospital, it said there had been increases in stillbirths but "no apparent rationale had been established at present". The letter adds; "there were some midwives who may have been acting outside of their competency in respect of reviewing scans."
In relation to the rate of still births, documents show director of midwifery, Sharon Wallis said at a Quality Assurance Committee meeting in February that 'an issue remained around data', citing as an example, late pregnancy terminations in December. Chief nurse Michelle Rhodes made a similar point at the same committee a month earlier.
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The CQC letter did however outline a number of improvements, such as better CTG practice, record keeping and handovers between midwives and medical staff. Almost all patients and relatives were positive about their care across both sites, however the CQC said one woman "appeared to receive poor care which resulted in her requiring a caesarean section".
In the documents, released ahead of NUH's board meeting on Friday, March 28, medical director Keith Girling acknowledged; "whilst the CQC found many notable improvements in relation to deficiencies in care identified in their last visit they have raised concerns particularly around triage. The actions taken to date in response to the concerns raised and a warning notice that has been issued are set out."
Describing what action had been taken since the feedback, Mr Girling and Ms Wallis said triage staffing had been increased and audit of triage had been strengthened. On the week commencing on March 14, of the women who had not been triaged within 15 minutes, all women had completed triage in less than 30 minutes and no women were harmed by the delay.
Mr Egginton said: “We note the recent CQC initial feedback following their visit earlier this month – where the inspectors highlighted a number of improvements including almost all families being very positive about their care, our teams working well together, and our monitoring of babies. “They also told us where they want further assurances, including in triage and observations, which we accept are areas to improve.
"Following feedback from CQC, we have reviewed our triage processes so that there is clear monitoring of mothers and babies at every stage, and rapid escalation of any issues. This will improve the care and support available for everyone attending maternity, and we will be making further changes.
“We remain committed to improving our maternity services while responding to feedback from patients, colleagues and partners, to ensure our communities receive the care they deserve.”
The maternity services at NUH are also subject to a thematic review by the Nottingham CCG and NHS England. The CQC said the findings would be published "in due course".
