A new report has stated Nottingham University Hospitals must make 'widespread and rapid improvements' to its maternity services. The Care Quality Commission (CQC) carried out an unannounced inspection of the trust’s maternity services during March at Nottingham City Hospital and Queen’s Medical Centre (QMC).
The inspection was carried out in response to concerns received about the safety and quality of the services and to check if improvements had been made since conditions were placed on the Trust’s registration around staffing, following an inspection in October 2020, and on the progress of improvements, the trust was told to make following an inspection in April 2021.
Following the latest inspection, the overall rating for both Nottingham City Hospital and QMC remains rated as requires improvement. Maternity services at both sites remain rated inadequate overall, as well as for being safe and well-led.
The report found the maternity service did not have enough staff to care for women and keep them safe, with not all staff having been trained in key skills. Staff did not always assess all risks to women, and inspectors were not assured staff acted upon concerns in a timely way.
Throughout both maternity departments, inspectors found there were concerns around women’s access to services and the assessment of risk once they were seen. Women were often waiting to be triaged longer than the Trust’s target of 15 minutes and risk assessments weren’t consistently being completed on arrival or admission.
Records showed there was also a declining performance trend in meeting the 15-minute target. Home births were cancelled and women’s planned care and treatment were delayed due to staffing issues.
Fiona Allinson, CQC’s director of operations, Midlands network, said: “We saw staff in the maternity departments at Nottingham University Hospitals NHS Trust working hard to provide care to patients in very challenging circumstances and this is reflected in the good caring rating we gave.
“Although we found some improvements, they are not widespread or rapid enough to address the areas of concern we identified during previous inspections. It’s disappointing that despite several inspections where CQC has told the trust areas they must improve to keep mums and babies safe, serious problems remain.
“One of our biggest concerns was that staff weren’t always carrying out observations on women to check that their condition hadn’t deteriorated. Midwives weren’t always clear who could perform observations, some staff didn’t carry them out as they said it wasn’t their role, and overdue observations went unrecognised. This gave us serious concerns about their ability to recognise and respond to women who were deteriorating, so we have taken enforcement action against the trust to focus them on rapid improvement in this area.
“Despite placing conditions on the trust’s registration in October 2020 due to staffing concerns, we found there were still not enough staff with the right qualifications, skills, training and experience to keep people safe. Although there was good planning work being done to try and manage these shortages, we found services operating with staffing levels that didn’t match planned numbers.
“It was, however, positive to see improved morale as a result of improvements to reduce the bullying culture we found at our last inspection."
Amongst the improvements listed by inspectors, the report stated staff generally felt confident to make complaints or raise concerns if they had concerns, and new processes to address these formally had been well received by managers and staff.
It added that staff understood how to protect women from abuse and controlled infection risk well. Inspectors also found staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
Sharon Wallis, Director of Midwifery at Nottingham University Hospitals said: “Keeping mums and babies safe and providing them with high quality care remains our top priority, and we are committed to continuing our work with local families and healthcare partners to make the changes still needed.
“Our teams are working hard to make the necessary improvements, but recognise we have more to do and are absolutely determined to speed up the pace of change and deliver quality services for women and their families.”
