Maternity services 'inadequate' at Nottingham hospitals, says health watchdog
Maternity services at two Nottingham hospitals have been downgraded to "inadequate" after inspectors found "several serious concerns".
The Care Quality Commission (CQC) looked at Nottingham City Hospital and the city’s Queen’s Medical Centre, run by Nottingham University Hospitals NHS Trust, over two days in October, speaking to maternity and midwifery staff and assessing a sample of patient records.
The short-notice visits were triggered "in response to concerns raised from serious incidents, external investigations… and coronial inquests", said the watchdog.
The CQC has now announced it imposed conditions on the registration of maternity and midwifery services at both sites, under Section 31 of the Health and Social Care Act.
"This urgent action was undertaken to prevent patients being exposed to the risk of harm," said the watchdog.
"Imposing conditions means the trust must comply with the instructions set in order to drive improvements."
In addition a warning notice was handed to the trust over “concerns found around the documentation for risk assessments and IT systems”.
The notice gives the trust three months to make the necessary improvements.
The trust has apologised and said it has made “immediate changes” to staffing, training, staff feedback and IT.
It will also recruit 17 extra midwives.
From January to December 2019, there were 8,265 deliveries at the trust, the report said.
In findings published on Wednesday, inspectors highlighted serious concerns including basic risk assessments for women and babies not being completed.
There were not always enough staff and while it was acknowledged managers regularly reviewed shift headcount and skill mix they were "limited to the resources available".
Some staff had not completed training in key skills and “did not always understand how to keep women and babies safe”.
Inspectors also found records which were patch-work, "incidents were not always reported due to the demand on staff and the ineffective feedback and escalation" and "lessons were not being learnt".
The CQC found only "limited evidence" of managers monitoring care and driving improvements, while leaders did not have all the skills and abilities "to effectively lead the service", with governance also lacking.
Inspectors also said: "The service did not have an open culture where staff felt confident raising concerns without fear."
However, the inspection team also concluded maternity services at both hospitals "mostly" had enough qualified staff "to keep women and babies safe from avoidable harm".
Staff were also focused on the needs of women receiving care.
At Nottingham City Hospital, inspectors also found "doctors, midwives, nurses and other healthcare professionals worked together as a team to benefit women and supported each other to provide good care".
Following the inspections, maternity services were down-graded to inadequate overall, as well as being rated inadequate, the lowest possible grading, for being safe, effective and well-led.
Professor Ted Baker, chief inspector of hospitals, said: "We were disappointed to find some serious concerns which were impacting on women’s care and safety.
“We found fundamental practice, like adequately risk assessing women and babies, was not always done.
“We also found staff did not always complete growth charts which enable staff to identify possible growth problems.
“Women’s notes were not comprehensive and not all staff could access them easily.
“We found that there was a combination of paper and electronic records in use across the unit.”
The main electronic records system could only be accessed by hospital midwives, but the lack of shared record-keeping meant GPs and community midwives were unable to see those records.
However, managers said the current community record-keeping system would be replaced with the same system used in both hospitals.
Prof Baker added the CQC had taken action "to ensure mothers and babies experience the safe, effective and personalised care they are entitled to".
"The leadership team is clear about the steps they need to take, and we will continue to monitor progress closely and will inspect again to check the necessary improvements have been made," he added.
Tracy Taylor, chief executive at Nottingham University Hospitals said: "We want to provide the best maternity services for local people, and the priority of our maternity team is to provide safe care to the families they come into contact with every day but we know we haven’t always got this right, and we are very sorry.
"We accept the report from the CQC and have already made some immediate changes and will continue to make further improvements, and I would like to reassure local people that we are committed to working to make its maternity service one that we can all be proud of."