Maternity services at two Leicester hospitals rated downgraded from good to requires improvement
The safety of some maternity services at a Leicester NHS trust being rated as inadequate by the health watchdog is "worrying but not unsurprising", a law firm representing patients has said.
It comes as inspectors found maternity services at both the Royal Infirmary and the General Hospital had moved down from "good" to "requires improvement".
The Care Quality Commission visited Leicester Royal Infirmary, Leicester General Hospital and St Mary's Birth Centre, run by University Hospitals of Leicester NHS Trust, in February and March.
The inspectors did say though that the overall rating for maternity services at St Mary’s Birth Centre remains as "good".
Following the inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to how they were managing each maternity service. The report says the overall rating for the trust remains as requires improvement.
In response the trust says it takes the report and its findings "incredibly seriously and are using them to drive further improvements for women and birthing people."
Staff at the trust have also written an open letter to parents, parents-to-be and families concerning the report where they say that "Leicester remains a safe place to give birth and there are several ways [people] can get in touch with [them] if you have any concerns."
KEY FINDINGS
Inspectors found the following during this inspection:
St Mary’s Birth Centre:
Leaders didn’t always operate effective governance processes throughout the service.
The design, maintenance and use of facilities, premises and equipment didn’t always keep people safe.
The birth centre had enough suitable staff
Staff were focused on the needs of women and people receiving care, and staff were clear about their roles and accountabilities.
Staff described happy, healthy working relationships within their teams.
Leicester Royal Infirmary:
Staff didn’t always feel respected, supported, and valued.
Actions to mitigate risks and make improvements weren’t always identified.
Staff had training in key skills, and generally understood how to protect women and people from abuse.
Staff understood the service’s vision and were developing a strategy with key stakeholders to implement it.
Leicester General Hospital:
Staff didn’t always feel respected, supported, and valued.
Actions to mitigate risks and make improvements weren’t always identified.
Records were not always clear, up-to-date, easily available and stored securely.
Staff had training in key skills, and generally understood how to protect women and people from abuse.
Staff understood the service’s vision and were developing a strategy with key stakeholders to implement it.
What did the inspectors say?
Carolyn Jenkinson, deputy director of secondary and specialist healthcare, said: “When we inspected maternity services at University Hospitals of Leicester NHS Trust, we observed a deterioration in the level of care being provided to women, people using the service and their babies.
“The leadership team has recently restructured with many new posts still needing to be embedded.
"Leaders should continue to focus on improving their oversight of risks and managing performance so people can receive a better, and safer standard of care.
“Senior leaders already had plans in place to prioritise the main risks, including staffing levels, so we hope to see these changes embedded when we next inspect.
"Staff spoke positively about the new leadership team, describing them as visible and approachable and felt they supported staff to develop their skills and take on more senior roles.
"In addition, a matron had recently been appointed to focus solely on recruitment, retention, and staff wellbeing.
“Both services were regularly understaffed which placed people and their babies at risk.
"It also meant staff weren’t always able to take their breaks, which affected their well-being, morale and ability to do their job."
Care delayed
Ms Jenkinson said inspectors also found multiple examples where people’s care had been delayed in maternity triage due to doctors not being available.
She said: "Some of these delays were very long, for example six hours, and some resulted in people self-discharging before they had a medical review, which could place them at risk.
“It was positive, however, to hear that leaders were working closely with staff and an external agency to improve culture across all maternity locations."
MATERNITY RATINGS
According to the report the rating for maternity services at Leicester Royal Infirmary has moved down from good to requires improvement.
Safe moved down from requires improvement to inadequate, and well-led moved down from good to requires improvement.
The rating for maternity services at Leicester General Hospital has moved down from good to requires improvement.
Safe has moved down from requires improvement to inadequate and well-led moved down from good to requires improvement.
For St Mary’s Birth Centre, inspectors said the rating for safe remains as good and the rating for well-led has moved down from good to requires improvement.
This means the overall rating for maternity services at St Mary’s Birth Centre remains as good.
'Proud of their safe care'
Ms Jenkinson did go on to praise St Mary's Birth Centre.
She said: "Staff at St Mary’s Birth Centre should be proud of the safe care they were providing.
"Staff there were focused on the needs of people and babies in their care and were fully supported by managers to develop their skills.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people and their babies can receive safe and appropriate care.”
What does the Trust say?
Julie Hogg, chief nurse at University Hospitals of Leicester NHS Trust, said: “Improving maternity services is a key priority and many of the highlighted challenges had already been identified before the inspection with plans in place to tackle them.
"However, we take the report and its findings incredibly seriously and are using them to drive further improvements for women and birthing people.
“Our new Director of Midwifery has overseen plans to strengthen staffing.
"Since January this year, 25 new midwives have joined us, and we will welcome 24 more in November.
"We have invested in new equipment and daily safety checking and made rapid improvements to cleanliness and infection prevention practices.
"We are also progressing plans for a new maternity theatre at the Leicester General Hospital, meaning that planned and emergency caesareans will take place in separate areas.
“While we know there is more to do to, we are committed to providing safe, high-quality and compassionate care and are encouraged that the reports highlight our hardworking staff and the actions being taken to ensure a culture of safety and openness.
“We have invited the CQC back to see the changes we have made and the positive impacts they are having on the safety and quality of our service.”
Open Letter from University Hospitals Leicester NHS Trust in full
Dear parents, parents-to-be and families,
We are writing to you following publication of the recent Care Quality Commission (CQC) reports into maternity services at our hospitals. The CQC inspected maternity services at the University Hospitals of Leicester NHS Trust (UHL) in February and March 2023, as part of its new national maternity inspection programme.
Their findings were published on Wednesday 20 September.
Inspectors visited services at the Leicester Royal Infirmary, the Leicester General and St Mary’s Birth Centre, rating the overall UHL service as ‘Requires Improvement’.
This is a move down from our previous rating of ‘Good’.
We were also instructed to make immediate improvements in several areas following the inspections.
We understand this may be concerning to hear. We want to reassure you that we had already identified many of the challenges raised by the CQC and put plans in place to address them.
These changes are now embedding. They include improving our staffing levels to ensure a consistently safe service for all.
Thirty-five new neonatal nurses have joined us since April last year, 25 new midwives have joined us since January, and a further 24 midwives will join UHL in November.
Other important changes include investment in new equipment and our estate, daily safety checking, and improvements to cleanliness and infection prevention practices.
We now have bereavement support in place 7 days a week and have separated telephone triage from our assessment unit to ensure that urgent calls are answered in a timely way by an experienced clinician.
We are also progressing work on a new maternity theatre at the Leicester General Hospital meaning that planned and emergency caesareans can take place in separate areas.
While we know there is much more to do to, we are encouraged by the reports’ reference to the commitment of our hardworking team and the actions being taken to ensure a culture of safety and openness.
We have invited the CQC back to see the changes we have made and the impact they are having on the safety and quality of our services.
Please be assured that Leicester remains a safe place to give birth, and there are several ways you can get in touch with us if you have any concerns.
If you are ever worried about the care you are receiving, please contact your community midwife or your named consultant in the first instance.
We promise to listen to you and take your concerns seriously.
If your concerns are not resolved or you wish to raise them to someone outside of the clinical team, you can contact our Patient Information and Liaison Service.
You may also wish to engage with the local Maternity & Neonatal Voice Partnership (MNVP), a network of local parents and health professionals that work together to help improve maternity care in our area.
We are committed to working with you to improve maternity services in Leicester and to ensure any feedback you have is heard, recognised, and acted upon.