Maternity services in Durham and Darlington inadequate due to understaffing and delays
Maternity services in County Durham and Darlington have been rated as inadequate following a deterioration in the care being provided to new mothers and pregnant women.
The services at both the University Hospital of North Durham (UHND) and Darlington Memorial Hospital have been downgraded by the Care Quality Commission (CQC).
The watchdog said leaders at the hospitals, run by County Durham and Darlington NHS Foundation Trust, “urgently need to mitigate” the negative impact of understaffing.
Staff have reported delayed inductions to labour, including for high risk babies, people using the service not being observed or risk assessed appropriately and multiple examples of where screening tests had not been carried out to safely manage pregnancies.
Sue Jacques, chief executive of the trust, said the report made “difficult reading” and said work was taking place to improve the areas highlighted.
Carolyn Jenkinson, deputy director of secondary and specialist healthcare, said: “When we inspected maternity services at County Durham and Darlington NHS Foundation Trust, it was concerning to see such a deterioration in the level of care being provided to women, people using the service and their babies.
“Across both maternity services, leaders urgently need to mitigate the negative impact of understaffing. We saw that staff had reported delayed inductions of labour, including babies categorised as high risk, due to understaffing.
"Midwives had told managers they found the unit was unsafe, but no improvement had been made and staff continued to work late, miss breaks, and take sick leave due to stress which is totally unacceptable.
“We were concerned that women and people using the service weren’t being observed or risk assessed appropriately which increased the risk of a delay in recognising when their condition deteriorated and that their care could be delayed.
"Following the inspection, however, trust leaders provided information on the action they had taken to improve this, including risk assessment on arrival, the provision of additional staff and the creation of a waiting area with call bells.
“We found multiple examples where screening tests hadn’t been carried out to safely manage the pregnancies of women and people using the service. There had been over 70 incidents over the past year where national screening standards or internal policies hadn’t been followed which could place women, people using the service and their babies at risk.
“It was positive, however, that staff were kind and worked well together, often under pressure, to benefit those in their care.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary and rapid improvements are made so people using the service and their babies can receive safe and appropriate care.”
The inspection was carried out as part of the CQC’s national maternity inspection programme.
About 4,500 babies were born at the two hospitals between April 2021 and March 2022, of which about 3,000 were born at UHND and 1,500 in Darlington.
The maternity services at both are now inadequate. It means the overall ratings for the two hospitals has gone down from ‘good’ to ‘requires improvement’.
The overall rating for the trust 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.
Inspectors found the following at both services:
Senior leaders didn’t always support staff to develop their skills.
Not all staff had training in key skills needed for their roles.
The service didn’t always engage well with women people using the service, and the local community to plan and manage services.
Staff had limited awareness and understanding of the service’s vision and values and weren’t always able to apply them in their work.
Leaders didn’t operate effective systems and didn’t always manage risk and performance well.
Staff didn’t consistently carry out checks on equipment.
Staff didn’t always feel respected, supported, and valued.
Ms Jacques said: “We are of course very disappointed with the CQC’s rating for our maternity services.
“We take the concerns raised during the inspection extremely seriously and would like to assure all our birthing people and families that we are absolutely committed to providing you with the best care and experience at this special time in your lives.
“We acknowledge that the report makes difficult reading for us, our colleagues and our local communities.
“We recognise the areas for improvement raised by the CQC. A lot of work has already taken place to make improvements in the highlighted areas since the inspection in March and we have developed focused action plans to improve safety and efficiency further.
“I’d like to thank our staff, patients and families who took part in this inspection and who continue to support the services. The report summarises the challenges we face with high demand and staffing pressures but also highlights that our colleagues promote a culture that places the patient at the heart of the service and recognises the power of caring relationships between people.
“Every year we help welcome over 4,000 new babies and our teams are committed to providing a safe, compassionate and supported experience to each and every delivery.
“We have updated our website with information for birthing people and families and would encourage you to speak with one of our team if you do have any concerns at this time.”
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