Maternity services at an NHS trust have been rated inadequate by a health watchdog after inspectors found multiple issues across two hospitals.
The ratings for maternity care at the Royal Derby Hospital (RDH) and Queen’s Hospital in Burton-upon-Trent, Staffordshire, were downgraded after an inspection by the Care Quality Commission (CQC).
Patients were put at risk of harm and staff at both sites, run by the University Hospitals of Derby and Burton NHS Foundation Trust, were faced with “overwhelming workloads”, while some felt working conditions were unsafe, the watchdog said.
The trust said it took the findings of the inspections “very seriously” and that despite improvements being made, more needed to be done.
At Queen's Hospital, leaders didn’t make sure staff were up to date with their mandatory training, meaning we couldn’t be certain that staff had the appropriate skills to keep women and people using the service safe— Carolyn Jenkinson, Care Quality Commission
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “When we visited the maternity services at Queen’s Hospital and Royal Derby Hospital, it was disappointing to see such a significant lack of strong leadership.
“At both services, we found that leaders didn’t have the capacity to effectively manage them and they weren’t always visible or approachable for staff or people using them.
“We found staff didn’t always feel respected, supported, or valued by leaders at both hospitals, with staff at Royal Derby Hospital becoming visibly distressed when we spoke to them due to the overwhelming workloads and lack of clinical and emotional support from them.
“Some staff at Queen’s Hospital felt there weren’t equal job opportunities or safe working conditions, or that their hard work was recognised by management.
“When we visited Royal Derby Hospital, we found managers couldn’t be sure that people calling the pregnancy assessment line were receiving timely responses as they didn’t monitor this.
“This and the fact that staff didn’t always escalate concerns when there were signs that people’s health was deteriorating, was putting them at risk of harm.
“At Queen’s Hospital, leaders didn’t make sure staff were up to date with their mandatory training, meaning we couldn’t be certain that staff had the appropriate skills to keep women and people using the service safe.”
The service did not always have enough midwifery or medical staff to care for women and birthing people to keep them safe— Care Quality Commission
The inspections, which took place in August this year, found multiple issues at both sites relating to risk assessments, infection control and ensuring measures were taken to keep patients safe.
It also found that there were inadequate facilities to meet the needs of patients, including two showers being shared by 26 beds in one ward.
In its report for the RDH, the CQC said: “The service did not always assess risks relating to fetal monitoring and post-partum haemorrhage effectively.
“Staff did not always complete risk assessments at every antenatal contact.
“The service did not always have enough midwifery or medical staff to care for women and birthing people to keep them safe. Staffing levels impacted on delays to induction of labour.
“Staff were not always up to date with training in key skills.
“The service did not identify, manage and investigate safety incidents in a timely way or effectively embed lessons learned from them.
The watchdog said it would continue to closely monitor the trust.
Following the inspection, the rating for the “safe” and “well-led” criteria for maternity care at both RDH and Queen’s dropped from “good” to “inadequate”, the lowest rating.
The overall rating for the RDH also dropped from “good” to “requires improvement”, while Queens’ overall rating remains as “requires improvement”.
The trust’s overall rating has not changed and remains as “good” overall.
We took the CQC's findings very seriously and made immediate changes, including increased fetal monitoring in labour checks, ensuring we are using clinical best practices, and putting more leadership roles in place to support staff, parents and parents-to-be.— Dr Gis Robinson, UHDB
Responding to the inspections, UHDB’s interim executive medical director and consultant paediatrician Dr Gis Robinson said: “We apologise to mothers and families that our service is not consistently delivering to the standard we strive for or they should expect, and our staff are determined to use this feedback to deliver improvements at pace.
“We took the CQC’s findings very seriously and made immediate changes, including increased fetal monitoring in labour checks, ensuring we are using clinical best practices, and putting more leadership roles in place to support staff, parents and parents-to-be.
“We have welcomed 28 new midwives to our team since August and a further 18 are set to join us in December, which supports the £6 million investment we have already made to fund additional doctors, specialist midwifery roles, sonographers and new ultrasound software to help us better monitor how babies are growing during pregnancy.
“We know we must go further, however, and whilst we are pleased the reports recognise the compassion and commitment of our maternity staff, we remain dedicated to improving services for local mothers and babies under our care.”
The report comes as an independent review into maternity care at the Nottingham University Hospitals NHS Trust continues.
The review, led by Donna Ockenden, is set to be the biggest review into maternity care in the service’s history, with 1,800 families from across Nottingham and Nottinghamshire set to be included in the inquiry.
