Women in labour at a London maternity unit deemed “inadequate” were left alone with unsupervised support workers who were not given any guidance, an NHS safety watchdog has found.
In a scathing report of North Middlesex Hospital’s maternity services, the Care Quality Commission also found examples of delays to induction of birth for women, and one case of a woman with a still-born baby who was left waiting for the unit to call her in for an induction.
Inspectors have downgraded the maternity unit from “good” to the lowest possible rating “inadequate” following an inspection earlier this year, according to a report published on Friday.
Staff reportedly told inspectors they felt they were “criticised” or “bullied” when reporting safety incidents within the unit.
“We heard that the criticism or bullying was worse if the incident reported was relative to other staff and their perceived behaviours,” the report said.
There was also evidence the hospital was not recording the severity of safety incidents correctly for example two “never events”, which are among the highest category incidents, were categorised as “low harm”.
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Other findings included:
- Women and babies came to harm as the hospitals did not follow standards to language interpretation despite covering a higher than average minority ethnic population
- Staff were not adequately trained in emergency procedures needed for water births after the trust paused these during Covid
- The hospital was not fulfilling its duties to be truthful with families in cases where harm may have been caused such as stillbirths, neonatal deaths, or brain injuries to babies
The report comes as the families of babies who died or were harmed at the hands of the NHS came together to call for a full statutory inquiry into England’s maternity services.
Meanwhile, an inquiry into maternity services in Nottingham is underway after an expose by The Independent in 2019. It is set to become the largest maternity scandal inquiry in history with the cases of 2,000 families expected to be reviewed by Donna Ockenden, who also led the major inquiry into Shrewsbury and Telford services.
In its report on North Middlesex Hospital the CQC highlighted repeated instances of short-staffing within the hospital’s maternity services
Inspectors found evidence that “maternity support workers are at times left without a registered professional to provide care to women, birthing people and babies without any guidance, standard operating procedure or policy in triage including postnatal care.”
Maternity support workers are meant to undertake tasks which do not have to be done by a midwife “under the direction and supervision of a registered midwife”, according to the Royal College of Midwives. They are not registered or regulated by the Nursing and Midwifery Council.
The report also said during the inspection the unit was not able to adjust its staffing levels to match the needs of women, was forced to move staff at short notice and frequently had to close its birthing centre.
According to staff, there were delays in getting agency workers in due to “complex internal processes” which required manager sign-off and so shifts frequently went unfilled.
During the visit, the maternity unit had 13 women who experienced delays to induction of labour, and three women who were waiting for their labour to be delayed under a process called “augmentation.”
The report said: “Sadly, in addition to these 16 cases which were delayed over a three-day period there was a high-risk case of a woman or birthing person with a stillborn baby waiting at home for a telephone call to be advised when to attend the service for IOL.
“However due to staffing issues, the service delayed bringing the woman or birthing person in for IOL.”
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “When we inspected maternity services at North Middlesex University Hospital we were deeply concerned to find both staff and women and people using the service being let down by poor leadership. Leaders lacked oversight of the issues we found, and we saw signs that a closed culture could be developing within the service, discouraging staff from speaking up to improve people’s care.
“While many staff were committed to improving the service, we found leaders didn’t always support them to do so. Staff told us leaders didn’t always take action when they reported incidents, and some midwifery staff told us they felt bullied, intimidated and undermined by leaders.”
Chief nurse Professor Lenny Byrne for North Middlesex University NHS Trust said:“There are very clear and defined roles and responsibilities for both registered midwives and maternity support workers (MSWs).
“While MSWs can work with women without direct supervision of a midwife in certain circumstances, they do so always under the direction of a registered midwife.
“MSWs do not undertake midwifery duties, but can assist and support women, including oversight of women awaiting collection for discharge.”
This story was updated to include a response from North Middlesex.
