The Care Quality Commission (CQC) has improved the rating of maternity services at North Middlesex University Hospital, from inadequate to requires improvement following a focused inspection in January but has also told leaders more improvement is needed.
As of 1 January 2025, North Middlesex University Hospital merged with the Royal Free London NHS Foundation Trust.
This unannounced focused inspection was carried out to follow up on the progress of improvements they were told to make in a previous inspection when the service was rated inadequate in May 2023. While CQC have found improvements at this inspection, they need to be embedded and sustained.
As a result of this follow-up inspection, the overall rating for maternity services at North Middlesex University Hospital has improved from inadequate to requires improvement, as have the ratings for how safe and well-led the service was. Caring, responsive and effective were not looked at during this inspection and remain rated as good from their previous inspection.
The ratings of the hospital and the trust overall remain unchanged as requires improvement.
Jane Ray, CQC deputy director of operations in London, said:
“It was positive to see progress at North Middlesex University Hospital’s maternity service following our previous inspection. We found leaders to be more stable, since the hospital merged with the Royal Free London NHS Foundation Trust and staff told us senior leaders were more visible and supportive.
“Women and people using the service described staff as kind, compassionate and responsive to their individual needs. Many told us they felt listened to, involved in decisions about their care and gave examples of adjustments made by staff to accommodate their needs.
“At our last inspection, the triage process, the order in which people were seen by a clinician, was ineffective meaning people weren’t always prioritised safely. This time, we saw a dedicated telephone triage midwife in place and improved use of a recognised triage tool, to help to ensure quicker and safer assessments.
“Previously, not all staff had completed mandatory training to keep women, people and their babies safe, including in areas like safeguarding and life support. Midwifery staff have made significant progress, now meeting or exceeding trust targets in all areas of mandatory training, including obstetric emergencies and neonatal life support. However, medical staff still need to improve their training completion rates in several key areas to ensure consistently safe care.
“The trust has made some improvements, but they have much more work to do to make sure people are safer and leadership continues to improve as we know that better leaders mean better care. They should continue to build on these foundations, ensure their improvements are embedded and sustained, and we’ll continue to monitor them to make sure this happens.”
Inspectors also found:
- Staff made reasonable adjustments to support individual needs, including for mothers and people with mental health conditions.
- The service provided leaflets produced in multiple languages, to ensure they catered to the diverse population of people they provide care to.
- The service had enough suitable equipment to help them to safely care for people. Staff also told inspectors there was an improvement in the amount of equipment available.
- Staff introduced a dedicated breastfeeding midwife to offer one-to-one and group support, after people raised concerns about babies being readmitted due to weight loss.
- Leaders had introduced a new handover tool to improve communication between midwives and neonatal doctors, helping ensure the right staff respond quickly in emergencies.
However:
- Risk assessments were not always carried out or recorded in a timely way, meaning staff could not be assured that safety concerns were identified early.
- Most managers and staff reported an improvement in the culture within the service, however, some staff continued to experience bullying and inequality. Leaders did not take immediate action to prevent and address bullying, discrimination and harassment at all levels.
- The bereavement room required people to walk through the labour ward, which did not align with national best practice as it was insensitive to people who had experienced fetal loss.