The Care Quality Commission (CQC) has published two reports on maternity services run by Nottingham University Hospitals NHS Trust, following an inspection carried out on 18, 19 June and 3 July last year.
CQC inspected maternity services at Nottingham City Hospital and Queen’s Medical Centre after receiving information of concern by staff in both maternity services.
Following the inspection, both services were again rated as requires improvement overall and for being safe and well-led. Its rating for being effective has improved from requires improvement to good. Caring was re-rated as good. Responsive was not included in this inspection and remains rated as good.
During the inspection of maternity services at Nottingham City Hospital, CQC identified four breaches of regulation in safe care and treatment. These relate to infection control procedures, equipment safety, medicines and expressed milk storage.
At maternity services at Queen’s Medical Centre, CQC identified three breaches of regulation in safe care and treatment, regarding infection control procedures, equipment safety, and medicines management and storage.
CQC asked the trust to submit an action plan showing what action it is taking in response to these concerns. This has been provided, and CQC will continue to monitor the trust to ensure people are receiving safe care.
The rating for Nottingham City Hospital has not changed following this inspection and remains rated as good overall. The rating for Queen’s Medical Centre has also not changed and remains rated as requires improvement.
Helen Rawlings, interim director of network operations in the midlands, said:
When we inspected maternity services at Nottingham University Hospitals NHS Trust in June and July last year, we found some improvements had been made, although more changes were needed to improve the standard of care women, people using the services, and their babies were receiving.
Prior to the inspection, we were concerned by information we received from whistleblowers, who expressed their concerns regarding both services.
We would like to thank those staff for sharing their concerns, as it helped us to have a better picture of the care being provided to people, which determines if we need to take any action to keep people safe, including carrying out an inspection.
In both maternity services, people felt safe when they were on the wards and in the labour suite. However, a number of people told us that there were delays with induction processes. Also, staff weren’t always available if they needed any help or support.
It was positive to hear that staff treated people well and with kindness and compassion. One person at Nottingham City Hospital told us that staff were thoughtful and caring, they felt listened to and staff communicated with them in a way which they could understand.
There were clear signs that the culture was improving, however some staff felt there was a lack of understanding of individual roles and responsibilities, which led to staff not understanding each other's challenges. However, leaders were working to address the negative culture that remained in some areas. This is important as staff’s ability to speak up when things aren’t working has an impact on people’s care.
It’s clear that staff and leaders had worked hard to make some improvements, and since the inspection last year, leaders have assured us that further improvements have been made. We’ll continue to monitor the trust to ensure that more changes are made and embedded so women, people using the service and their babies receive the safe care they have a right to expect.
At both maternity services, inspectors found:
- There was a safety culture where events were investigated. However, learning was not always shared consistently with staff to promote good practice.
- When the service was busy, leaders reviewed staffing levels to meet the needs of people. However, this was not always possible due to low numbers of sufficiently qualified staff.
- People were not always confident about raising concerns. They did not always feel that they were taken seriously. However, when concerns were raised, reports of how those concerns were handled, were shared with them.
- Room temperatures and medicine refrigerator temperatures were recorded inconsistently with different methods meaning medicines might not be effective.
- Staff checks on emergency equipment were not always complete putting people at risk in an emergency if it didn’t work.
However:
- Most people felt the environment was safe and had no concerns regarding their surroundings.
- People could mostly access care and treatment when they needed it.
- Staff understood how to protect people from abuse and the service worked well with other agencies to do so.
Due to a large-scale transformation programme at CQC, this report has not published as soon after the inspection as it should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish this report falls far short of what people using services and the trust should be able to expect and CQC apologises for this.
While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services has not been affected. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.
The report for Nottingham City Hospital will be published on CQC’s website in the next few days. The report for Queen's Medical Centre will also be published on CQC's website in the next few days.