• Hospital
  • NHS hospital

Bedford Hospital

Overall: Insufficient evidence to rate read more about inspection ratings

South Wing, Kempston Road, Bedford, Bedfordshire, MK42 9DJ (01234) 355122

Provided and run by:
Bedfordshire Hospitals NHS Foundation Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

6 and 7 November 2023

During a routine inspection

Bedfordshire Hospitals NHS Foundation Trust (BHFT) formed as a new entity in April 2020 as a result of a merger of Luton and Dunstable Hospital NHS Foundation Trust and Bedford Hospitals NHS Trust. Both sites provide maternity services.

Bedford Hospital maternity unit comprises of a joint consultant led and midwife led birthing unit, a joint antenatal ward and postnatal ward, and community services. Outpatient services are also provided in antenatal clinics, a day assessment unit and a triage unit.

From January to December 2023 there were 2629 babies born at the hospital.

We last inspected maternity services at Bedford Hospital on 2-3 August and 20-21 September 2022. We previously only inspected safe, responsive and well led domains. We rated both safe and well-led domains as requires improvement, the responsive domain was not rated. The main concerns we found were around safeguarding and mandatory training completion figures and infection prevention and control.

We carried out this unannounced focused inspection of the maternity services following emerging concerns regarding safety, culture, and governance. Between August and September 2023, we received 3 concerns raised by whistleblowers.

During this inspection we visited all areas of the maternity unit, spoke with 32 members of staff both during and following our inspection. This included consultants, registrars, junior doctors, anaesthetists, midwives, student midwives, specialist midwives, matrons, and members of the senior leadership team. We observed procedures, handovers, safety huddles, reviewed policies and looked at 9 maternity care records.

We rated maternity as inadequate because:

  • The service did not always have enough staff to care for women and keep them safe.
  • The service provided mandatory training in key skills to all staff but did not always ensure that medical staff had completed it.
  • The design, maintenance and use of facilities, premises and equipment did not always adhere to safety standards. Some equipment safety checks were out of date and daily checks were not always completed.
  • Staff did not always assess risks to women. They did not always store medicines securely. The service did not always manage safety incidents well.
  • Staff did not always feel respected, supported and valued. The service did not manage cultural issues raised by staff effectively.
  • Serious incidents were not always reviewed in a timely manner and lessons were not always learned and embedded from serious incidents and external investigation when there were poor outcomes for women and birthing people, to reduce reoccurrence.
  • There was a lack of operational oversight and management of risk. Governance systems and processes to assess, monitor and manage risks within maternity services were not robust.

However:

  • Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
  • Staff provided good care and treatment and gave women enough to eat and drink. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

As we only inspected maternity services at Bedford hospital, we did not rate the hospital overall.

3 June 2021

During an inspection looking at part of the service

We carried out this unannounced focused inspection to follow up on concerns from our inspection in November 2020. At our last inspection we rated the service as inadequate and issued the trust with a section 29A warning notice which gave instructions for the trust to significantly improve the areas identified.

Since the COVID-19 outbreak we have been adapting our approach to inspection whilst addressing risks, which delayed our return to the service.

Bedford Hospital is operated by Bedfordshire Hospitals NHS Foundation Trust and provides maternity services to women living across the county of Bedfordshire.

The maternity unit at Bedford Hospital provides a comprehensive range of inpatient and outpatient services from pregnancy, birth and post-natal care.

The maternity unit is located in the Cygnet wing at Bedford Hospital. The service provides consultant and midwife-led care for both high and low risk women. The consultant-led delivery suite is located on the first floor and has eight delivery rooms, one dedicated obstetric theatre and a two-bedded recovery bay for post-operative women. There is also a dedicated bereavement suite called the Butterfly room.

The Acorn suite is the midwife-led birthing unit and consists of three low-risk birthing rooms and is situated at the far end of the delivery suite.

There is a 24-bedded joint postnatal and antenatal ward, called the Orchard ward located on the second floor of the Cygnet wing. This ward consists of five four-bedded bays and four side rooms, two of which are amenity rooms, which are normally available to women who wish to pay for a private room, although this option had been suspended during the COVID- 19 pandemic. Orchard ward also contains the four-bedded maternity day assessment unit.

The maternity service also has an antenatal outpatient department situated on the first floor of the Cygnet wing. The department includes screening services, the early pregnancy assessment clinic, and antenatal clinics. Community midwives provide care for women and their babies both during the antenatal and postnatal period. They also provide a home birth service.

The maternity service is managed through the trust’s maternity clinical service line which is part of the women’s health and sexual health clinical service line. The current leadership structure includes a clinical director, a senior general manager, and a director of midwifery. This triumvirate is replicated on both hospital sites with a clinical lead, general manager and head of midwifery. Obstetricians, matrons, and senior midwives also support the senior leadership team.

We last inspected the maternity service at Bedford Hospital in November 2020 when we identified a number of concerns regarding staffing numbers, staff competency, poor triage and escalation processes, poor multidisciplinary team working, records were not held securely, and the culture did not encourage staff to share concerns. As a result, a section 29A warning notice was issued under the Health and Social care Act 2008 which required the trust to make improvements to reduce risks. The service was rated as inadequate overall; safe and well led were rated inadequate and effective was rated as requires improvement.

We did not rate this inspection as we used our focused methodology. Consequently, the rating for the service remains inadequate.

We did not rate this inspection. Our previous rating of inadequate remains:

  • The service compliance with mandatory, safeguarding and competency based specialist training was generally below the trust target.
  • Not all staff maintained effective infection control and prevention for all patients.
  • The maternity triage area was not fully suitable to the service needs.
  • Safety tools were not always fully used or recorded.
  • The service did not have enough midwifery staff; however, we did not see any evidence of this impacting negatively on women’s safety.
  • The service did not always have enough medical staff with the right qualifications, skills, training and experience, although we did not see any evidence of this impacting negatively on women and baby’s safety.
  • Women’s care and treatment records were often loose papers with no structure.
  • Women were not always able to access specialist nutritional support in a timely way.
  • The leadership team were relatively new and had not had sufficient time to embed changes.
  • Staff did not always feel supported and valued. Some staff reported that they did not raise concerns as a result of challenges by some leaders.

However:

  • Staff understood how to protect women from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service generally controlled infection risk well. Staff used equipment and control measures to protect women, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff generally completed and updated risk assessments for each woman and took action to remove or minimise risks. Staff identified and quickly acted upon women at risk of deterioration.
  • Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • Managers regularly reviewed and adjusted staffing levels and skill mix and gave locum staff a full induction.
  • Staff kept records of women’s care and treatment. Records were stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff monitored the effectiveness of care and treatment. They used findings to make improvements and mostly achieved good outcomes for women.
  • Staff gave women enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for women’s religious, cultural and other needs.
  • The service made sure staff were competent for their roles.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit women. They supported each other to provide good care.
  • The service was accessible seven days per week.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the skills and abilities to run the service. Service leads understood and managed the priorities and issues the service faced. They were visible and approachable in the service.
  • Staff were focused on the needs of women receiving care.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events.
  • Leaders and staff actively and openly engaged with women, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for women.
  • All staff were committed to continually learning and improving services.

How we carried out the inspection

We visited clinical areas in the service including the delivery suite, Acorn suite, Orchard ward and the maternity day assessment unit. We spoke with 29 staff, including service leads, midwives, medical staff and maternity care assistants. We reviewed nine sets of women’s records and observed staff providing care and treatment to women.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. We carried out a focused inspection related to the concerns raised, this does not include all of our key lines of enquiry (KLOEs). As a result of this inspection ratings for this service remain unchanged. Safe and well-led are rated inadequate, and effective rated as requires improvement. Overall, the service was rated as inadequate.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

05 November 2020

During an inspection looking at part of the service

Bedford Hospital is operated by Bedfordshire Hospitals NHS Foundation Trust and provides maternity services to women living across the county of Bedfordshire. The maternity unit at Bedford Hospital provides a comprehensive range of inpatient and outpatient services from pregnancy, birth and post-natal care.

The maternity service is managed through the trust’s maternity clinical service line. The current leadership structure includes a clinical director, a general manager, an interim director of midwifery and an interim head of midwifery. Obstetricians, matrons, and senior midwives also support the senior leadership team.

The maternity unit is located in the Cygnet wing at Bedford Hospital. The service provides consultant and midwife-led care for both high and low risk women. The consultant-led delivery suite is located on the first floor and has eight delivery rooms, two dedicated obstetric theatres and a two-bedded recovery bay for post-operative women. The Acorn suite is the midwife-led birthing unit and consists of three low-risk birthing rooms and the dedicated bereavement suite called the Butterfly room. The Acorn suite is situated at the far end of the delivery suite.

There is a 24-bedded joint postnatal and antenatal ward, called the Orchard ward located on the second floor of the Cygnet wing. This ward consists of five four-bedded bays and four side rooms, two of which are amenity rooms, which are available to women who wish to pay for a private room. Orchard ward also contains the four-bedded maternity day assessment clinic. The maternity service also has an antenatal outpatient department situated on the first floor of the Cygnet wing. The department includes screening services, the early pregnancy assessment clinic, and antenatal clinics.

Community midwives provide care for women and their babies both during the antenatal and postnatal period. They also provide a home birth service. As at November 2020, the trust reported an average homebirth rate of 4.42%.

From November 2019 and October 2020, there were 2,779 deliveries at the trust. This was similar to the number previously reported for the period April 2017 to March 2018, at 2,867 births.

We last inspected the maternity service at Bedford Hospital in August 2018. Bedford Hospital was registered as a different provider during this inspection. The service was rated as requires improvement overall; safe and well led were rated requires improvement, effective, caring and responsive were rated good.

During the 2018 inspection, we identified a number of concerns in the maternity service. As a result, requirement notices for breaches of regulation 12, 17 and 18 of the health and social care act (2014), were issued against the trust. The requirement notices informed the action the trust must comply with its legal obligation, and we requested an action plan from the trust, outlining steps that had to be taken to address the concerns we raised. The trust submitted an action plan following publication of the inspection report in December 2018.

Following 14 whistle-blower enquiries we had received between August and November 2020, and information we received from the trust, we carried out an unannounced focused inspection at Bedford Hospital on 5 November 2020.

We visited clinical areas in the service including the delivery suite, Acorn suite, Orchard ward, the antenatal clinic, and the maternity day assessment unit. We spoke with 21 staff, including service leads, midwives, medical staff, maternity care support workers and student midwives. We reviewed 13 sets of patient records & six prescription charts and observed staff providing care and treatment to women.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. We carried out a focused inspection related to the concerns raised, this does not include all of our key lines of enquiry (KLOEs). As a result of this inspection we rated safe and well-led as inadequate, and effective as requires improvement. Overall the service was rated as inadequate.

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we issued a letter of intent to the provider in respect to the regulated activity; Maternity and midwifery services. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. We also issued a notice of decision to put conditions on the trust’s registration as we had significant concerns relating to staffing. In addition, we issued a section 29A warning notice to the trust as we found significant improvement was required in several areas. The section 29A warning notice gave the trust two months to rectify the significant improvements we identified. The trust took some immediate actions and developed an action plan to address the concerns raised.