Care regulator lifts conditions on Milton Keynes Hospital NHS Foundation Trust

6 October 2010

The Care Quality Commission has lifted some of the conditions which had been imposed on Milton Keynes Hospital NHS Foundation Trust in response to concerns over its maternity services.

When CQC introduced a new registration system in April, the trust was registered with conditions because it was not meeting four essential standards of quality and safety. Hospital managers were required to make a series of improvements within strict deadlines.

Today CQC publishes its findings on progress by the trust, acknowledging that there has been significant change to maternity services and that the trust is now better placed to cope with peaks in demand from the women it serves.

Among conditions which have been met is one requiring that all women in established labour should receive one-to-one care from a registered midwife. Those conditions are lifted from today.

But the regulator has decided that conditions relating to the care and welfare of people who use services should remain in place until the trust has been given further time to demonstrate that the services have improved.

CQC inspectors say they are satisfied that the trust can demonstrate that it is compliant with the following conditions which are being lifted:

• All women in established labour receive one to one care from a registered midwife
• A revised action plan must be produced to address a number of outstanding recommendations made by the Healthcare Commission in 2008.
• The trust must ensure that the action plan is implemented and monitored
• The trust must have systems in place which allow midwives to assess and monitor the quality of service provided by the maternity department to all mothers.
• The trust must revise its audit programme to include audits arising from incidents and complaints.
• The trust must ensure that detailed information on serious incidents and identified risks are reported to the board and healthcare governance committee, and that action is taken as a result
• The trust must have clinical governance systems to assess and monitor the quality of service provision in place across all services
• All midwives recruited since 1 January 2010 must have received protected time and comprehensive training in local maternity policies and procedures, escalation procedures and in promoting normal births
• The trust must review and responded to the recommendations of the Oxford Deanery with regard to medical training experience of trainees.

The following conditions will remain in place until CQC is satisfied that the full effect of changes has been assessed.

• The trust must have appropriate systems to detect and monitor ‘at risk’ mothers and babies to ensure suitable care is provided at all times.
• The trust must have appropriate maternity escalation and risk management plans in place and in use by staff.
• The trust must have enough senior midwives and obstetrician cover to cope with demand.

Roxy Boyce, Regional Director for the Care Quality Commission in the South East said the regulators had longstanding concerns about the quality of maternity services, level of staffing, and whether the maternity unit could cope with unscheduled surges in demand.

She said: "While the trust has recently recruited more midwives, we recognise that this is a continuing challenge in Milton Keynes, and must remain a high priority for some time to come.

"However Milton Keynes Hospital NHS Foundation Trust has now made a concerted effort to address concerns which have been overshadowing its maternity services and damaging the trust's standing with the local population.

"Childbirth is a stressful time for mothers - they, and their families, need to have confidence that they are in the best place when the time comes.

"In the past the maternity unit at Milton Keynes showed that it couldn't cope with a sudden rise in demand. It is now better placed to demonstrate that it has developed a robust system to respond and to ensure that even at the busiest times, every mother receives the care she needs. We still want to see good evidence of that.

"But we must be clear: while we have decided to relax the legal condition which insists on one registered midwife for every woman in the established stages of labour, every woman is entitled to high standards of supportive care during labour and we will still expect the Trust to observe best practice in this.

"We will continue to monitor the performance of Milton Keynes Hospital NHS Foundation Trust and we will be prepared to take further action if it becomes necessary."

Ends

For further information please contact Nick Kerswell on 07919 540326 or the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

Inadequate midwifery staffing levels were cited by the coroner as factors in the deaths of two babies in 2007 and 2009. A Healthcare Commission intervention in 2008 identified the staffing levels as a key area of concern. A follow up report by the Care Quality Commission found that significant concerns remained around staffing levels.

Conditions imposed on the registration of Milton Keynes Hospital NHS Foundation Trust in April:

• The trust must ensure that all women in established labour receive one to one care from a registered midwife from 1 April 2010.
• The trust must have appropriate systems to detect and monitor ‘at risk’ mothers and babies to ensure suitable care is provided at all times. Evidence that these are effective and in day to day use must be available to CQC by 30 June 2010.
• The service provider must have appropriate maternity escalation and risk management plans in place and in use by staff. Evidence that these are effective and in day to day use must be available by 30 June 2010.
• The service provider must ensure that it has sufficient senior midwife and obstetrician cover of the maternity department to manage demand and risk in the maternity department effectively. Evidence to demonstrate this must be available to CQC by 30 June 2010.
• The service provider must provide a revised action plan to address the outstanding Healthcare Commission recommendations, as per the CQC January 2010 report. The action plan must detail not only the inputs, but also the resulting outcomes for patients, which will demonstrate the safety and quality of the service. The finalised action plan must be provided to CQC by 1 May 2010.
• The trust board must ensure that implementation of the action plan is actively monitored. Evidence must be available to CQC to demonstrate this by 31July 2010.
• The service provider must ensure that midwife-led governance and audit systems to assess, monitor and act upon the quality of service provision within the maternity department are in place. Evidence to demonstrate this must be available to CQC by 31 July 2010.
• The service provider must revise its audit programme to include audits arising from incidents and complaints. Evidence of this change must be available to CQC by 31 July 2010.
• The service provider must ensure that detailed information on serious incidents and identified risks are being reported to the board and Healthcare Governance Committee, and that action is taken as a result. Evidence of this change must be available to CQC by 31 July 2010.
• The service provider must ensure that clinical governance systems to assess and monitor the quality of service provision are in place across all services by 1 April 2010. Evidence to demonstrate this must be available to CQC from 1 April 2010.
• The service provider must ensure that all midwives recruited since 1 January 2010 have received protected time and comprehensive training in local maternity policies and procedures, escalation procedures and in promoting normal births. Evidence to demonstrate this must be available to CQC by 31 July 2010.
• The service provider must review and respond to the recommendations of the Oxford Deanery with regard to medical training experience of trainees. Evidence must be available to demonstrate this to CQC by 31 July 2010.