The Care Quality Commission has found significant improvements at two locations run by Barts NHS Trust. The trust exited special measures earlier this year.
Maternity inpatients services and End of Life care at The Royal London Hospital are now rated as Good overall. Maternity inpatient services at Newham University Hospital are now rated Requires Improvement, previously it was Inadequate.
The Royal London Maternity services were rated Outstanding for being well-led, Good for being safe, effective, caring and responsive, following the inspection in December 2018. The Royal London Hospital has now moved from Requires Improvement to Good overall.
The systems to keep vulnerable women and babies safe were good and took account of best practice and national guidance. Staff said that morale and attendance had improved. There was now an embedded and secure electronic tagging system to prevent infant abduction.
There was also a clear and comprehensive enforced security policy where all staff and visitors had to display badges and lanyards and could only access the unit through swipe card doors or through a buzzer. Leadership was visible and the trust board now had a maternity champion to improve board involvement with the department.
Inspectors found that records were all securely tracked and stored - an improvement from the previous inspection. Staffing levels for midwives was better, with a minimum use of agency staff.
There was a new openness and transparency with staff and visitors to risks and safety within the unit. Staff could now access their training records electronically to see if they were up to date with their training.
The Royal London Hospital provided mandatory training data for medical staff in the maternity and gynaecology services. This showed that in all areas of mandatory training there was an overall compliance level of 96%.
There was a dedicated vulnerable patient team (Gateway Team) in place that was well established in the maternity department. The team of nine whole time equivalent staff was headed by the dedicated safeguarding lead midwife. This team offered specialist midwifery support in the hospital and the community.
All the clinical areas were visibly clean and clutter free. Domestic staff in the maternity areas followed cleaning schedules on required cleaning standards, practices and frequency of cleaning.
There were many compliments displayed in the unit, for all the wards. In the delivery suite there were several recent thank you cards and sentiments that expressed appreciation for the compassionate care, the individual attention given and the support shown. At the previous inspection CQC rated this service as Requires Improvement for well-led. There was an emphasis on improving staff morale and in retaining and progressing those in employment with the trust.
In the End of Life service, relatives were encouraged to contribute to giving care to their loved ones by ward staff. Inspectors were told they were shown how to provide mouthcare and assist with feeding. CQC was told this was encouraged as it had a therapeutic and calming effect on patients and helped their wellbeing.
There was a bereavement care, before, during and after death policy which described the care given to a body after death. The process demonstrated respect for the deceased and their religious and cultural beliefs, as well as health and safety and legal requirements.
There was an open and engaged approach towards End of Life care. CQC observed teams that were proud of their efforts and ongoing investment in end of life care.
At Newham University Hospital in Plaistow, East London, CQC’s rating went up from Inadequate to Requires Improvement for maternity services. During the January 2019 inspection, CQC rated the service as Requires Improvement in both safe and well-led categories.
When CQC inspected this service in September 2018 there were concerns around the safety of patients and the effectiveness of the leadership, management and governance systems that were in place. CQC issued a Warning Notice. The trust responded appropriately with a comprehensive action plan to address these concerns.
Rooms that were found to overheat now had air conditioning and all damaged fridges had been replaced. Waste management had significantly improved and better hand hygiene has improved infection control.
Records were now stored securely and available to all staff providing care. There was a new leadership team in the hospital and in maternity, and a new trust-wide divisional structure bringing more clinical experience into the division. Staff morale had improved.
There was a new leadership team in the hospital and in maternity, and a new trust-wide divisional structure bringing more clinical experience into the management structure to ensure the team had the right skills and abilities to run a service providing high-quality care.
England’s Chief Inspector of Hospitals, Ted Baker, said: “At The Royal London Hospital, Maternity and End of Life care are both now Good. This is a significant achievement for which management and staff deserve praise. Maternity’s well-led category was rated Outstanding.
“Newham University Hospital had a vision for what it wanted to achieve in improving key areas of safety and leadership with the involvement of staff. However, while its Requires Improvement rating is better than its previous Inadequate, there is still a long way to go and many more improvements that I’d like to see.”