The Care Quality Commission (CQC) has told Salisbury NHS Foundation Trust that improvements need to be made in its maternity and spinal services following a recent inspection at Salisbury District Hospital.
CQC carried out an unannounced, focused inspection of the maternity and spinal services on 31 March, after receiving information of concern regarding the safety, quality and leadership of the services.
Following the inspection, the overall rating of the maternity service moves from good to requires improvement. The rating for how well-led the service is also moves down, from good to inadequate. The rating for safe remains requires improvement. CQC inspected whether services were caring and effective but did not rate these domains.
The Duke of Cornwall Spinal Treatment Centre specialises in the management of patients affected by spinal cord injury or disease. Following the inspection, the overall rating of the service did not change, and remains requires improvement. The rating for well-led moves from good to requires improvement. The safe domain remains requires improvement.
Amanda Williams, CQC’s head of hospital inspection, said:
“Following our recent inspection of Salisbury District Hospital’s maternity services, we found that women and babies using the service received effective care and treatment which met their needs most of the time. But most of the time is not good enough.
“We have told the trust it must ensure there are effective systems in place to improve the quality and safety of the maternity service, and that risks are regularly assessed, monitored and mitigated to keep people safe.
“We were concerned about the leadership of the service, and the lack of systems in place to ensure that people were receiving good care. We also wanted to follow up on previous concerns we had about the overall culture of the maternity service which meant that staff were worried about being blamed for incidents that occurred. Because of this, there had been a reluctance to speak out, when staff should be encouraged to report incidents and share learnings, so that improvements can be made. This in turn had an impact on the safety of the service for patients. Although the trust had taken steps to address this, there was still more work to be done.
“We have told the trust that it needs to make significant improvements in these areas. If sufficient improvements are not made rapidly, we will consider what further action to take.
“In the Duke of Cornwall Spinal Treatment Centre, we told the trust that it needed to review governance arrangements, including regular audits, to make sure improvements were consistently being made at the service. We also told the trust that risk assessments, with supporting documentation, must be completed for each patient in order to keep them safe.
“We will keep both services under review and will re-inspect to check that improvements have been made.”
In the maternity service, inspectors found:
- The arrangements for governance and performance management were not clear and did not operate effectively. This meant that systems were not used to manage performance, identify and manage risks and review staffing in line with national guidance
- Safety concerns were not consistently identified or addressed quickly enough. The service had previously identified a culture of blame around incident reporting that leaders were working to improve. However, this was happening too slowly and there was little evidence of learning from incidents leading to improvements in safety.
Inspectors found the following in the spinal service:
- During periods of the COVID-19 pandemic, there had been a lack of leadership due to absence and changes in the divisional structure which were still being embedded
- Leaders did not always operate effective governance processes. Staff were not always able to contribute to decision-making to help avoid compromising the quality of care
- Leaders and teams used systems to manage performance, but these were not always effective
- The service did not always have enough nursing staff and allied health professionals with the right qualifications, skills, training and experience to keep patients safe and to provide the right care and treatment. Insufficient staffing levels sometimes impacted on the responsiveness of the service to meet individual needs
- Staff did not always complete and update risk assessments for each patient to minimise risks, and they did not always identify and act quickly when a patient was at risk of deterioration
- Staff did not always keep detailed records of patients’ care and treatment. Some records were incomplete and inconsistent, although they were stored securely and available to all staff providing care.
Full details of the inspection are given in the report published on our website.
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