The Care Quality Commission (CQC) has welcomed improvements made to maternity services at North Middlesex University Hospital, run by North Middlesex University Hospital Trust.
CQC carried out an unannounced focused inspection in September to check on the progress that the trust was making after it raised concerns with CQC about the assessment and monitoring of patients and the culture within the service. Inspectors wanted to follow up to see if the action plan the trust had put in place had addressed those concerns.
The inspection looked at how safe, effective and well-led the maternity service was. Community midwifery services were not inspected on this occasion. As this was a focused inspection, no ratings were produced and the overall rating of good for maternity services at the trust remains in place.
Nicola Wise, CQC’s head of hospital inspection, said:
“We inspected maternity services at North Middlesex University Hospital in response to concerns the trust raised with us about how mothers and babies were being assessed and monitored, as well as reports of a poor culture for staff. This inspection was to check on the progress of the action plan they put in place to make improvements in these areas.
“There had been serious incident investigations in the last two years where the trust had identified staff needed additional training to ensure they were monitoring the mother’s contractions and the baby’s heartbeat correctly. We were pleased to see that a specialist midwife now ensures all staff monitor and assess this accurately, and new training has been introduced.
“There had also been three serious incident investigations where the trust identified staff had not properly recorded a baby’s size on their growth chart during scanning. Growth charts are used to detect babies that aren’t growing at the expected rate and can be an early indicator of possible complications, so it’s important they are documented, and action is taken if needed. It was reassuring to see that the trust has now introduced additional training for staff to make sure these checks are happening and correctly documented.
“Last year, we received reports of bullying, harassment and favouritism of staff within the maternity department which was having an impact on the morale of those working there. At this inspection we found the culture had improved significantly and in the main, staff felt they could approach the senior team to raise any concerns. However, there were still areas of concern, with some staff telling us they felt burnt out due to the pressure they were under. Senior leaders knew about these issues and were working to make improvements.
“Overall, the trust has worked hard to make improvements, but there is still more work to be done. We will continue to monitor the service to ensure these are made and fully embedded.”
Inspectors found the following during this inspection:
- Leaders planned and managed the service well using reliable information systems, which they also used to monitor the effectiveness of the service.
- Staff were clear about their roles, supported to develop their skills and were committed to improving services continually. They also worked well together for the benefit of women.
- Most of the time, the service had enough maternity midwives, nursing and medical staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. However, some shifts were one or two midwives short.
- Staff received comprehensive mandatory training in key skills and leaders made sure everyone completed it. Bank and agency staff received a full induction. Staff also received enhanced cardiotography training, for checks on the mother’s contractions and the baby’s heartbeat to detect potential stillbirth risks.
- Growth assessments, which are used to detect babies that are not growing at the expected, had improved, and the service was now above the national average for the detection of small growth babies.
- Staff completed and updated risk assessments and identified and acted when women were at risk of deterioration.
- Staff had training on how to recognise and report abuse and knew how to apply it. The service worked well with other agencies to protect women from abuse.
- 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. Managers ensured that actions from patient safety alerts were implemented and monitored.
- The service controlled infection risk well and kept equipment and premises visibly clean.
However:
- Bed occupancy levels for maternity have been higher than the England average since October 2019. Although there were complex issues that prevented smooth discharge, this meant the service’s capacity was limited and could pose difficulties in times of more demand.
- Feedback from junior doctors revealed that their induction needed to be improved.
- Inspectors did not find any evidence of conversations or records of advice given to pregnant women regarding the advantages and risks of the COVID-19 vaccine, so women could make an informed decision.
- Although people using the maternity service spoke over 100 different languages, the interpreting service was not always reliable, and the trust was in the process of reviewing the issue. Not having a reliable interpretation service available meant staff were at risk of missing key information from women which may put them or their babies at risk.
For enquiries about this press release please email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters.)
For general enquiries, please call 03000 61 61 61.