Maternity services at University Hospitals of Morecambe Bay NHS Foundation Trust must improve says regulator

9 September 2011

A review of maternity services at University of Morecambe Bay NHS Foundation Trust has found that the trust is not meeting six essential standards.

CQC inspectors carried out unannounced inspections of maternity services across three hospitals: Furness General Hospital on 18 July, Helme Chase unit at Westmorland General Hospital 19 July, and Royal Lancaster Infirmary on 20 July 2011. These inspections followed concerns raised with the Care Quality Commission (CQC) about the provision of maternity care at the trust.

Providers of services have a legal responsibility to make sure they are meeting all the essential standards of quality and safety.

CQC conducted the unannounced inspections jointly with the Nursing and Midwifery Council (NMC). The NMC have completed a separate investigation into the provision of supervision arrangements for midwives at the trust. Their report will be available in early October.

The CQC report, which is published today on our website, highlights major concerns with three areas.

People who use services and people who work in or visit the premises are in safe, accessible surroundings that promote their wellbeing

The people using the labour ward at the Furness General Hospital site are inconvenienced and may be disadvantaged because of an outdated care environment and poor arrangements for people to access facilities. People may feel exposed and restricted as the environment does not offer modern facilities to support the more complex needs of families who may need privacy. It does not meet staff needs for a suitable work environment or fully meet the needs of people with disabilities.

People who use services are safe and their health and welfare needs are met by sufficient numbers of appropriate staff

Having observed care, spoken to staff and looked at the risk registers for the operating theatres, it was clear to inspectors that there were problems associated with having only one emergency team available out of hours and at weekends. Staffing in theatres was not adequate to cover out of hours. Whilst people may not as yet have come to harm in such situations they were being put at risk, and may have received a substandard level of care due to insufficient numbers of staff in the theatres. They may also have experienced delays in receiving the care they needed.

People who use services should benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety

The maternity and midwifery services have systems in place to evaluate and monitor care delivery and practice, but actions arising from the monitoring do not always take place in a timely manner. There are risk registers in place, but risk ratings are not consistently applied, nor are concerns always escalated to the most appropriate management level. Staff were also not always reporting ‘near miss’ events. The trust is therefore reacting to events rather than promoting a preventative/ proactive culture.

We found that the medical team do not always work effectively within the clinical governance and leadership arrangements across all three sites. This means that clinical leadership and integrated working does not always achieve consistent approaches; for example, medical staff are not always developing and delivering evidence based guidelines consistently across all three hospitals.

Relationships between some senior medical staff in certain areas did not demonstrate a joined up approach to working together. Long term inconsistencies and divisions may increase the risk of a two tier service which will not meet nationally recognised care pathways.

CQC also had moderate concerns about a further three outcomes.

• Respecting and involving people
• Hygiene and infection control
• Record keeping

Sue McMillan, Regional Director for CQC in the North West, says: “Although many of the women we spoke to were positive about the care they received, our inspectors found that the Trust needed to do more to ensure that women and babies receive safe care. Labour ward facilities and infection control procedures need improving, staffing issues need to be addressed urgently and better systems to identify and mitigate risk must be put in place.

‘CQC will be making more unannounced visits soon to check progress. If we’re not satisfied that the Trust has delivered rapid and sustainable improvement, we have a range of enforcement powers we can use to protect the safety and welfare of people”

Ends

For media enquires, please contact David Fryer on 07901 514220, CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

The review was undertaken in response to a number of concerns that were brought to the attention of Care Quality Commission in relation to the provision of maternity care at the trust. These concerns included the findings of the Coroner, Ian Smith’s inquest (Death of baby Joshua Titcombe) and the subsequent rule 43 letter issued to the trust in June 2011.

A rule 43 letter is sent to an organisation by the coroner when they believe action should be taken to prevent any further deaths. Although the inquest case was in relation to a death in 2008 the coroner believed that some aspects of the care failures in the case may still have some relevance to improve the trust working practices today. The areas highlighted in this letter included; records management, team working, and the pressure of work and continuity of care.

The trust commissioned a review of all serious untoward incidences that occurred in maternity services in 2008. This review was undertaken by three external maternity professional experts and was called the Fielding Review (finalised August 2010). The review identified many areas for improvement and change along with issues relating to the ‘culture of team working’.