Regulator finds maternity services at Barking, Havering and Redbridge University Hospitals NHS Trust failing essential standards

20 April 2011

The Care Quality Commission (CQC) has told Barking, Havering and Redbridge University Hospitals NHS Trust that it is failing to comply with essential standards of quality and safety and that it must make improvements.

Queen’s Hospital, part of Barking, Havering and Redbridge University Hospitals NHS Trust, is located in Romford and provides maternity services, for women including those who have high risk pregnancies. 

The CQC carried out this review because the trust was registered on condition that it improve staffing for maternity and midwifery services. Inspectors reviewed all the information the regulator holds about this provider, surveyed people who use services, and carried out unannounced visits. They talked to people who use the service, talked to staff, checked the provider’s records, and looked at the records of people who use services.

CQC inspectors found that care is falling far short of the essential standards of quality and safety people should be able to expect. The trust was failing to meet six essential standards and we had major concerns in two areas:

• Care and welfare of people: Some patients suffered delays in being transferred to the labour ward and delays in going to theatre. Some were left alone for long periods and some did not receive the pain relief they required.
• Staffing: There were not enough staff to ensure people who use the services were safe and their health and welfare needs were met.  Staff from all maternity wards told us that they were very understaffed and that the main staff shortage was in the labour ward.  Staff from the antenatal and postnatal wards told us that they were frequently asked to help when the labour ward was short staffed, which meant that their own ward became short staffed. 

There were other areas of minor and moderate concern:

• Respecting and involving people who use services: Whilst some of the new mothers we spoke to were happy with the care they received during labour, there was evidence that people who use services were not always involved in the care, treatment and support they received before, during and after birth.
• Safety, availability and suitability of equipment: Evidence provided demonstrated that equipment at Queen’s hospital maternity department was not always available in sufficient quantities, and that self checks performed by the department were not always made often enough
• Supporting workers: The needs of service users were not always being met by staff who had attended relevant training sessions.  Less than half of the obstetricians have received training on interpreting CTG monitors and a ‘fresh eyes’ approach (which means that if a member of staff is unsure about something they ask another member of staff to have a look) is not followed by hospital staff. The ratio of supervisors to midwives was higher than recommended, meaning that supervisors were responsible for too many midwives.
• Records: Patient records were not always stored securely. During our visit, we observed patients’ notes randomly left on the counter within a treatment room on the postnatal ward. The door to the room was open and there did not appear to be any restricted entry mechanism.  We also observed patients’ notes in open trolleys next to the midwives’ station. 

The major concern about staffing was raised with the Trust immediately following CQC’s visit. Some improvements have since been made and CQC continues to keep this issue under close scrutiny. In addition, the Trust has been given seven days from the issue of this report to produce plans to show how it intends to meet the other essential standards. We have also referred our concerns to Nursing and Midwifery Council and Strategic Health Authority. 

By law, providers of health care services have a legal responsibility to make sure they are meeting the essential standards of quality and safety. Inspectors will return to the trust unannounced to check whether the necessary improvements have been made and to decide whether to initiate formal enforcement action.

CQC Regional Director for London, Colin Hough, said:

“When we visited Queen’s Hospital, we were so concerned about what we found that we raised urgent concerns with the Trust about staffing, ahead of the publication of this report.

“Since the inspection visit that generated this report, we have been back to the hospital to check that these concerns are being addressed. There is evidence that the number of midwives has been increased, and the staff we spoke to – who had previously expressed concerns about capacity – confirmed that they were happier with staffing levels. The Trust now needs to demonstrate that these improvements can be sustained going forward, with sufficient numbers of appropriately trained midwives in post on a permanent basis. We will continue to make unannounced visits to ensure this is happening.

“Now we are giving the Trust seven days to tell us how they plan to address other areas where we have found they are not meeting essential standards of quality and safety. These include record keeping and ensuring staff are properly trained to use equipment. Again, we will be checking that they have made these improvements; we will also be working closely with the Nursing and Midwifery Council and the Strategic Health Authority.

“This Trust will continue to be under intense scrutiny until we are sure that they have taken all necessary steps to ensure that all women and babies using their maternity services receive safe Care. If we are not satisfied that they have done so, we have a range of enforcement powers available which include prosecution, restriction of services or closure.”

Under the Health and Social Care Act 2008, the Care Quality Commission has a number of new enforcement powers to deal with underperforming services - to inspect and investigate, to issue a statutory warning notice, to issue a financial penalty notice in lieu of prosecution and, in the most serious cases, to prosecute or suspend registration. In the most serious cases, the Commission can prosecute or cancel registration.

Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal processes.

Ends

For further information please contact the CQC press office on 0207 448 9239 or out of hours on 07917 232 143.

Notes to editors