The Care Quality Commission (CQC) has published a report following an inspection of maternity and gynaecology services at Liverpool Women’s NHS Foundation Trust in January and February.
Liverpool Women’s NHS Foundation Trust specialises in the health of women and people who need these services, their babies, and their families. It is the only specialist trust in the UK and the largest women’s hospital in Europe.
An unannounced inspection of the gynaecology services was carried out, as well as a focused inspection of maternity services as part of CQC’s national maternity inspection programme.
The programme aims to provide an up to date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement at a local and national level.
An inspection of the well-led key question for the trust overall was also undertaken. Following the inspection, the trust’s overall rating for well-led remains as requires improvement.
Following the inspection, the overall rating for gynaecology services at Liverpool Women’s Hospital has gone up from requires improvement to good, however maternity services has gone down from good to requires improvement. Liverpool Women’s Hospital remains rated as good overall.
Inspectors looked at the areas of safe and well-led only in maternity. Following the inspection, safe is rated as inadequate and well-led is rated requires improvement. Gynaecology is rated as good for the areas of safe, effective, caring and well-led, and requires improvement for the area of responsive.
The overall rating for the trust has gone down from good to requires improvement.
Carolyn Jenkinson, deputy director of secondary and specialist healthcare, said:
“When we inspected these services, it was pleasing to see widespread improvements had been made in gynaecology, but improvements were needed in the maternity service to ensure safe care is provided to women, people using this service, and their babies.
“Within maternity, leaders urgently need to mitigate the negative impact of understaffing. Frequent staff shortages meant people didn’t always receive timely treatment which could place them and their babies at risk.
“For example, during the inspection a call bell hadn’t been answered for 15 minutes so the inspection team had to intervene so the person could be seen which is unacceptable. Feedback showed people sometimes waited up to three hours for call bells to be answered which could place them and their babies at risk of harm.
“In addition, there were triage delays when people arrived at the maternity unit, with many frequently waiting over 30 minutes to be seen by a midwife. The triage telephone helpline was often not staffed which meant people couldn’t not always access timely advice and support.
“Staff told us they didn’t always feel supported or valued in their roles. Some had raised concerns several times regarding safety and staffing directly to senior leaders but had seen no action or improvement.
“However, it was positive that staff were focused on the needs of people and strived to deliver the best possible care in difficult circumstances. They had a good understanding of the needs of the local community and the health inequalities some people faced.
“In contrast, gynaecology, staff and leaders worked well together and were committed to improving services and providing the best care for people. It was obvious leadership in this department had improved since the last inspection.
“We were impressed that the department was one of the first in the country to offer robotic assisted surgery for women undergoing urogynaecology operations.
“Our well-led inspection of the trust overall found that the leadership team had knowledge of the main priorities and challenges they faced but didn’t always understand and manage the immediate priorities and issues.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made in the maternity service so people and their babies receive safe and appropriate care.”
Inspectors found the following during this inspection:
In gynaecology:
- Nursing staff had training in key skills, understood how to protect patients from abuse, and managed safety well
- Staff worked well together for the benefit of patients and advised them on how to lead healthier lives
- Staff supported people and helped to make decisions about their care
- Leaders ran services well using reliable information systems and supported staff to develop their skills
- The Bedford Unit had been awarded an internal gold rating for a ‘Be Brilliant Accreditation System’
- People couldn’t always access the service when they needed it nor receive treatment within agreed timeframes and national targets.
In maternity:
- People couldn’t always access the service when they needed it nor receive treatment within agreed timeframes and national targets
- Staff did not consistently assess risks to people or act on them in a timely manner
- Though staff were committed to improving services they did not always have the skills and resources to do so
- The service did not always manage safety incidents well or learn lessons from them
- The service used charitable funds to get SIM cards for people who were digitally excluded, as well as food vouchers for anybody in need.