The Care Quality Commission (CQC) has published a report following an inspection of maternity services and leadership at Nottingham University Hospitals NHS Trust in April and June.
The inspection of maternity services was carried out to check on improvements since the last inspection when the service was rated inadequate overall.
CQC’s comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, inspectors also looked at the quality of leadership and carried out a well-led inspection of the whole trust.
Following the inspection, the following ratings were given:
- The trust’s overall rating for well-led has gone up from inadequate to requires improvement.
- The overall rating for maternity at Nottingham City Hospital has gone up from inadequate to requires improvement. The rating for responsive has gone up from requires improvement to good, safe and well-led have gone up from inadequate to requires improvement, effective remains as requires improvement and caring remains as good.
- The overall rating for maternity at Queen’s Medical Centre has gone up from inadequate to requires improvement. The rating for responsive has gone up from requires improvement to good, safe and well-led have gone up from inadequate to requires improvement, effective remains as requires improvement and caring remains as good.
The overall rating for the trust remains as requires improvement. The overall rating for Nottingham City Hospital has gone up to good and the overall rating for Queen’s Medical Centre remains as requires improvement.
Greg Rielly, CQC deputy director of operations in the midlands, said:
“When we inspected Nottingham University Hospitals NHS Trust, it was positive to see improvements had been made across both maternity services and the trust’s leadership. It was clear that staff in all areas have been working hard to ensure changes are made so people can receive a better standard of care.
“At both maternity services, we saw an improvement in the level of care being provided to people and their babies since we last rated both services as inadequate. It is positive to see that the trust is now on an improvement journey to bring about better and safer care.
“Staff in both maternity services were kind and understood the personal, cultural, religious, and social needs of each person and showed understanding and a non-judgmental attitude when caring for or discussing people with mental health needs.
“At our last well-led inspection, we had concerns around the values and behaviours of some members of the executive team and the negative impact this had on the wider trust. During this inspection, we saw a team that consistently led with integrity who were open and honest in their approach.
“The executive team’s actions matched their words and owned up to their mistakes rather than blaming their team or making excuses. However, while the culture across the trust was improving and encouraged openness and honesty at all levels within the organisation, some staff still didn’t always feel able to raise concerns without fear of retribution.
“Leaders were aware of this and were working to create a workplace that is free from bullying, harassment, racism, and discrimination so we hope to see an improved picture soon.
“Within maternity services, staff must ensure thorough risk assessments are undertaken to ensure people and their babies are free from harm and abuse. Improvements are also needed to ensure medicines are stored and administered safely.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people and can receive safe and appropriate care.”
Inspectors found the following during this inspection:
At Nottingham City Hospital:
- Staff could give examples of how to protect women, and people using services from harassment and discrimination, including those with protected characteristics under the Equality Act.
- The design of the environment followed national guidance. There had been a reduction in beds on Bonington ward to reflect safe staffing levels.
- The service provided enough midwifery staff using bank and agency staff, to keep people and babies safe.
- Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of people in their care.
- Midwifery and medical staff understood their responsibilities to raise concerns and to record safety incidents, concerns, and near misses.
At Queen’s Medical Centre:
- The service had suitable facilities to meet the needs of people’s families. Birth partners were supported to attend the birth and provide support.
- Managers regularly reviewed and adjusted nursing staffing levels and skill mix and gave bank and agency staff a full induction.
- People’s medical notes were comprehensive and contained information to provide effective care and treatment.
- Where areas for improvement were identified, staff used the results to try and drive improvement.
- However, staff didn’t always follow systems and processes to prescribe, administer and store medicines safely.
Overall trust well-led inspection:
- There was widespread praise from the non-executive directors about how the chair had brought a sense of order and calm to the board.
- Without exception, leaders understood the challenges to quality and sustainability and could identify the actions needed to address them.
- Most staff were complementary of the leadership team at executive level, particularly the chief executive.
- Action was taken to address behaviour and performance that was inconsistent with the vision and values, regardless of seniority.
- Staff still didn’t always feel able to raise concerns without fear of retribution. However, leaders were aware of this and were working to address it.