The Care Quality Commission (CQC) has told King’s College Hospital NHS Foundation Trust it needs to improve maternity care at two of its hospitals, following inspections at King’s College Hospital (KCH), and Princess Royal University Hospital (PRUH) in August.
This inspection was undertaken as part of CQC’s regular ongoing monitoring of services.
The overall rating for maternity services at Kings College Hospital has declined from good, to requires improvement. How effective, responsive and well-led the service is, has also declined from good to requires improvement, safety remains rated as requires improvement and how caring maternity is remains rated good.
Following this inspection, a letter of intent was issued to take enforcement action against the trust for KCH, to focus their attention on making rapid improvements as CQC believed people may be exposed to the risk of harm otherwise. The trust took immediate action to address CQC’s concerns.
At their previous inspection, maternity services at PRUH were combined with gynaecology services. It is now a stand-alone service, so this is their first rating, which is requires improvement. They are rated good for how effective, caring and well-led the service is, and they are rated as requires improvement for being safe and responsive.
The overall hospital ratings, and overall trust ratings all remain unaffected by the maternity inspections. These remain rated as requires improvement.
Nicola Wise, CQC head of hospital inspection, said:
“When we inspected maternity services across King’s College Hospital NHS Foundation Trust, although we found staff that were caring, there were issues affecting the safety of care being delivered to mothers and babies.
“For example, we saw pockets of good care at Princess Royal Hospital, but the design and maintenance of facilities, premises and equipment wasn’t always safe, which was putting people at risk. This included staff not following the trust’s own policies on equipment checks and infection prevention and control.
“Access to maternity services also needed to be more responsive at the Princess Royal, with people often facing long wait times.
“Over at King’s College Hospital, it was worrying there’d been a decline in the quality of maternity care, which is why we issued a letter of intent to take urgent enforcement action if the trust didn’t make immediate improvements.
“I’m pleased to say the trust did take rapid action to address the issues we raised which included ensuring all its maternity staff receive the right training to deliver safe care and treatment, and that it has the right policies in place to help staff fulfil their roles.
“The trust’s leaders must develop strategies enabling them to identify issues and then make further widespread improvements, ensuring these are embedded. They have the skills to do this, and we’ll continue to monitor their progress closely, including through future inspections, and won’t hesitate to take further action if people are at risk of harm.”
At Princess Royal University Hospital, inspectors found:
- The service provided mandatory training in key skills to all staff but didn’t always ensure everyone completed it
- The service didn’t always control infection risks well with staff not always following best practice to protect women, themselves and others
- The design, maintenance and use of facilities, premises and equipment didn’t always follow safety standards. Some equipment safety checks were out of date and daily checks hadn’t always been completed
- People couldn’t always access the service when they needed it and didn’t receive the right care promptly. Waiting times were not always in line with national standards
- Leaders had the skills and abilities to run the service, but they did not always understand and manage the priorities and issues the service faced.
However:
- Staff understood how to protect women from abuse and the service worked well with other agencies to do so. Staff also protected the rights of women subject to the Mental Health Act 1983
- 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
- Doctors, nurses and other healthcare professionals worked together as a team to benefit women
- The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
At King’s College Hospital’s maternity service, inspectors found:
- The service did not control infection risk well. Staff did not always follow best practice to protect women, themselves and others from infection.
- Staff did not always assess risks to women, act on them or keep good care records
- The service didn’t manage medicines well
- Staff didn’t manage safety incidents well or always learn lessons from them. There were often delays in the investigations of incidents and where lessons were learned, they were not always shared amongst the whole team and the wider service
- The service provided mandatory and maternity specific training in key skills to all staff but did not always ensure everyone had completed it
- National recommendations aimed at keeping women and babies safe had not been fully implemented
- Leaders did not always effectively identify and mitigate risks to the service
- There was no systematic approach to prioritising women who attended triage.
However, there were some positive findings:
- Staff treated women with compassion, kindness and provided emotional support to women, families and their carers
- People received good care and treatment, were given enough to eat and drink, and were given pain relief when they needed it
- Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of women receiving care.