The Care Quality Commission (CQC) has told Barts Health NHS Trust it needs to improve maternity care in some of its services, following inspections at The Royal London Hospital, Whipps Cross Hospital, Barking Birth Centre and the Barkantine Birth Centre.
Following the inspections, Whipps Cross Hospital’s maternity was rated good.
Maternity at The Royal London Hospital and Barking Birth Centre were rated requires improvement.
The Barkantine Birth Centre, a maternity unit on the Isle of Dogs, was rated inadequate. CQC also issued this service a warning notice, requiring it to take urgent action to ensure people’s safety.
Following the inspection and in response to CQC’s initial findings, the trust proactively reduced its services at the Barkantine Birth Centre so it could focus on addressing areas of concern.
The inspections were undertaken as part of CQC’s national maternity services inspection programme. This will 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.
The overall trust rating, requires improvement, was not affected by the maternity safety inspections.
Nicola Wise, CQC head of hospital inspection, said:
“Maternity services across England face significant challenges, but there are steps Barts Health NHS Trust can and must take to ensure all risks to mothers and babies are well managed while they are in its care.
“These challenges include staffing shortages, and Barts Health is affected like many other trusts.
“However, the trust’s leaders must develop strategies to meet patient need despite this. This should include developing a comprehensive understanding of the issues it faces, so it can tailor its response accordingly.
“The trust must also ensure 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.
“A poor grasp of issues was particularly evident at the Barkantine Birth Centre, where mothers and babies didn’t always receive care meeting standards of safety or quality that they have a right to expect.
“However, we saw instances of good practice across the trust – including good engagement with women, the community and other healthcare partners to help shape care to meet people’s needs.
“We also found some staff felt valued and respected, and there were instances of good collaboration in the interest of women and babies.
“The trust has our findings and it knows where it must improve. We continue to monitor it closely, including through future inspections, and we will not hesitate to take further action if people are at risk of harm.”
At Whipps Cross Hospital’s maternity service, inspectors found:
- Staff received key skills training and collaborated for patients. They also understood how to protect patients from abuse.
- Infection risks, medicines and safety incidents were managed well.
- Staff felt mostly felt respected, supported and valued, and they were focused on people’s needs.
- The service engaged well with women and communities to plan and manage services, and people could access it when they needed.
- Staff were committed to continually improving services.
- Interpreting and maternity bereavement services were good.
However:
- There weren’t enough staff to provide care and ensure patient safety.
- Some staff did not complete mandatory training within targets, and not all staff received an appraisal.
- Staff didn’t always assess risks to women and babies in line with guidance.
- Records were not always up to date.
- There wasn’t seven-day-a-week access to a pharmacist.
- Effectiveness was monitored, but staff competence checks were not always made.
- Some staff were unclear about their roles and accountabilities because some policies did not exist, and new processes had not been implemented.
At The Royal London Hospital’s maternity service, inspectors found:
- There weren’t enough staff to care for women and keep them safe, and some anaesthetists were not compliant with specialist training.
- Risk assessments and care records were not always accurate.
- Not all incidents were appropriately reviewed.
- Participation in safeguarding and infection prevention and control training were below trust targets.
- There was not enough new-born resuscitative equipment in every labour room.
- Medication was not managed safely.
- Patient records were not always stored safely.
- Leadership changes led to gaps in governance processes, and the service did not have reliable information systems.
- The workforce strategy was ineffective, and the service’s vision was unclear.
- Staff were not supported to develop their skills, due to workloads, and some reported feeling disrespected, unsupported or undervalued.
However, there were some positive findings:
- Most staff received mandatory training in key skills.
- Safeguarding systems protected mothers and babies.
- Staff worked hard to maintain services and care for women, despite high pressures. They were focused on the needs of women receiving care.
- Staff mostly understood their roles and accountabilities.
- Managers monitored the service’s effectiveness, and all staff were committed to continual improvement.
- The service engaged well with women and the community to plan and manage services. People could access it when they needed, and they did not have to wait too long for treatment.
- The new leadership team was implementing a new strategy.
At Barking Birth Centre, inspectors found:
- Staffing challenges across the trust affected the sustainability of the service.
- Infection risk was not always well controlled.
- Checks on emergency equipment were not always completed.
- There was a risk that incidents were not always reported and investigated, and leaders did not always use risk management systems effectively.
- Monitoring of outcomes for women and babies was limited.
- There wasn’t a clear vision.
- Staff satisfaction was mixed.
- Women couldn’t always access the service when they needed, due to intermittent closures.
However, there were some positive findings:
- Staff had training in key skills and knew how to protect women from abuse.
- There were enough staff to care for women and keep them safe.
- People could easily give feedback, raise concerns about their care and provide input to investigations. Lessons learned from all investigations were shared with all staff.
- Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.
At the Barkantine Birth Centre, inspectors found:
- Risks were not always effectively assessed, monitored and managed – so there were missed opportunities to minimise harm.
- There wasn’t adequate equipment to respond to a maternal collapse.
- Infection risk was not always controlled well.
- There weren’t adequate leadership or effective governance processes to ensure compliance with regulations and drive improvement. Leaders had little understanding and management of risks and issues.
- Leaders lacked a vision or strategy to provide safe and sustainable services.
- Staff satisfaction was mixed, and staff didn’t work collaboratively with the main hospital site.