The maternity service at Lister Hospital, Stevenage, has seen its rating drop from good to inadequate – following a Care Quality Commission (CQC) inspection undertaken in October.
This inspection was carried out as part of CQC’s national maternity services 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.
The inspection found women and babies were not receiving standards of care they have a right to expect in the hospital’s maternity service, which is run by East and North Hertfordshire NHS Trust.
In addition to rating the service inadequate, CQC served a warning notice. This means the trust now has a legal requirement to make improvements in the service to avoid further enforcement action.
While Lister Hospital’s maternity service is now rated inadequate, ratings for the trust and hospital overall are unchanged following this inspection. Both remain requires improvement.
Carolyn Jenkinson, CQC head of hospital inspection, said:
“I’m very concerned by the deterioration in the quality and safety of maternity care at Lister Hospital which falls shorts of what women should be able to expect.
“This drop in quality and safety was down to insufficient management from leaders to ensure staff understood their roles, and to ensure the service was available to people when they needed it. We have issued the trust with a warning notice to focus its attention on rapid improvement in this area.
“Our inspection found the service lacked enough staff to provide good care and keep people safe. This was worsened because training targets weren’t being met, meaning even when there were enough staff, they didn’t always have right skills.
“We also found staff didn’t always follow best practice to protect people from infection or assess risk.
“However, we did find some good practice – including collaboration between staff, good monitoring of the service’s effectiveness and constructive community engagement.
“We also found the service had a strong culture where improvement, research and innovation were prioritised.
“Following the inspection, we have told senior leaders at East and North Hertfordshire NHS Trust where they must make improvements. They must use our report to address where the service is not meeting standards people have a right to expect.
“We continue to monitor the service and the wider trust, including through future inspections, to support it to deliver safe and effective patient care.”
The inspection found:
- There were not enough staff to care for women and keep them safe
- Mandatory and maternity-specific training in key skills was provided to all staff, but steps were not taken to ensure everyone completed it
- Best practice was not always followed to protect women, staff and others from infection
- Staff did not always assess risks to women, act on them and keep good care records. They did not manage medicines well and there were delays in the investigation of incidents
- Although staff understood how to protect women from abuse and had training on how to recognise and report abuse, not all staff had completed mandatory safeguarding training
- Equipment was not always well maintained
- The trust performed worse than other trusts in CQC’s 2021 maternity survey, and was highlighted as one of eight ‘worse than expected’ trusts in England for cleanliness. The trust was also highlighted as one of seven performing ‘worse than expected’ in CQC’s 2022 maternity survey, although the results of this were published after the inspection took place
- Leaders did not always ensure staff were competent, neither did they support staff to develop their skills. Staff were not always clear about their roles and accountabilities
- People could not access the service when they needed it. Some waited too long for treatment, which impacted on the care they received
- Leaders did not always effectively identify and mitigate risks to the service, and there was no systematic approach to prioritising women who attended triage.
However:
- Staff worked well together for the benefit of people
- Managers monitored the effectiveness of the service
- The service engaged well with women, staff, equality groups and the community to plan and manage services
- There was a strong culture for improvement, research and innovation
- The service celebrated safe innovation, exemplary staff and team success
- Findings were used to make improvements and achieve good outcomes for women
- Leaders used reliable information systems.
Following the inspection, CQC told the trust it must make several improvements to comply with all its legal obligations in the service, including:
- Implementing a system to assess risks to women attending the triage unit, prioritise their care and ensure they are appropriately and monitored
- Completing timely risk assessments, including to manage the risk of infections, and taking action to remove or minimise risks
- Ensuring the abduction policy is embedded and tested
- The trust must ensure there is enough equipment, particularly cardiotocograph (CTG) monitors to assess foetal heart rates in a timely manner
- Managing and storing medicines safely and effectively
- Ensuring all equipment is clean, fit for purpose, regularly maintained and replaced in line with policy
- Undertaking timely investigations of incidents
- Ensuring the risk register accurately reflects the risks in the service
- Implementing effective risk and governance systems to support safe, high-quality care
- Ensuring there are enough suitably qualified competent staff to meet the needs of the service, and mitigating shortfalls
- Ensuring staff receive appropriate support, training, professional development, supervision to help them deliver good patient care.