The Care Quality Commission (CQC) has rated the maternity service James Paget University Hospital, run by James Paget University Hospitals NHS Foundation Trust, as inadequate following an inspection in January. This inspection also affects CQC’s rating of James Paget University Hospital overall which has now dropped from good to requires improvement.
The inspection was carried out as part of CQC’s national maternity services inspection programme. This 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 locally and nationally.
At this inspection of maternity services, CQC also rated how safe and well-led the service was as inadequate. How effective, caring and responsive the service is, are unrated, because CQC didn’t look at these three domains at this inspection.
Following the inspection, CQC served James Paget University Hospitals NHS Foundation Trust, which runs the hospital, a warning notice. This means the trust must take urgent action to ensure people using this service and babies in its care are not exposed to risk of harm in the service.
CQC’s rating of James Paget University Hospitals NHS Foundation Trust remains unchanged at good following this inspection.
Carolyn Jenkinson, CQC deputy director of operations in the south of England, said:
“It’s concerning that the quality and safety of maternity care at the James Paget Hospital has deteriorated since our last inspection. We found that women and people using the services as well as their babies, were not receiving the safe care they should expect.
“Leaders need to do more to have better management of the service and support staff with good policies and processes to help them keep people safe.
“Staff worked hard and were focused on the needs of people receiving care but, people couldn’t access the service when they needed it and sometimes they waited too long for treatment which put them at risk. Part of this included triage, where staff would sometimes have to leave the triage area to go to the rapid assessment part of the unit. This left other people in triage unattended, and we weren’t assured anyone had oversight of this issue or were doing anything to reduce this risk.
“At a previous inspection we told trust leaders that there was a breach of the regulations regarding the training of midwives to care for people using the service who required enhanced observations. Despite other follow up inspections since then, this issue has still not been addressed.
“Part of the solution to improving the safety of people using the service must be addressing gaps in staff training and using safety incidents to drive learning. But the trust’s senior leaders must also improve their oversight of the service and set the right priorities to help it respond to the challenges it faces.
“Following the inspection, we have issued a warning notice to focus the trust’s attention on how they are managing risks to women and people using this service, as well as their babies, and we expect to see rapid and significant improvements.
“We continue to monitor the service and the wider trust, including through future inspections, to ensure it is delivering safe and effective care.”
The inspection found:
- The service didn’t have enough staff to care for women, people using the service and babies and keep them safe
- “The service must ensure the culture significantly improves so that it doesn’t impact on the safety and care of people using the service. In a recent survey 88% of midwives and 18% of medical staff had experienced or witnessed behaviours which weren’t in line with the trust ethos
- Medical staff had not always completed mandatory training
- There wasn’t assurance that managers monitored waiting times and made sure women could access emergency services when they needed or received treatment within national targets
- The service did not always control infection risks well
- Staff did not always assess the risks to women or act on them
- The service did not always manage or report safety incidents well and learn lessons from them
- Leaders did not always monitor how effective the service was or make sure staff were competent
- There was no assurance that people could always access the service when they needed it or wait too long for treatment
- Staff did not always feel respected, supported, and valued.