The Care Quality Commission has dropped the rating for maternity services at North Middlesex University Hospital from good to inadequate following an inspection in May.
The hospital is run by North Middlesex University Hospital NHS Trust and was inspected 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.
As well as maternity services dropping from good to inadequate overall, they’ve also dropped from good to inadequate for being well-led. They’ve dropped from requires improvement to inadequate for being safe. This inspection didn’t rate how effective, caring, and responsive the service was.
The overall rating for the hospital as a whole remains requires improvement. The overall rating for North Middlesex University Hospital NHS Trust also remains requires improvement.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“When we inspected maternity services at North Middlesex University Hospital we were deeply concerned to find both staff and women and people using the service being let down by poor leadership. Leaders lacked oversight of the issues we found, and we saw signs that a closed culture could be developing within the service, discouraging staff from speaking up to improve people’s care.
“For example, there was a process in place to assess people’s risks during triage, however staff were not using it, meaning they didn’t always prioritise the people who needed care the most urgently. We saw the trust had identified these poor risk assessments during triage in August last year, but little action was taken to improve this.
“While many staff were committed to improving the service, we found leaders didn’t always support them to do so. Staff told us leaders didn’t always take action when they reported incidents, and some midwifery staff told us they felt bullied, intimidated and undermined by leaders.
“Women and people using the service also told us of poor experiences, but we found leaders were not always using people’s feedback to drive improvements.
“The trust needs to take immediate action to ensure leaders are listening to their staff and the people using this service to drive improvement. We’ll continue to closely monitor this service, including through further inspections, and won’t hesitate to take action if we’re not assured people are receiving safe care.”
Inspectors also found:
- The service had a significantly higher number of stillbirths than the national average, but inspectors found no evidence that leaders had made plans to reduce this
- Leaders hadn’t made sure all staff got the training they needed to keep women, people using the service, and their babies safe, in areas such as basic life support and safeguarding. The trust told inspectors staff shortages had made this difficult
- There weren’t always enough midwifery staff with the right skills and experience to keep people safe. While staffing pressures are an issue across much of the NHS, leaders must make sure this does not impact people’s safety
- The service didn’t always ensure equipment was properly maintained to keep people safe. There was only one resuscitaire, a device used to support babies’ breathing, for both the birthing centre and maternity triage, and this wasn’t kept prepared for immediate use in case of an emergency. The trust took prompt action to fix this after the inspection
- People’s care records weren’t always detailed, up-to-date and easy to access to ensure staff knew how to meet their individual needs
- Many midwives said they felt they’d experienced discrimination from managers or colleagues.