The Care Quality Commission (CQC) has published a report following inspections of two maternity service at hospitals run by University Hospitals of Derby and Burton NHS Foundation Trust in August.
The inspection was carried out 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.
Following the inspection both Royal Derby Hospital and Queens Hospital maternity service ratings have dropped from good to inadequate overall and for being safe and well-led.
This was a focused inspection, so CQC didn’t rate how effective, caring and responsive the services were. These domains are currently unrated.
Due to breaches being identified in relation to the trust not having up to date policies and procedures and not learning from when things went wrong at Royal Derby Hospital, CQC placed urgent conditions on the provider’s registration as people using the service may have been at risk of harm.
The rating for Royal Derby Hospital has dropped from good to requires improvement following this inspection.
Queens Hospital remains rated as requires improvement.
The trust rating has not changed following the inspection; therefore, it remains rated as good overall.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“When we visited the maternity services at Queens Hospital and Royal Derby Hospital, it was disappointing to see such a significant lack of strong leadership. At both services we found that leaders didn’t have the capacity to effectively manage them and they weren’t always visible or approachable for staff or people using them.
"We found staff didn’t always feel respected, supported, or valued by leaders at both hospitals, with staff at Royal Derby Hospital becoming visibly distressed when we spoke to them due to the overwhelming workloads and lack of clinical and emotional support from them. Some staff at Queens Hospital felt there weren’t equal job opportunities or safe working conditions, or that their hard work was recognised by management.
“When we visited Royal Derby Hospital, we found managers couldn’t be sure that people calling the pregnancy assessment line were receiving timely responses as they didn’t monitor this. This and the fact that staff didn’t always escalate concerns when there were signs that people’s health was deteriorating, was putting them at risk of harm.
“At Queens Hospital, leaders didn’t make sure staff were up to date with their mandatory training, meaning we couldn’t be certain that staff had the appropriate skills to keep women and people using the service safe.
“During the inspection, we also found the service didn’t have suitable facilities to meet the needs of people and their families. We found limited access to showers and on one ward, two showers being shared between 26 beds. Furthermore, staff told us people were encouraged to shower with the door slightly ajar due to ventilation issues but there were no privacy/shower curtains to protect their dignity.
“After the inspection, we informed the trust’s leadership team that they needed to make significant improvements. We will continue to monitor the service closely, including through future inspections, to determine whether the issues we identified are addressed so women and people using the service receive the care they have a right to expect.”
During the inspection of Royal Derby Hospital, inspectors found:
- The service did not always assess risks in relating to fetal monitoring and post-partum haemorrhage effectively
- Staff did not always complete risk assessments at every antenatal contact
- Staff were not always up to date with training in key skills
- The service did not identify, manage and investigate safety incidents in a timely way or effectively embed lessons learned from them
- Information processes were inadequate to monitor and improve clinical outcomes
- Leaders did not have access to reliable information systems to support monitoring of the service due to paper-based record keeping systems
- Clinical guidelines were not always in line with national guidelines
- There was limited engagement with local people and stakeholders in relation to improving services.
During the inspection of Queens Hospital, inspectors found:
- Staff did not always complete risk assessments for each woman or person using the service in order to remove or minimise risks. Additionally, staff did not always recognise and report incidents reducing the ability to identify learning from incidents
- The service did not always control infection risk well
- Staff did not always follow control measures to protect women, themselves and others from infection and managers did not regularly complete cleaning audits
- There was no stable leadership team, with high unplanned turnover and/or vacancies
- The approach to service delivery and improvement was reactive and significant failures in audit systems and processes were impacting on the management of risks and issues
- There were trends in feedback from people using the service where they were not treated with kindness or respect during interactions with staff or when they were receiving care and treatment.