The Care Quality Commission (CQC) has called for urgent improvements to be made following an inspection of maternity services at Hull University Teaching Hospitals NHS Trust that took place from March to April.
The inspection of maternity services at Hull Royal Infirmary was carried out as part of CQC’s national maternity 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.
Following the inspection, the overall rating for maternity at Hull Royal Infirmary, as well as the ratings for safe and well-led, have moved down from good to inadequate. CQC didn’t look at how effective, caring and responsive the service was at this inspection, these areas retain their previous rating of good.
The overall rating for Hull Royal Infirmary has gone down from requires improvement to inadequate, and the overall trust rating remains unchanged as requires improvement.
Following the inspection, CQC imposed urgent conditions on the trust’s maternity service registration to ensure rapid improvements are made to keep people safe. Details of these conditions can be found here.
Carolyn Jenkinson, deputy director of secondary and specialist healthcare, said:
“When we inspected the maternity services at Hull, it was really concerning to see such a deterioration in the standard of care being delivered. We saw areas where urgent improvements are needed to ensure safer care is provided to women, people using this service, and their babies.
“The lack of effective management by leaders had caused poor practices to become normalised across the service, with minimal plans for improvement in place. For example, there was no senior oversight of the antenatal day unit and triage area which had become chaotic as it didn’t have an effective appointment system in place. This led to people waiting for long periods of time, with no offer of food or drink from staff.
“A lack of appropriate facilities meant people who were moved to the antenatal ward often didn’t have a bed or comfortable area to wait. Regular understaffing and poorly managed handovers added to this issue which had negatively impacted the care provided and led to poor outcomes people using the service and their babies.
“Risks associated with the inadequate triage system had been highlighted both internally and by external bodies as part of an investigation by the Healthcare Safety Investigation Branch (HSIB). We saw no evidence of any action taken to prevent serious incidents occurring following this investigation.
“This wasn’t the only area where we saw leaders not listening to staff. It was concerning that they had taken little action when staff raised concerns about the risk of burnout and frequent workforce shortages causing delays to people’s care and treatment. It’s important the leadership team tackle this as a priority, as everyone should feel they are able to speak up and be listened to. Staff have important information to share that can keep people safe.
“It was positive, however, that midwifery staff told us their direct line managers, ward managers and matrons were supportive, but they also found challenges in finding time to support their team properly.
“We will continue to monitor the trust closely, including through future inspections, to ensure the necessary and urgent improvements are made so women, people using the service and their babies receive the safe and appropriate care they deserve.”
Inspectors found the following during this inspection:
- Staff didn’t always work well together across the different units of the service for the benefit of people. women and birthing people
- Governance systems and processes to assess, monitor and manage risks within maternity services were not robust
- Staff spoke about unkindness between staff across the service
- Serious incidents weren’t always reviewed in a timely manner and lessons weren’t always learned afterwards
- Staff had not always received training specific for their role on how to recognise and report abuse
- There were multiple versions of risk assessments in circulation meaning a consistent approach wasn’t possible.
However:
- The service was clean and infection risk was well controlled. The environment, except for the antenatal day unit and triage area, was fit for purpose, clean and well-maintained
- The service had started to identify some concerns and take action to set up maternity specific meetings where risk and learning from serious incidents would take place
- Medicines administration was managed effectively across the service.