The Care Quality Commission (CQC) has told Gloucestershire Hospitals NHS Foundation Trust that it must make immediate improvements to its maternity services.
CQC carried out an unannounced focused inspection of the trust’s acute and community maternity services during April and May. The inspection was undertaken in response to concerns received about the culture, safety and quality of the services.
After this inspection, a warning notice was issued to the trust requiring it to take action to ensure significant improvements were made to the safety, leadership and governance of the maternity service.
The inspection focused specifically on the safety and leadership of the service. Following the inspection, the overall rating for maternity services has moved down from good to inadequate. How safe maternity services are has moved down from requires improvement to inadequate and well-led has moved from good to inadequate.
Catherine Campbell, CQC's head of hospital inspection, said:
“We are very aware of the pressure that the NHS is under and how hard staff are working to provide good care for patients.
“Our inspectors saw the impact that workforce shortages were having on both patients and staff in the maternity service at Gloucestershire Hospitals NHS Foundation Trust.
“We didn’t always see evidence that lessons had been learned following serious incidents, or that managers had the oversight of the use of modified early obstetric warning system (MEOWS) charts used to identify any risks of patient deterioration. Following the inspection, we requested a copy of the MEOWS audit and associated action plan, but this wasn’t provided. The trust told us that they had not completed a planned, formal MEOWS audit since 2019 due to continuing operational pressures.
“Staff knew how to report incidents, but not all incidents were being reported onto the electronic system. Mangers told us they couldn’t be assured that staff were reporting all near misses because the department was understaffed. Staff didn’t have the time to report incidents and near misses. Most staff told inspectors they would raise concerns with their manager but would not always report them as an incident through the electronic system.
“We also found not enough had been done to ensure staff were listened to when they raised concerns. Staff told inspectors they didn’t feel respected, supported or valued.
“We have issued a warning notice to ensure that immediate improvements are made, especially regarding the safety, leadership and governance of the department. There is also work to be done to improve the culture. We’re monitoring the trust closely and will return to check that the required improvements have been made.”
Throughout the maternity service inspectors found the following:
- The service didn’t always have enough staff to care for women and keep them safe. Staff across the service said they were exhausted, and morale was low with some members of the team experiencing stress and anxiety
- Some safety incidents were not investigated fully, or in a timely way and lessons were not always learned from them
- Most staff were keen to learn and improve services, but staffing shortages reduced their ability to complete training or develop the service and to be involved in research
- Leaders and staff engaged with patients, staff, and a variety of stakeholders to plan and manage services but they didn’t always create clear action plans to drive improvement. However, there was some collaboration with partner organisations to help improve services for patients
- Not all staff felt respected, supported, and valued. The service did not have a clear vision, values or strategy although this was in development. There wasn’t sufficient leadership capacity to focus on governance and managing risk. Leaders didn’t always have reliable information systems to support them to monitor services
- Not all staff had completed training updates on how to recognise and report abuse
- Not all medical staff received training specific for their role on how to recognise and report abuse. Junior medical staff did not receive level three safeguarding children training. There was a risk medical staff would not recognise and act on safeguarding concerns to keep vulnerable women and babies safe
- There were not sufficient competency frameworks for midwives and the professional midwifery advocate service to support midwives had been significantly reduced due to vacancies within the team. Managers did not have effective systems and processes to proactively monitor and improve services.
But, inspectors also found:
- Staff understood how to protect women from abuse and the service worked well with other agencies to do so. Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other organisations to protect them. Midwifery staff knew how to make a safeguarding referral and who to inform if they had concerns
- Ward areas were visibly clean and had suitable furnishings which were clean and well-maintained. Cleaning records demonstrated that most areas were cleaned regularly. Staff disposed of clinical waste safely
- Leaders understood the priorities and issues the service faced. Most were visible and approachable in the service for patients and staff
- Clinical staff completed training on recognising and responding to women with mental health needs, but training did not always include learning disabilities, autism or dementia. Maternity staff mandatory training included mental health and teenage pregnancy
- The bereavement midwife who provided support to women and their families within the division was recently awarded the Cavell Star Award for excellence. The Cavell Star Awards are a national awards programme