The Care Quality Commission (CQC) has rated a maternity service run by Maidstone and Tunbridge Wells NHS Trust, inadequate and taken action to protect people, following inspections in August.
Three maternity services run by Maidstone and Tunbridge Wells NHS Trust were inspected as part of CQC’s national maternity services 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 locally and nationally.
Following the inspections, The Tunbridge Wells Hospital at Pembury maternity services have been rated as inadequate; Maidstone Birthing Centre and Crowborough Birthing Centre have both been rated as requires improvement overall.
The overall rating for the trust remains as requires improvement.
This is the first time maternity services at The Tunbridge Wells Hospital at Pembury, as well as at Maidstone Birthing Centre, have been rated as a standalone core service. Previously, maternity and gynaecology services were inspected and rated together. Crowborough Birthing Centre has not been previously inspected.
The overall rating for maternity services at The Tunbridge Wells Hospital at Pembury is inadequate. They have been rated as inadequate for how safe they are, and as requires improvement for how well-led they are. The inspection didn’t rate how effective, caring, and responsive the service was. The overall rating for the hospital remains requires improvement.
The overall rating for Maidstone Birthing Centre maternity services is requires improvement. They have been rated as requires improvement for how well-led and safe they are. The inspection didn’t rate how effective, caring, and responsive the service was.
Crowborough Birthing Centre maternity services has been rated as requires improvement overall, and for how safe and well-led they are. The inspection didn’t rate how effective, caring, and responsive the service was.
CQC has served a warning notice to the trust to focus their attention on making rapid improvements to The Tunbridge Wells Hospital at Pembury, and to make sure they are providing safe care and treatment.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist care said:
“When we inspected maternity services at Maidstone and Tunbridge Wells NHS Trust we found a service with staff who were doing their best to provide safe care to women and people using the service despite ineffective systems and poor leadership.
“Across the maternity services, leaders didn’t have good systems in place to report and investigate incidents. We saw occasions at The Tunbridge Wells Hospital at Pembury where there had been delays in emergency caesarean sections, people had delays to birth being induced or people had experienced major blood loss after birth. These incidents were opportunities for the service to identify where improvements could be made and learn lessons for the future.
“At the same hospital, we were also concerned to find people couldn’t always access services when they needed to and didn’t always receive treatment quickly enough. This was partly caused by a high number of vacancies which meant the service couldn’t always adjust staffing to meet demand. Staff told inspectors sickness absence was increasing due to stress.
“We found poor record-keeping at Maidstone Birthing Centre, where people’s information was incomplete and sometimes documents were inaccurate. Inspectors found several incidents at the service related to this poor record-keeping. This included things like babies’ growth measurements, and breaches in confidentiality where information had been entered in the wrong person’s record.
“At Crowborough Birthing Centre, people weren’t always being risk assessed and records were also incomplete. This meant when someone booked an appointment, there wasn’t always documentation on whether they had a high or low risk pregnancy. This could put women, people using the service, and their babies, at risk of harm if they deteriorated during the appointment.
“We have issued a warning notice to ensure the trust concentrates on the areas where we have concerns and will return to check that the required improvements have been made. We’ll be monitoring the trust closely to make sure women, people using the services and their babies are safe. If further improvements are not implemented and embedded, we will not hesitate to take further action to ensure we are confident people are receiving the safe, consistent care they deserve.”
At The Tunbridge Wells Hospital at Pembury, inspectors found:
- Staff weren’t using a standard tool to check people’s needs when they arrived. This meant people were being assessed differently based on whichever member of staff saw them, although the trust was working on implementing a new system for this
- Staff training wasn’t being prioritised and staff didn’t always have dedicated time to study. Leaders didn’t always support staff to access specialist training for their role
- The service didn’t always complete daily safety checks of emergency and specialist equipment. Records showing when checks were carried out were incomplete
- There were concerns around the service’s infection control measures and inspectors found no cleaning schedules in place for areas such as the birthing pool
- Medicines weren’t always prescribed and administered safely and they weren’t always stored securely. Some records where people had been given controlled medicines (such as strong pain relief) were missing necessary signatures
- Generally, the trust managed formal complaints well. However, some staff didn’t show they understood duty of candour and weren’t always open and transparent with people when things went wrong.
However,
- Staff were focused on the needs of women and people using the service and cared for them with dignity and respect. Staff told inspectors they felt able to talk to departmental leaders about difficult issues.
At Maidstone Birthing Centre, inspectors found:
- Inspectors found several incidents at the service were related to poor record-keeping
- There were poor governance systems and a lack of auditing. Leaders didn’t always manage incidents properly, or identify risks, to learn lessons and prevent them from happening again
- Risk assessments weren’t always completed for women and people who chose to give birth at the birthing centre
- Mandatory training wasn’t always completed in key areas such as neonatal life support, safeguarding, and competency-based assessments on the use of baby heartbeat monitoring during pregnancy and labour.
However
- Staff told inspectors they felt respected, valued and supported. They were focused on the needs of women, people using the service and their babies and put their care at the heart of the service
- The service had an open culture where women and people using the service, as well as their families, could raise concerns without fear.
At Crowborough Birthing Centre, inspectors found:
- Midwifery staffing levels were unsafe and put people using the service and their babies at risk of harm
- Staff didn’t always complete records, including risk assessments. This meant when someone had an appointment, there wasn’t always documentation on whether they had a high or low risk pregnancy
- Mandatory training wasn’t always completed in key areas such as neonatal life support, safeguarding, and competency-based assessments on the use of baby heartbeat monitoring during pregnancy and labour.
However
- The service held a weekly drop-in breastfeeding café, to offer support and advice in a more relaxed environment. Inspectors saw one of the café sessions at Crowborough Birthing Centre and found it busy and there were many volunteers available to support people
- Staff told inspectors they felt respected, valued and supported. They understood how to protect people from abuse and were focused on the needs of women and birthing people in their care.