The Care Quality Commission (CQC) has found a decline in the quality of maternity services at both hospitals run by Bedfordshire Hospitals NHS Foundation Trust following an inspection in November last year. The ratings for maternity services at both Luton and Dunstable Hospital and Bedford Hospital have declined from requires improvement to inadequate.
This inspection was prompted by concerns around the safety, culture, and management of the service, which were raised to CQC by whistleblowers.
As well as the overall maternity rating at Luton and Dunstable Hospital dropping from requires improvement to inadequate, so have the ratings for how safe and well-led the service is. The service has dropped from good to requires improvement for how effective it was. How responsive the service was has again been rated requires improvement and caring has again been rated good. The decline in this rating has also affected Luton and Dunstable Hospital’s overall rating and its well-led rating, which both move from good to requires improvement.
Maternity services at Bedford Hospital have dropped from requires improvement to inadequate overall and for safe and well-led. They’ve dropped from good to requires improvement for responsive and have again been rated requires improvement for effective. Caring was again rated good.
The rating of the trust overall remains unchanged as good.
CQC also issued the trust with a warning notice in December to focus their attention on making immediate improvements to safe staffing. The trust submitted an action plan and the warning notice will remain live until the issues are addressed.
Stuart Dunn, CQC deputy director of operations in the East of England, said:
“At our inspection, we were concerned to find low staffing for midwives was still a significant risk to the safety of women, people using these services, and their babies despite us telling the trust they needed to address this previously. The trust had taken steps to address the issue by recruiting midwives internationally, but at this inspection we found this programme was being undermined by racism against staff, by their own colleagues, and a lack of support from leaders.
“Some international midwives told us they often felt excluded, and that it was normalised for colleagues from ethnic minorities to experience discrimination from colleagues. In the trust’s 2022 staff survey, a third of all midwives reported experiencing at least one incident of bullying or harassment from colleagues. Leaders hadn’t always taken meaningful action to address these issues, but have started to put actions in place since we raised this with them.
“While staff were working very hard, low staffing issues meant people could not always access services when they needed it. Capacity issues were particularly severe at Luton and Dunstable Hospital, which had to re-direct people to other hospitals on the first day of our inspection. We also saw women and people using the service at Luton and Dunstable hospital waiting a long time for call bells to be answered.
“Midwives in the community service told us day to day staffing was often difficult as they were pulled in to cover the labour wards. This meant they weren’t available for their planned work in the community the following day, impacting on people’s care.
“We issued the trust with a warning notice in December to focus their attention on making improvements to maternity services. Since the inspection they’ve produced an action plan to address our concerns.
“We’ll be monitoring these services closely, including through further inspections, to make sure people receive safe care while these improvements are implemented.”
Inspectors also found:
- Staff weren’t always completing daily safety checks to ensure equipment was ready in the event of an emergency
- When things went wrong, leaders weren’t always investigating quickly or making changes to protect people from the same issue happening again
- Leaders didn’t always understand and effectively manage the issues the service faced
- Not all staff were completing mandatory training designed to keep people safe
- Infection prevention and control risks weren’t always well managed
- The physical design of the service didn’t always enable staff to meet people’s needs at Luton and Dunstable Hospital, however a new unit was being built and was due to open in 2025.
However:
- Staff worked hard to meet people’s needs in a compassionate way, even where they had limited resources
- Both maternity services engaged well with the local community to plan services and made it easy for people to give feedback
- Staff made sure women living with mental health problems, learning disabilities, and dementia received the necessary care to meet all their needs.