The Care Quality Commission (CQC) has told Buckinghamshire Healthcare NHS Trust improvements are needed in maternity services at Stoke Mandeville Hospital, after an inspection in June rated them as requires improvement.
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.
This is the first time maternity services at Stoke Mandeville Hospital have been rated as a standalone core service. Previously, maternity and gynaecology services were inspected and rated together.
As well as maternity services being rated requires improvement overall, they’ve also been rated requires improvement for how safe they are. How well-led they are has been rated as good. This inspection didn’t rate how effective, caring and responsive the service was.
The overall ratings for Stoke Mandeville Hospital and Buckinghamshire Healthcare NHS Trust both remain as good overall.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“When we inspected maternity services at Stoke Mandeville Hospital, it was encouraging to see leaders had the necessary skills and abilities to run the service. They also understood and managed the priorities and issues the service faced, and staff spoke highly of them. However, there were areas where improvements needed to be made.
“There were high vacancy and sickness rates, and staff told us the low numbers of staff made them feel like aspects of the service could be unsafe. Sickness rates were increasing as staff became more stressed. However, leaders in the service took action to manage change when risks were identified.
“The environment in the triage area made it impossible to maintain confidentiality during any telephone calls, face-to-face conversations, or assessments.
“We also heard all the information requested and shared during telephone calls which included identifiable information, such as the caller’s name and date-of-birth, which we heard staff repeat. We overheard the advice staff provided too. It was also not possible for staff to discuss sensitive information such as safeguarding concerns in confidence. This meant safety of people using the services could be compromised or people might be put off from telling staff they are at risk.
“There were delays in triage when people arrived at the maternity unit waiting to be seen by a medical staff member. Sometimes the triage telephone helpline wasn’t staffed which meant people couldn’t always access timely advice and support. It also meant there was a risk people could arrive at hospital when they didn’t need to.
“We were told that a quality improvement project around triage had started in February. Its aim was to improve the flow, ensure timely risk assessments took place, and improve the environment. Leaders has recently introduced a designated waiting area as part of this triage improvement plan, and we’re looking forward to returning and seeing the difference these changes might make in people’s care.
“We will continue to monitor the trust closely, including through future inspections, to ensure the necessary and urgent improvements are made and embedded so women, people using the service and their babies receive the safe and appropriate care they deserve.”
Inspectors found:
- Staff did not always manage medicines effectively or correctly
- Workload was impacted in triage because staff often had to source suitable equipment from other areas, and they had no immediate access to medication. Staff did not report any of these issues as an incident because they had become normalised in the service
- The layout and design of the environment was not always suitable for the services provided. The dedicated bereavement suite for families who had experienced a baby loss was situated on the labour ward. This was not ideal, as bereaved families might have been able to hear babies cry and families celebrating
- The space limitations in the triage area created trip hazards because equipment wires fell on the floor between each bed space.
However:
- The service managed infection risk well
- Staff felt respected, supported, and valued
- Leaders were visible and approachable in the service, they escalated, and managed risk well
- Staff understood how to protect women and people using the service from abuse.