The Care Quality Commission (CQC) has published a report following inspections of two maternity services at three hospitals run by Epsom and St Helier University Hospital NHS trust in August.
These inspections were carried out as part of CQC’s national maternity services inspection programme. This 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 inspection, the overall maternity service ratings at Epsom General Hospital, as well as at St Helier Hospital and Queen Mary's Hospital for Children, have both dropped from good to requires improvement.
At Epsom General Hospital, as well as the overall maternity service rating change, how safe and well-led the service is has also dropped from good to requires improvement.
At St Helier Hospital and Queen Mary's Hospital for Children, a single maternity service is run across both sites. As well as the overall service rating change, how safe the service is has dropped from good to inadequate, and how well-led the service is has dropped from good to requires improvement.
Effective, caring and responsive were not included in this inspection.
The overall ratings for Epsom General Hospital and St Helier Hospital and Queen Mary's Hospital for Children remain as good. The overall rating for Epsom and St Helier University Hospitals NHS Trust remains as good.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“When we inspected maternity services at Epsom and St Helier University Hospital NHS trust, we found a decline in the quality of care being provided to women, people using the service, and their babies. Behind this, was a drop in the effectiveness of leadership across these services. Although leaders recognised and reported significant risks and issues, they didn't always act quickly to reduce the impact of them putting people at risk.
“The trust needs to make sure there are enough suitably qualified midwives to keep people safe. We saw a shortage of staff during this inspection which was having an impact on the level of care people were getting.
"The trust also needs to do more to ensure they’re supporting staff to follow best practice guidance in the physical environment of the services, as well as in the way women, people using the service, and their babies are cared for. For example, best practice is that the anaesthesia recovery room sits within the theatre suite, but it didn’t at Epsom or St Helier and Queen Mary hospitals. Staff also didn’t have specialist training in looking after babies in transitional care.
“Leaders needed to do more to create an environment that promoted people’s privacy and dignity. For example, the bereavement room was within the delivery suite and wasn't soundproof, and ensuite facilities had a shower curtain instead of a door. At the time of the inspection, the two operating theatres opened directly onto the corridor of the delivery suite and weren’t secured. This meant anyone using the service and their visitors could gain access.
“People also told us that staff weren’t always caring and compassionate. The trust told us they were aware of these issues and were monitoring them closely and acting on feedback from people.
“Despite the issues we found, we also saw staff who worked well together for the benefit of everyone using the service. They managed safety incidents well and learned lessons from them, with a real commitment to continual improvement. People could also access the services when they needed it and didn’t have to wait too long for treatment.
“We have told the trust what improvements we expect to see and will continue monitoring it to ensure people receive the high-quality care they deserve.”
Inspectors found the following during this inspection:
- Not all staff had training in key skills. Not all staff had completed mandatory maternity or safeguarding training
- The service did not have enough midwifery staff in the right areas with the right qualifications, skills and training to care for women, people using the service and their babies. Staff working in transitional care bays did not always have the qualifications and competence for the role they were undertaking
- Leaders did not operate effective systems and processes nor have clear oversight of maternity services to keep women, people using the service, and their babies safe.
- Safety was not managed well at the services
- There weren’t clear triage processes in place to assess the health of people using the service. There was also no dedicated triage phone line due to staff sickness and absence. People using the service could contact a central pregnancy advice line if they had any concerns, but that line could be picked up by staff without the appropriate training.
- Medicines were not always managed well
- Care records were not always fully completed.
However, inspectors also found:
- Staff were committed to improving the services continually
- People could access the service when they needed it and didn't have to wait too long for treatment
- The service had enough medical staff to keep women, people using the service, and their babies safe.