The Care Quality Commission (CQC) has rated maternity services at two Devon hospitals as requires improvement, following inspections in November.
Maternity services at Royal Devon & Exeter Hospital (Wonford) and North Devon District Hospital, run by Royal Devon University Healthcare NHS Foundation 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.
The overall rating for maternity services at Royal Devon & Exeter Hospital (Wonford) is requires improvement. They have also been rated as requires improvement for how safe and well-led they are. The inspection didn’t rate how effective, caring, and responsive the service was.
This is the first time maternity services at Royal Devon & Exeter Hospital (Wonford) have been rated as a standalone core service. Previously, maternity and gynaecology services were inspected and rated together.
Following the inspection, maternity services at North Devon District Hospital have been re-rated as requires improvement overall. The rating for how well-led they are has decreased from good to requires improvement. They have been re-rated as requires improvement for how safe they are.
The rating for effective remains requires improvement, and responsive and caring remain rated as good as they weren’t re-rated as part of this inspection.
The overall rating for Royal Devon University Healthcare NHS Foundation Trust remains as requires improvement.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist care said:
“When we inspected maternity services at Royal Devon University Healthcare NHS Foundation Trust we found staff doing their best to provide good care in a challenging environment due to staffing levels, but incidents and risks were being missed.
“Midwifery staff levels didn’t always keep people safe. At Royal Devon & Exeter Hospital, inspectors found there had been a number of safety incidents relating to staff levels which meant women, people using the service, and their babies were at risk of harm.
“We had a number of specific concerns with North Devon District Hospital, including around triage, incident reporting, and how leaders were auditing the service. Staff didn’t always risk assess people through telephone triage or on arrival using a standardised method. The service relied on individual clinical judgement to remove or minimise risks to people giving birth rather than supporting staff with good processes.
“At the same hospital, record keeping was poor which put people at risk of harm. Details were missing on incident reports of people who needed treatment for serious perineal tears, including how long they had to wait for treatment. Staff also didn’t always complete forms used to identify and monitor people at risk of deteriorating during birth, and it was unclear what action had been taken to address this issue.
“However, maternity staff across the trust told us leaders were visible and approachable. They also encouraged feedback from women, people using the service and their families. Leaders should be proud of creating an open culture where people are able to raise concerns without fear and be listened to.
“Leaders know where improvements need to be made and we will continue to monitor the trust, including through future inspections, to ensure women, people using the service and their babies receive a good standard of care.”
At Royal Devon & Exeter Hospital (Wonford) inspectors found:
- The service had issues with midwifery staff levels including high sickness rates. The number of staff didn’t always match planned numbers, which put people at risk of harm.
- Leaders didn’t have good systems to manage issues and risks, or to monitor how the service was performing.
- Staff hadn’t completed all mandatory role-specific training or safeguarding they needed to keep women, people using the service and their babies safe.
- Medicines weren’t always stored or managed safely. Some medicines inspectors reviewed were out-of-date or being stored at the wrong temperature. Fridge temperatures weren’t always being checked.
- The service hadn’t carried out a recent drill exercise for baby abductions, which went against national guidance.
However,
- Staff assessed people’s risks, acted on them, and kept good care records
- People were able to access the service when they needed to and didn’t have to wait too long for treatment
- The service engaged well with women and people in the community. The trust ran outpatient clinics hubs in different locations to support the needs of the local community.
At North Devon District Hospital inspectors found:
- The service had issues with midwifery staff levels and the number of staff didn’t always match planned numbers, which put people at risk of harm
- Leaders didn’t have good systems to manage issues and risks, or to monitor how the service was performing
- Medicines weren’t always being stored or managed effectively. Controlled drugs, such as strong painkillers, weren’t always checked regularly. For example, an emergency grab bag used to treat eclampsia was missing the required medicines, which could lead to treatment delays
- Records were unclear around if the service had followed duty of candour when they needed to, ensuring they were open and transparent with people when things went wrong
- The service hadn’t carried out a recent drill exercise for baby abductions, which went against national guidance.
However,
- People were able to access the service when they needed to and didn’t have to wait too long for treatment
- The service managed infection risk well and the environment was suitable and had enough equipment to meet the needs of women, people using the service and their babies
- The service engaged well with women and people in the community. The trust ran outpatient clinics hubs in different locations to support the needs of the local community.