The Care Quality Commission (CQC) has rated maternity care at St George’s Hospital inadequate following an inspection in March 2023.
The hospital is run by St George’s University Hospitals NHS Foundation Trust and was inspected 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.
This is the first time maternity services at St George’s 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 inadequate overall, they’ve also been rated inadequate for safe and well-led. This inspection didn’t rate how effective, caring and responsive the service was.
The overall rating for the trust remains as requires improvement.
Following this inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to keep people safe at St George’s Hospital.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“When we inspected maternity services at St George’s Hospital, it was concerning to see a deterioration in the standard of care being delivered. We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies.
“Both staff and people using the service were being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic.
“When things went wrong, we saw staff were honest and supportive to people, but leaders were slow to respond and often logged incidents as causing less harm than they did. We saw some baby deaths weren’t investigated as serious incidents and investigations didn’t always take place in a timely way. This is unacceptable and put people at risk of avoidable harm from mistakes being repeated.
“Staff told us care often felt unsafe because there weren’t enough of them, and we saw they’d reported numerous incidents in which people’s safety was at risk. Staff said managers told them nothing could be done, but we found opportunities to reduce risks had been missed or ignored.
“We also found people were at risk of infection because ward environments were dirty and poorly maintained. Again, staff had raised many issues with the trust but some longstanding problems still hadn’t been fixed. Leaders must listen and act when staff tell them something isn’t right.
“Following the inspection, we’ve issued a warning notice to focus the trust’s attention on how they’re managing risks to women and people using this service, as well as their babies, and we expect to see rapid and significant improvements. The trust has submitted an action plan on how they plan to resolve the issues raised.
“We’ll continue to monitor the service and the wider trust, including through future inspections, and won’t hesitate to take further action if we’re not assured it’s delivering safe and effective care.”
Inspectors also found:
- Leaders didn’t always act quickly to reduce risks to people’s safety from understaffing, didn’t always try to understand why many staff were leaving, and hadn’t mentioned issues in maternity during the trust’s annual staffing review. While staffing challenges are affecting much of the NHS, leaders must ensure this doesn’t undermine people’s safety
- The delivery suite had no clear leadership to make sure women and people using the service received safe, consistent care
- The service didn’t assess people’s risk in a consistent way when they arrived and didn’t always prioritise people according to their clinical need. Inspectors saw some people wait without privacy or a way to call for help. Inspectors found incidents in which some people left before being seen because they’d waited so long
- Medical staff didn’t always have enough training in resuscitation, caring for people with disabilities, or safeguarding children and young people. Training days were often rescheduled because there weren’t enough staff
- Staff said they felt opportunities weren't equal for all staff and inspectors saw that staff from ethnic minority groups were underrepresented in leadership roles and promotions.
However:
- Women and people using the service said most staff were friendly and explained their care to them. However, some people said staff were stressed
- Most staff knew how to care for parents with learning disabilities and used a ‘maternity passport’ to make sure they could communicate their needs and wishes
- A new maternity strategy had been implemented under the current director of midwifery, and staff said the workplace culture was improving
- There had been some improvements to equality in the hospital, and the trust’s Workforce Race Equality Standard (WRES) action plan was rated outstanding by the National WRES team.