The Care Quality Commission (CQC) has rated two out of three maternity services run by University Hospitals of Leicester NHS Trust as requires improvement following an inspection in February and March.
The inspection was carried out as part of CQC’s national maternity 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 at a local and national level.
Inspectors looked at the areas of safe and well-led in the maternity services. Following the inspection, the services were rated:
- St Mary’s Birth Centre – The rating for safe remains as good and the rating for well-led has moved down from good to requires improvement which means the overall rating for maternity services at St Mary’s Birth Centre remains as good.
- Leicester Royal Infirmary – the rating for maternity services at Leicester Royal Infirmary has moved down from good to requires improvement. Safe moved down from requires improvement to inadequate, and well-led moved down from good to requires improvement.
- Leicester General Hospital – the rating for maternity services at Leicester General Hospital has moved down from good to requires improvement. Safe has moved down from requires improvement to inadequate and well-led moved down from good to requires improvement.
Following the inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to how they were managing each maternity service.
The overall rating for the trust remains as requires improvement.
Carolyn Jenkinson, deputy director of secondary and specialist healthcare, said:
“When we inspected maternity services at University Hospitals of Leicester NHS Trust, we observed a deterioration in the level of care being provided to women, people using the service and their babies.
“The leadership team has recently restructured with many new posts still needing to be embedded. Leaders should continue to focus on improving their oversight of risks and managing performance so people can receive a better, and safer standard of care.
“Senior leaders already had plans in place to prioritise the main risks, including staffing levels, so we hope to see these changes embedded when we next inspect. Staff spoke positively about the new leadership team, describing them as visible and approachable and felt they supported staff to develop their skills and take on more senior roles. In addition, a matron had recently been appointed to focus solely on recruitment, retention, and staff wellbeing.
“Both services were regularly understaffed which placed people and their babies at risk. It also meant staff weren’t always able to take their breaks, which affected their well-being, morale, and ability to do their job.
“We also found multiple examples where people’s care had been delayed in maternity triage due to doctors not being available. Some of these delays were very long, for example six hours, and some resulted in people self-discharging before they had a medical review, which could place them at risk.
“It was positive, however, to hear that leaders were working closely with staff and an external agency to improve culture across all maternity locations. Staff at St Mary’s Birth Centre should be proud of the safe care they were providing. Staff there were focused on the needs of people and babies in their care and were fully supported by managers to develop their skills.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people and their babies can receive safe and appropriate care.”
Inspectors found the following during this inspection:
At St Mary’s Birth Centre:
- Leaders didn’t always operate effective governance processes throughout the service
- The design, maintenance and use of facilities, premises and equipment didn’t always keep people safe
- The birth centre had enough suitable staff
- Staff were focused on the needs of women and people receiving care, and staff were clear about their roles and accountabilities
- Staff described happy, healthy working relationships within their teams.
At Leicester Royal Infirmary:
- Staff didn’t always feel respected, supported, and valued
- Actions to mitigate risks and make improvements weren’t always identified
- Staff had training in key skills, and generally understood how to protect women and people from abuse
- Staff understood the service’s vision and were developing a strategy with key stakeholders to implement it.
At Leicester General Hospital:
- Staff didn’t always feel respected, supported, and valued
- Actions to mitigate risks and make improvements weren’t always identified
- Records were not always clear, up-to-date, easily available and stored securely
- Staff had training in key skills, and generally understood how to protect women and people from abuse
- Staff understood the service’s vision and were developing a strategy with key stakeholders to implement it.