Inspectors have found ‘serious problems remain’ at Nottingham University Hospital’s maternity units, which ‘did not have enough staff’ to keep women and babies safe.
The Care Quality Commission (CQC) has kept maternity services rated as ‘inadequate’ at the City Hospital and Queen’s Medical Centre, which were first given the rating following a 2020 inspection.
The CQC returned in March this year and raised concerns over the triage service – where pregnant women are advised and assessed – but did say some improvements had been made.
Fiona Allinson, CQC’s director of operations, Midlands network, said one of the biggest concerns was that staff weren’t always carrying out observations on women to check if they had deteriorated.
It comes as NHS England announced on May 26 that Donna Ockenden will lead a new review into the trust’s maternity services.
A warning notice was also served to the trust – when care “falls below what is legally required” – in relation to the triage problems.
A new report, published on May 27, said that “the service did not have enough staff to care for women and keep them safe” at both maternity departments.
The new CQC report also listed some improvements, including the new 24/7 maternity advice line to support women throughout their pregnancy.
Inspectors also found that staff treated women with compassion and kindness, and respected their privacy and dignity.
But the report stated that the trust was missing its target to triage women within 15 minutes in some cases, and risk assessments were not consistently completed on arrival.
The report added: “Records showed there was also a declining performance trend in the 15-minute target.”
Following the latest inspection, the overall rating for both Nottingham City Hospital and Queen’s Medical Centre remains rated requires improvement.
Fiona Allinson, CQC’s director of operations, Midlands network, said that staff were working hard under “challenging circumstances” which was reflected in the ‘good’ rating for how caring the service was.
But Ms Allinson said: “Although we found some improvements, they are not widespread or rapid enough to address the areas of concern we identified during previous inspections.
“It’s disappointing that despite several inspections where CQC has told the trust areas they must improve to keep mums and babies safe, serious problems remain.
“One of our biggest concerns was that staff weren’t always carrying out observations on women to check that their condition hadn’t deteriorated.
“Midwives weren’t always clear who could perform observations, some staff didn’t carry them out as they said it wasn’t their role, and overdue observations went unrecognised.
“This gave us serious concerns about their ability to recognise and respond to women who were deteriorating, so we have taken enforcement action against the trust to focus them on rapid improvement in this area.
“Despite placing conditions on the trust’s registration in October 2020 due to staffing concerns, we found there were still not enough staff with the right qualifications, skills, training and experience to keep people safe. Although there was good planning work being done to try and manage these shortages, we found services operating with staffing levels that didn’t match planned numbers.
“It was however positive to see improved morale as a result of improvements to reduce the bullying culture we found at our last inspection.”
Ms Allinson added that the trust has a detailed improvement plan and has been receiving “intensive support” from NHS England and NHS Improvement since October 2020.
The trust is expecting a new Chief Executive, Anthony May of Nottinghamshire County Council, to start in post this September.
Sharon Wallis, Director of Midwifery at Nottingham University Hospitals said: “Keeping mums and babies safe and providing them with high quality care remains our top priority, and we are committed to continuing our work with local families and healthcare partners to make the changes still needed.
“Our teams are working hard to make the necessary improvements, but recognise we have more to do and are absolutely determined to speed up the pace of change and deliver quality services for women and their families.”