The Care Quality Commission (CQC) has told East Kent Hospitals University NHS Foundation Trust that it must make immediate improvements to its maternity services following an inspection in January which saw the service’s rating drop from requires improvement to inadequate.
CQC carried out an unannounced focused inspection of the trust’s maternity services at William Harvey Hospital in Ashford and the Queen Elizabeth the Queen Mother Hospital in Margate. The inspection was undertaken in response to concerns received about the culture, safety and quality of the services.
‘Urgent conditions’
Immediately after the inspection, CQC imposed urgent conditions upon the trust requiring it to take action to ensure significant improvements were made to the environment and access to vital equipment in the maternity service.
At Queen Elizabeth the Queen Mother Hospital, the overall rating for maternity services has dropped from requires improvement to inadequate as has the rating for safe and well-led. Effective and caring have gone down from good to requires improvement and responsive remains as good.
The overall rating for maternity services at William Harvey Hospital has dropped from requires improvement to inadequate, as has the rating for safety. Responsive service is at the hospital has dropped from good to inadequate. Effective, caring and well-led have dropped from good to requires improvement.
‘Further decline’
Deanna Westwood, CQC’s director of operations south, said: “Over the last few years we have monitored the maternity services at East Kent Hospitals University NHS Foundation Trust closely and where we have found action is needed this has been made clear so that the trust knows exactly where it must make improvements.
“Yet despite this we still found concerns and it is extremely disappointing that this latest inspection found a further decline in the quality of care people were receiving. “That is why we have used our urgent enforcement powers to require immediate improvements. In particular we identified concerns around the use of resuscitation equipment at both hospitals we inspected. Babies needing emergency resuscitation were taken to a resuscitaire device – however in some cases these were outside the labour room and in the corridor. This could potentially result in delays in vital care and treatment for newborns, as well as separation from the mother and an increase in the potential for babies to be mis-identified.
“We saw staff working extremely hard in difficult circumstances to provide compassionate and responsive care, but not enough had been done to ensure those staff were listened to or fully supported. Staff told inspectors they didn’t feel respected or valued which was having an impact on the quality of care being delivered. Leaders at the trust need to do further work to improve the culture, ensure staff are actively encouraged to raise concerns and clinicians are engaged and encouraged to collaborate in improving the quality of care.
“We’re monitoring the trust very closely, as are system partners and we’ll return to check that the required improvements have been made. If further improvements are not implemented and embedded, we will not hesitate to take further action to ensure we are confident people are receiving the safe, consistent care they deserve.”
For the Queen Elizabeth the Queen Mother Hospital maternity services, inspectors found the following:
- Reception staff could control who entered the unit and staff were encouraged to challenge individuals who were not wearing an identifiable wristband. However, the service did not have a system to control who exited the unit, which was a potential security risk. The service had an infant and child abduction plan; however, this was past its review date of November 2022. Inspectors were told this was currently under review.
- Expressed milk was labelled and dated correctly in the designated fridge. However, the fridge and freezers weren’t individually locked, and neither was the room they were in. The head of midwifery said these should have been locked but staff told us they never were. They replaced the lock on the fridge at the time of inspection after inspectors raised concerns.
- Equality and diversity were not always promoted within the service. The trust did not perform well in the workforce race equality standard (WRES) data. For example, the trust performed worse than the national average for ethnic minority staff receiving harassment, bullying or abuse from patients, relatives or the public, staff and from a manager/team leader or other colleagues in last 12 months. The trust had an action plan to address this.
But inspectors also found:
- Women and people using the service were treated with compassion and kindness by staff. Staff gave emotional support to families and carers.
- The needs of local people were met and service planning took account of women and people using the service individual needs.
- People could access the service when they needed it and did not have to wait too long for treatment.
- Women and people using the service were supported by enough staff in the department who also understood how to protect them from abuse.
The maternity service at the QEQM includes; St Nicholas’ suite which is a daycare and antenatal clinic, St Peter’s
midwifery led unit, Kingsgate ward which is an antenatal and postnatal ward and the labour ward.
‘Acted at once’
Tracey Fletcher, Chief Executive, East Kent Hospitals, said: “I am sorry that despite the commitment and hard work of our staff, when they inspected in January, the CQC found that the Trust was not consistently providing the standards of maternity care women and families should expect.
“We acted at once to respond to the CQC’s immediate safety concerns. We have:
- Increased doctor staffing in the triage service at William Harvey Hospital, which has improved the time within which women are seen by a doctor.
- Made immediate changes to ensure better access to and regular checking of emergency equipment.
- Introduced electronic alerts for staff when a fetal monitoring check is due and ensured all staff have completed fetal monitoring training.
- Appointed a new dedicated fetal heart monitoring midwife who works alongside our clinical teams to ensure safe monitoring is consistently completed.
- We have increased cleaning of the environment and the equipment and this is monitored daily, alongside hand hygiene and PPE compliance.
- We are committed to giving both the women and families using our service and the CQC confidence in the quality and safety of our care.
“Our staff are determined to improve our services for patients. The CQC reports recognise the compassion and kindness they have shown to women and families and the outstanding practice of the service in proactively listening to and seeking feedback from every person who gives birth with us about what we can improve.
“To date, we have spoken with more than 3,600 families, and have received positive feedback of our service as well as areas we need to improve. We are making changes from what they tell us, such as improving facilities for partners and improving choice of pain relief options. Ninety per cent of these families said they were positive about their care but we will continue to listen to families and act so all families can have greater confidence in our services.
“We recognise that, despite the changes that have been made to the service so far, there is a lot more to do to ensure we are consistently providing high standards of care for every family, every time.
“We are continuing to work hard to improve the culture and multi-professional teamworking highlighted by Dr Bill Kirkup through the independent investigation into our maternity services, including implementing ‘civility saves lives’ staff training. I am grateful to the families who are helping us as we seek to make these improvements and to our staff, for their commitment.”
Maternity failings
The urgent enforcement conditions came on the heels of the damning independent report into maternity failings at QEQM and William Harvey Hospitals which found 45 baby deaths could have been avoided.
The report, led by Dr Bill Kirkup and published in October, reviewed the circumstances of maternity deaths at the East Kent Hospitals Trust sites in between 2009 and 2020 in response to a concerning number of avoidable baby deaths.
Issues with maternity were brought into the spotlight following the death of baby Harry Richford at Margate’s QEQM Hospital in 2017 after a series of errors.
The coroner ruled that Harry’s death had been avoidable. The inquest during January 2020 had heard of the “panic” after Harry was born by emergency Caesarean section during which his heartbeat kept dropping. Harry died seven days after his delivery from a condition caused by a lack of oxygen. An independent report said he might have survived had there not been a delay in resuscitation at his birth that caused irreversible brain damage. The coroner said there were 7 gross failings that amounted to neglect.
In 2021 East Kent Hospitals Trust was fined a total of £761,170 – inclusive of costs – for failing to discharge its duty to provide safe care and treatment, resulting in avoidable harm with the death of seven day old Harry Richford and sub standard care of his mum Sarah at QEQM Hospital in 2017.
