Published 28 May 2020
The Care Quality Commission has today rated East Kent Hospitals’ maternity service as ‘good’ for effectiveness, care and responsiveness and ‘requires improvement’ for leadership and safety.
The CQC carried out an unannounced inspection of maternity services at Queen Elizabeth The Queen Mother Hospital, Margate, and William Harvey Hospital, Ashford, on 22 and 23 January 2020, along with a further unannounced visit to the hospitals on 4 and 5 February 2020.
The CQC inspections took place after concerns were raised about the safety of maternity services at the Trust, including the inquest this January into the death of baby Harry Richford, who died at Queen Elizabeth The Queen Mother Hospital in 2017, and a number of families coming forward.
The CQC report notes that ‘following the investigations into serious incidents, we found the maternity service implemented learning to improve safety for women and babies… Duty of candour had improved with the head of midwifery and senior maternity leadership having strengthened the way in which they communicated incidents with families following serious incidents’.
The CQC’s report says the Trust had ‘implemented processes to make sure patient safety was at the centre of women’s care’, that the service ‘provided care and treatment based on national guidance and evidence-based practice’, and ‘made sure staff were competent for their roles’.
Since 2017, many changes had been put in place within the maternity service, including a new leadership team, a staff training programme and new equipment. Following its inspection, the CQC recognised that leaders had improved the governance processes throughout the service with support from partner organisations. It found ‘effective structures, systems and processes to support delivery of the maternity service’. However, it found the new governance processes were not yet fully embedded in some areas. It cited areas requiring improvement, primarily in the hospital antenatal triage and day care services used to assess and monitor women experiencing pain or symptoms from 16 weeks of pregnancy.
The maternity service retained its rating as ‘requires improvement’ overall, while the service at Queen Elizabeth The Queen Mother Hospital, Margate, was upgraded to ‘good’ for ‘Responsive’, which means services are organised in a way that meets women’s needs.
Specific findings of the report include:
- Staff monitored the effectiveness of care and treatment and used their findings to make improvements and achieved good outcomes for women.
- Staff worked well together for the benefit of women.
- The Trust had reviewed its escalation process and implemented processes to make sure patient safety was at the centre of women’s care, and safety huddles, on-call medics, and the centralised fetal monitoring system would ensure that escalation processes were strengthened.
- The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
The report said: “Staff felt respected, supported and valued. They were focused on the needs of women receiving care... The service had an open culture where women, their families and staff could raise concerns without fear”.
Inspectors also found areas of ‘outstanding practice’, including the Trust’s state-of-the-art simulation training equipment, which allows all staff exposure to simulated ‘real life’ emergency situations for life-saving training, and providing wraps to help new mums give ‘skin to skin’ care when breastfeeding their babies.
Improvements noted by the CQC following their previous inspection in 2018 include:
- Scanning all women at 36 weeks of pregnancy to reduce the incidence of birth complications, caesarean sections, breech birth and pre-term babies, in line with best practice
- Women receive one-to-one care during childbirth
- Midwifery staffing levels had improved and were safe and in line with national guidance
- Strengthened clinical leadership.
The CQC also cited areas requiring improvement:
The CQC also cited areas requiring improvement and has issued two Requirement Notices, relating to improvements needed with regard to the governance and the provision of the safe care and treatment.
Action the CQC has asked us to take includes acting on:
- Standard operating procedures within the new antenatal triage service, including guidelines for risk assessment and escalation - the CQC found these were not always followed within the triage service, which meant the necessary care and treatment were not always identified quickly. The CQC found these guidelines were being followed on the hospitals’ labour and post-labour wards. The CQC found staff in day care did not always report incidents, which meant managers could be unaware of avoidable events on the unit.
Since the CQC’s inspection, the service has begun using the nationally-recommended safety communication system called ‘Situation, Background, Assessment and Recommendation’ (SBAR) for all women presenting to triage. The Trust has also recently appointed a Maternity Governance Lead to co-ordinate the review and improvement of the service’s internal governance processes and improve reporting of incidents.
- Antenatal documentation – this was not always clear or up-to-date, because 50% of records were stored digitally and 50% were hand written. The CQC found documentation was well kept and detailed on the labour and post-labour wards.
The Trust is investing in the Maternity Information System, which is supplied by an external provider, so the Trust can begin using further digital recording throughout pregnancy and birth as soon as the technology becomes available.
- Long waits and limited senior doctor cover in the hospitals’ antenatal day care service.
The Trust has since changed the midwifery rota to improve midwifery staffing levels in the antenatal triage and day care service and has increased the senior doctor presence throughout the day. Additional consultants have been recruited, which will ensure continued senior doctor presence.
Since the CQC’s inspection, the service has included all waiting times on the electronic patient records, reported them in the care group quality and risk report, and introduced a weekly review by a senior midwife.
- At William Harvey Hospital, the inspection team found cleaning checks were out of date on some equipment in the antenatal and day care service. The cleaning checks are now being monitored regularly.
Trust Chief Executive Susan Acott said:
“The improvements and positive work cited in the CQC’s report is a testament to the hard work put in by the maternity and obstetric teams to improve the quality of services for women and babies in east Kent.
“We know we have much more to do. We are already acting on the CQC’s recommendations, and have improved staffing levels in the antenatal triage and day care service, implemented a nationally-recognised safety system in that service, and appointed a Maternity Governance Lead to co-ordinate the review and improvement of the service’s internal governance processes.
“We are determined to provide an excellent standard of care to every mother and child who uses our maternity service and we will continue to make improvements and make sure positive changes are thoroughly embedded, so local families can have absolute confidence in their care.”
Healthwatch’s Robbie Goatham said:
“We know staff have been working hard to improve the maternity service in East Kent so it’s good to see this has been recognised by the CQC. There’s still more to be done and if you’re reading this today, and you’ve recently used maternity services in East Kent, we’d urge you to share your story. Healthwatch is an independent organisation set up to listen to patients so do get in touch. Your experience could help improve the service for someone else.”
You can read the reports in full on the Care Quality Commission website
The Healthwatch Kent Helpline is on 0808 801 0102 or email info@healthwatchkent.co.uk
