Agenda item
Maternity Services at Royal London - CQC Inspection
Presentation from Max Geraghty, (Inspection Manager, Care Quality Commission)
The report provides an overview of the Care Quality Commission’s findings from their most recent inspection of the Royal London maternity & gynaecology services.
Minutes:
Max Geraghty provided the Panel with an overview of the Care Quality Commission’s (CQC) findings from their most recent inspection of the Royal London maternity & gynaecology services and informed the Panel of the following: -
· CQC makes sure health and social care services provide people with safe, effective, compassionate, high-quality care and encourages care services to improve;
· CQC monitors, inspects and regulates services to make sure it meets fundamental standards of quality and safety and publishes its findings, including performance ratings to help people choose care;
· CQC is introducing ratings to tell whether an organisation and its main services are outstanding, good, requires improvement or is inadequate;
· CQC publishes reports after every inspection setting out what it has found and includes examples of good practice as well as areas for improvement;
· The CQC asks five key questions on all inspections:
-
- are services safe?
- are they effective?
- are they caring?
- are they responsive to people’s needs?
- are they well-led?
- The Quality Report was published in
May 2015 and the overall rating for maternity & gynaecology
services was “Requires Improvement” and the following
concerns were highlighted -
- Staffing –
- There was not enough medical and midwifery staff and there was evidence that this compromised the care offered to some women;
- The Trust did not meet the London Safety Standards recommended minimum birth to midwife ratio of 1 midwife to every 30 births; and
- Women in labour were prioritised, but this meant that other areas were often short-staffed with an impact on waiting times for other women.
- Security -
- CQC also had concerns about the security of mothers and babies because of the high number of visitors at all hours;
- There was no ward clerk at night, which meant there was further reduced control over visitors;
- Neonatal security had been identified as a risk on the risk register; and
- Baby security tags.
- Leadership -
- Leadership for maternity and gynaecology services was provided by the Women’s and Children’s Health Clinical Academic Group (CAG);
- This did not appear to provide an effective route from ward to Board and neither doctors nor midwives felt that their concerns about safety, or the sustainability of working under pressure were acknowledged by management; and
- A number of staff perceived the leadership to be remote and unsupportive.
- Culture -
- A number of medical and midwifery staff had been in post for several years and enjoyed working at the hospital and spoke well of the way all staff worked together as teams, both doctors and nurses;
- Staff were positive about management at service level; and
- Staff valued the teamwork and shared values on the ground to keep patients safe.
- CQC will continue to engage with Barts Health NHS Trust as part of the wider stakeholder involvement.
- Staffing –
The Chair, Councillor Amina Ali invited the representatives from the Royal London Maternity Services to respond to the CQC report.
Sandra Reading (Director of Midwifery) and Deborah Kelly (Deputy Chief Nurse), provided a written response to the CQC report and highlighted the following key actions –
· Maternity Services Action Plan –
o Uplift in mother to midwife ratio of 1:28 – this is an increase of 22 midwives (whole time equivalents)
o Reduce temporary staff by ensuring 95% of staff are permanent
o Improved consultant presence
o Reviewed baby tagging system, and implementing new system by April 2016
o Immediately improved security on the wards, through installing swipe access, introducing 24/7 clerical reception desk cover and reviewed and amended visitor and discharge policy
o Improved access to data through maternity performance dashboard for staff
o Two new ultrasound machines procured to ensure image quality
o Progress work on midwifery – led unit
· Improving women’s experience -
o Focus on changes throughout the maternity pathway
o Improving information and communication
o Women and Family Centred Care
o Focus on safe and compassionate care
o New leaflet to get more detailed feedback
· Maternity information pathway
o One stop booking//pregnancy information pack
o Referral to Vulnerable team/maternity mates
o Bump start project for further information on community support
o New women’s information range
o Weight management and GDM sessions
o Birth plan/antenatal class
o VBAC/birth options clinic
· New Developments –
o Induction of Labour (IOL) pathways including OPIOL and timing of admission for high risk IOL
o Co-located birth centre opening in Summer 2016
o Postnatal information improvement project
o Joint project with Lead Nurse for neonates and neonatologist to review TC and reduce length of stay – possibility of care in the community
o Enhance continuity of care with opening of co-located birth centre and increase in integrated teams
o New consultant posts – 1 post with special interest in fetal medicine
o Transforming Services Together plan – with 30% of all births to be out of Consultant led unit over next few years
o Design of a maternity app planned – link to new birth centre and information for women
· Listening and responding to feedback –
o Review of staffing
o Increase in funding – up to 22 midwives
o Recruitment days
§ 26 applied – 6 hired
o Improve hours – 2 consultants and tertiary unit
o Achieving over 95%
o Full review of security arrangements
§ Baby tagging
§ Different swipe system
§ 24/7 administration
§ Change of access
§ Discharge policy
o Live data – more accurate
o Capacity – extremely busy
Members considered the presentation and made the following comments –
o Where does women and their views feature in the response to the CQC
o If the staff have been listened to, what has changed
o The HSP recently had a site visit to the hospital and there were still some negative comments
o It is as though a culture of fear within the patients has been developed
o Patients also fed back that some of the comments being made by nursing professionals were unacceptable and in some cases derogatory to the patients
o It is all about the public perception
o Is there anyway for the CQC to provide additional feedback to the hospital as to where they are up to currently
o The findings report that the HSP have to write will need to be read by mothers in the Borough and reflect their experiences, but to date it is a worry about what the content of the report will contain unless there is some radical cultural changes and changes in perception quite quickly.
Deborah Kelly commented that the patient experience in the maternity unit has been poor, but they are listening and responding to the negative feedback by providing patient feedback, conducting patient surveys and having friends and family testing. The services are hoping to engage more with patients and to change the culture by launching a Patient Experience and Engagement Strategy shortly. She also stated that improvements are being implemented to the Governance and Accountability framework with programmes being developed on trust, expectations and leadership. She also stated that there is a change of leadership underway at the Board level with a significant programme of change being negotiated with staff. Changes are being made to the culture, environment, training, awareness and staff.
Dr Sam Everington informed the Panel that the hospital is operating at a deficit of £135m which is a challenge across the sector. He also stated that the National Maternity Report due out in late February is proposing to increase home births/community births by up to 20%, which would contribute even further to the existing challenges. There needs to be some acknowledgement at the hospital that there is a generic cultural issue from the top down and there needs to be a more modern approach from the team.
Healthwatch representatives commented that Healthwatch operate a complaints and comments website and to date they have not had any evidence of patients being ill-treated.
Max Geraghty informed the Panel that if the Inspectors were to engage with the hospital at this stage there would be further risks of issues being identified for improvement. The next inspection is likely to take place at the end of quarter 1.
RESOLVED THAT –
1. The presentations and reports be noted; and
2. The Chief Executive of the hospital be invited to the next meeting.
Supporting documents:
- 3.1 - Cover Report Maternity Services at Royal London CQC, item 4. PDF 45 KB
- 3.1a - Maternity Services at Royal London CQC Presentation [Compatibility Mode], item 4. PDF 384 KB
- 3.1b - The Royal London Maternity Service response to the CQC report, item 4. PDF 306 KB