Maternity services at Hull Royal Infirmary have been downgraded from 'good' to 'inadequate' by the Care Quality Commission (CQC) after inspectors found a "chaotic environment that was not fit for purpose".
During checks carried out over the course of 3 days in March and April, the regulator found that systems and risks in the antenatal day unit and triage department were "not well managed" and led to long delays in women being seen.
Inspectors also highlighted concerns that staff did not complete training in areas where there was a known risk and that there was "no policy in place to outline what training was mandatory and how often training topics should be completed in line with staff roles". Despite an exercise completed in January to find out what areas of training staff felt they needed to develop, no action had been taken to implement this by the time of the inspection.
Some staff at the unit, which forms part of the Hull University Teaching Hospitals NHS Trust, said they had been told that they were expected to complete training in their own time, while oversight of training was described in the report as "disjointed".
The CQC said it had been unable to review mandatory training compliance "due to the lack of trust policy", but training records indicated that just 39% of staff had completed the perinatal institute growth assessment protocol training, and 51% of all staff groups had completed the fundal height measurement training, against the trust target of 90%.
Safety Issues Identified
The report also found that the "design, use of facilities, premises and equipment did not always ensure women and birthing people were safe". In one example inspectors highlighted that on the antenatal day unit "there was no neonatal resuscitaire and there was no plan in place for how staff would access one in an emergency".
The CQC said it had reviewed one serious incident where the lack of a continuous cardiotocograph had "led to poor outcomes", and found that this had not been appropriately graded as part of the perinatal mortality review of the baby’s death. "This meant that the failures in care provided had not been fully recognised and shared with the family involved," and that "not enough action had been taken to learn from this and reduce the chance of re-occurrence".
Staff did not always keep detailed records of women and birthing people’s care and treatment, while records were not always clear or up to date, the inspection found. It also noted that staff "did not always work well together across the different units of the service for the benefit of women and birthing people", and that "some staff spoke about unkindness between staff".
Understaffing Made Women Feel Unsafe
The CQC also expressed some concerns about staffing levels, noting that on the day of inspection, "midwifery staffing levels were below the expected levels across each department of the service", leading some women and birthing people to say they felt "unsafe".
Carolyn Jenkinson, deputy director of secondary and specialist healthcare at the CQC, said: "When we inspected the maternity services at Hull, it was really concerning to see such a deterioration in the standard of care being delivered. We saw areas where urgent improvements are needed to ensure safer care is provided to women, people using this service, and their babies.
"The lack of effective management by leaders had caused poor practices to become normalised across the service, with minimal plans for improvement in place. For example, there was no senior oversight of the antenatal day unit and triage area, which had become chaotic as it didn’t have an effective appointment system in place. This led to people waiting for long periods of time, with no offer of food or drink from staff."
The CQC recognised some positive aspects of maternity services offered at Hull Royal Infirmary. The service was clean and infection risk was well controlled, and management had started to identify some concerns and take action to make improvements, the report noted.
Trust Taking "Immediate Action"
Hull University Teaching Hospitals NHS Trust said it was "extremely disappointed" with the outcome of the inspection. In a statement emailed to Medscape News UK, a spokesperson said: "Since the inspectors visited, we have reviewed all of the areas highlighted by the CQC and we are taking immediate action to address the urgent issues raised in the report."
The trust said it had appointed a head of midwifery and two additional matrons to support the director of midwifery and oversee an improvement programme, "including the way we respond to incidents and how we share learning across our teams".
The spokesperson added: "We have also strengthened the medical leadership team with the appointment of a dedicated clinical director for maternity and neonates to address the challenges and embed improvements being made. Crucially, we have appointed an additional consultant, with three further consultant posts created as part of our 5-year plan to ensure we have more, suitably qualified, competent staff to deliver our ante-natal triage in line with national guidance."