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CQC Finds Risk From Unsafe Care at London Maternity Service

A London hospital has been issued with a warning that it must rapidly improve its maternity services, after inspectors found a concerning deterioration in patient care and safety standards. 

Maternity care at St George's Hospital in Tooting was rated 'inadequate' by the Care Quality Commission (CQC) after inspectors paid a visit in March. The regulator has since issued a notice to St George's University Hospitals NHS Foundation Trust stating that "significant and urgent improvements are needed to ensure safe care is provided".

Unsafe staffing levels, inadequate risk management, key safety training gaps, and a failure to correctly investigate some baby deaths were among the serious issues highlighted in the report.

As well as maternity services being rated 'inadequate' overall by the CQC, they were also rated 'inadequate' for safety and leadership. This inspection didn't rate how effective, caring, and responsive the service was, but the overall rating for St George's remains as 'requires improvement'. 

"Significant and Urgent Improvements Needed"

Commenting on the inspection findings, Carolyn Jenkinson, CQC's deputy director of secondary and specialist healthcare, said: "When we inspected maternity services at St George's Hospital, it was concerning to see a deterioration in the standard of care being delivered. We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies.  

"Both staff and people using the service were being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic. 

"When things went wrong, we saw staff were honest and supportive to people, but leaders were slow to respond and often logged incidents as causing less harm than they did. We saw some baby deaths weren't investigated as serious incidents and investigations didn't always take place in a timely way."

Ms Jenkinson described the state of maternity care at the hospital as "unacceptable" and said it "put people at risk of avoidable harm from mistakes being repeated".

Staff told CQC inspectors that care often felt unsafe in the unit because there weren't enough of them, and they reported numerous incidents in which people's safety was at risk. "Staff said managers told them nothing could be done, but we found opportunities to reduce risks had been missed or ignored," Ms Jenkinson said.

People were also found to be at risk of infection because ward environments were dirty and poorly maintained. Staff said that despite raising many issues with the trust , some longstanding problems still hadn't been fixed. "Leaders must listen and act when staff tell them something isn't right," Ms Jenkinson said.

On the positive side, the CQC found that a new maternity strategy had been implemented under the current director of midwifery, and that staff reported improvements to the workplace culture. There had also been some improvements to equality in the hospital, and the trust's Workforce Race Equality Standard (WRES) action plan was rated outstanding by the National WRES team. 

NHS Trust Taking Action to Address Issues

Following the inspection, the trust submitted an action plan to the CQC outlining how it plans to resolve the issues raised. It will continue to be monitored to ensure the necessary improvements have been made and patients are not being put at risk.

In a statement seen by Medscape News UK, the trust said that since March, it had made significant progress in a number of areas to improve its maternity services. These include recruiting an additional 15 midwifes, improving the patient triage assessment process on the delivery suite, and addressing risk assessment and cleanliness issues.

Jacqueline Totterdell, group chief executive of St George's, Epsom and St Helier University Hospitals and Health Group, said: "We take the findings of this report extremely seriously and accept that the standards on our maternity unit have fallen below what we expect."

She said the trust had taken immediate action to address the concerns raised by the CQC and remains committed to making improvements to ensure those providing and receiving care have the best possible experience.

"I would like to reassure those due to give birth in our maternity unit that it continues to be a safe and positive environment to give birth in, which has been recognised by the CQC national patient experience maternity survey that rated St George's as receiving the fourth highest patient satisfaction levels nationally in 2022, as well as being rated in the top three performing trusts in London for antenatal care," Ms Totterdell said.

She added: "We understand that people may be concerned, and I would encourage anyone who is to get in touch so we can listen to and answer questions directly."

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