The maternity service at Lister Hospital, Stevenage has been served a legal warning notice to improve the quality and safety of its services, following a critical inspection report from the health care regulator.
The hospital, which is run by East and North Hertfordshire NHS Trust, has seen its maternity service rating drop from 'good' to 'inadequate' following a Care Quality Commission (CQC) inspection last October as part of the national maternity services inspection programme.
The inspection report, published Friday, says women and babies were not receiving standards of care they have a right to expect in the hospital’s maternity service. Insufficient staffing levels and a failure to always follow best practices for infection control, medicines management, and risk assessments were among the key issues identified by CQC inspectors, though there were some positive findings too.
While Lister Hospital's maternity service is now rated 'inadequate', ratings for the trust and hospital overall are unchanged and remain as 'requires improvement' following this inspection.
The CQC's Lister hospital maternity services inspection found:
- There were not enough staff to care for women and keep them safe.
- Mandatory and maternity-specific training in key skills was provided to all staff, but steps were not taken to ensure everyone completed it.
- Best practice was not always followed to protect people from infection.
- Staff did not always assess risks to women, act on them and keep good care records. They did not manage medicines well and there were delays in the investigation of incidents.
- Not all staff had completed mandatory safeguarding training.
- Equipment was not always well maintained.
- Leaders did not always ensure staff were competent, neither did they support staff to develop their skills.
- People could not access the service when they needed it. Some waited too long for treatment, which impacted on the care they received.
The hospital will be served with further enforcement action if the improvement actions outlined by the CQC are not made.
'Drop in Quality and Safety'
Commenting on the maternity inspection report, Carolyn Jenkinson, CQC head of hospital inspection, said she was "very concerned" by the deterioration in the quality and safety of maternity care at Lister Hospital, "which falls shorts of what women should be able to expect".
"This drop in quality and safety was down to insufficient management from leaders to ensure staff understood their roles, and to ensure the service was available to people when they needed it," she said, leading the CQC to issue the trust with a warning notice to "focus its attention on rapid improvement in this area".
She added that staffing and training was an issue in the inspection.
"Our inspection found the service lacked enough staff to provide good care and keep people safe. This was worsened because training targets were not being met, meaning even when there were enough staff, they didn't always have right skills." Inspectors also found that staff "didn’t always follow best practice to protect people from infection or assess risk".
However, the inspectors did find some good practice, including collaboration between staff, good monitoring of the service’s effectiveness, and constructive community engagement.
“We also found the service had a strong culture where improvement, research, and innovation were prioritised," Ms Jenkinson said.
'Immediate and Thorough Action'
In a statement to Medscape News UK, East and North Hertfordshire NHS Trust Chief Executive Adam Sewell-Jones said: "Our maternity team work incredibly hard and keep the interests of women and birthing people central to everything they do. I want to reassure you that our hospital remains a safe place to give birth – as shown by other national measures that we regularly review and report on.
"However, we take this report very seriously and our new director of midwifery has already led immediate and thorough action to increase cleanliness, and to ensure that our equipment is up to the required standard.
"We have a detailed improvement plan to address remaining issues and will report openly on our progress," he said, adding that they had already recruited more maternity staff.
"We recognise the national shortage of midwives, however, our staffing levels are in-line with other maternity units in the east of England and since the inspection we have recruited 17 more midwives."
Maternity Care Deteriorating Across NHS
Today’s report on Lister hospital is the latest in a series of negative CQC inspection reports on NHS maternity services, including four London maternity services under Barts Health NHS Trust, which found that staff shortages and care failures were putting mothers and infants at risk.
The CQC also published the results of its 2022 nationwide maternity survey earlier this month, which revealed that fewer women who gave birth in NHS maternity services last year had a positive experience of care compared to 5 years ago.
East and North Hertfordshire NHS Trust was categorised as 1 of 7 performing 'worse than expected' in CQC’s 2022 maternity survey, although these results were published after the latest inspection took place.
The trust also performed worse than other trusts in CQC’s 2021 maternity survey and was highlighted as 1 of 8 'worse than expected' trusts in England for cleanliness.