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Maternity Service Ordered to Make Improvements by Regulator

An NHS maternity service in the north east is the latest facility to be ordered to improve its services, under the health and care regulator’s national maternity services inspection programme.

The Care Quality Commission (CQC) has rated maternity services at the Royal Victoria Infirmary in Newcastle upon Tyne as 'requires improvement' overall and in relation to safety, following an inspection in January.

Safety concerns identified by CQC inspectors included out-of-date equipment, some staff shortages, medicines management issues, and a failure to ensure all staff were trained in key skills.

The hospital has now been given a list of areas where it must take immediate action to improve its maternity services. 

However, the maternity service has strongly defended its performance and pointed out that it received positive CQC ratings across many areas, was rated as 'good' in relation to being well-led, while four areas of 'outstanding' practice were identified for wider learning across the NHS. 

This is the first time maternity services at Royal Victoria Infirmary, which is run by the Newcastle upon Tyne Hospitals NHS Foundation Trust, have been rated as a standalone core service. The CQC did not inspect how effective, caring, and responsive the service was at this inspection, so these areas remained as unrated. The overall rating for Royal Victoria Infirmary remains as 'outstanding'.

CQC: 'More Needs to be Done' to Address Safety Concerns

Carolyn Jenkinson, CQC's deputy director of secondary and specialist healthcare, said: "When we visited maternity services at Royal Victoria Infirmary, we found leaders understood and managed the priorities and issues the service faced, however more work needs to be done to address safety concerns across the service."

The said that inspectors found out-of-date equipment on wards and resuscitation trolleys in the Newcastle Birthing Centre. In addition, daily checks on emergency equipment "weren't adequate", Ms Jenkinson said, which could put people's health at risk if their condition deteriorates. On the positive side, inspectors noted that staff worked well together for the patients and "understood how to protect them from abuse".

Inspectors also found:

  • Not all staff had training in key skills.
  • Staff did not always manage medicines well, inspectors found unsecured and out of date medicines in some areas.
  • Some staff did not feel respected, supported, and valued. Some staff expressed dissatisfaction that they had not been involved in changes to working practices and the way in which senior leaders had communicated these to them.
However, on the positive side:
  • Leaders ran services well using reliable information systems and supported staff to develop their skills.
  • The service engaged well with woman and birthing people and the community to plan and manage services.

Trust 'Very Disappointed' with the Rating

Trust Chief Executive Dame Jackie Daniel said the Trust would review the inspector's recommendations, but she also noted that she did not think the rating was a "fair reflection" of the birthing centre.

"The safety of women and birthing people and their children is of utmost importance to us all and we will prioritise listening and learning to ensure we can provide the high-quality care our patients deserve," she said. "With such positive findings in the CQC report, it is difficult to understand the resultant rating, which we do not think this is a fair reflection of the maternity service and dedicated care that our teams provide every day.

Dame Jackie pointed out that the Trust had has achieved all 10 of NHS Resolutions Maternity Safety Actions for the last 4 consecutive years on the CQC's national maternity survey, demonstrating an "ongoing commitment to the highest standards of safety in maternity care provision".

"As a trust which also provides tertiary and quaternary (highly specialist) level care to women with complex medical conditions, our neonatal and maternal outcomes are amongst the best in the country when benchmarked against peers," she said. "We are very disappointed with the rating applied to the service. Whatever the rating, our response will be to focus on learning and improvement, as it is for any external or internal service review.

Ongoing Maternity Inspections

The inspection at the Royal Victoria Infirmary was carried out as part of CQC’s national maternity services inspection programme, which aims to give an up-to-date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement. There have been a number of critical reports issued under the programme to date.

As recently reported, CQC’s 2022 national maternity survey showed that while experiences of maternity care at a national level were positive overall for the majority of women, they had deteriorated in the last 5 years. In particular, there was a notable decline in the number of women able to get help from staff when they needed it.