Two maternity services in North East England have been ordered by the healthcare regulator to make rapid improvements to their services following a "concerning" deterioration in the care provided to women and babies.
The Care Quality Commission (CQC) rated both services run by County Durham and Darlington NHS Foundation Trust as 'inadequate' following an inspection in March and has issued them with a warning notice.
Inspectors found a raft of safety issues at University Hospital North Durham and Darlington Memorial Hospital, many of which were exacerbated by understaffing. Key issues included staff not consistently assessing risks to women or acting on them, delayed inductions, and failures to carry out screening tests and adhere to national guidelines.
Following the inspection, both services saw their ratings for being safe and well-led decline from 'good' to 'inadequate'.
These ratings changes mean that the overall ratings for both hospitals have gone down from 'good' to 'requires improvement'.
Concerning Deterioration in Care
Carolyn Jenkinson, CQC deputy director of secondary and specialist healthcare, said: "When we inspected maternity services at County Durham and Darlington NHS Foundation Trust, it was concerning to see such a deterioration in the level of care being provided to women, people using the service and their babies.
"Across both maternity services, leaders urgently need to mitigate the negative impact of understaffing. We saw that staff had reported delayed inductions of labour, including babies categorised as high risk, due to understaffing. Midwives had told managers they found the unit was unsafe, but no improvement had been made and staff continued to work late, miss breaks, and take sick leave due to stress which is totally unacceptable.
"We were concerned that women and people using the service weren't being observed or risk assessed appropriately, which increased the risk of a delay in recognising when their condition deteriorated and that their care could be delayed."
Following the inspection, however, trust leaders provided information on the action they had taken to address this issue, she acknowledged.
Concerningly, CQC inspectors also found multiple examples where screening tests hadn't been carried out to safely manage the pregnancies of women and people using the service. There had been over 70 incidents over the past year where national screening standards or internal policies hadn't been followed, which could place women and their babies at risk.
Other issues recorded by CQC inspectors were that:
- Senior leaders didn't always support staff to develop their skills
- Not all staff had training in key skills needed for their roles
- The service didn't always engage well with women using the service, and the local community to plan and manage services
- Staff had limited awareness and understanding of the service's vision and values and weren't always able to apply them in their work
- Leaders didn't operate effective systems and didn't always manage risk and performance well
- Staff didn't consistently carry out checks on equipment
- Staff didn't always feel respected, supported, and valued
"It was positive, however, that staff were kind and worked well together, often under pressure, to benefit those in their care," Ms Jenkinson said. "We will continue to monitor the trust, including through future inspections, to ensure the necessary and rapid improvements are made so people using the service and their babies can receive safe and appropriate care."
Committed to Making Improvements
In response to the findings, Sue Jacques, chief executive of County Durham and Darlington NHS Foundation Trust, said: "W e are of course very disappointed with the CQC's rating for our maternity services. We take the concerns raised during the inspection extremely seriously and would like to assure all our birthing people and families that we are absolutely committed to providing you with the best care and experience at this special time in your lives.
"We acknowledge that the report makes difficult reading for us, our colleagues, and our local communities. We recognise the areas for improvement raised by the CQC.
"A lot of work has already taken place to make improvements in the highlighted areas since the inspection in March and we have developed focused action plans to improve safety and efficiency further."