An under-fire NHS trust at the centre of a major investigation into its maternity services has received improved inspection ratings from the health and care regulator.
The Care Quality Commission (CQC) published its findings following an inspection of maternity services and leadership at Nottingham University Hospitals (NUH) NHS Trust in April and June. This inspection was conducted to check on improvements since the previous inspection, when services were rated 'inadequate' overall and the trust was ordered to make significant improvements in care.
Following the latest inspection, the trust's overall rating for being well-led changed from 'inadequate' to 'requires improvement'.
The overall rating for maternity services at both Nottingham City Hospital and Queen's Medical Centre went up from 'inadequate' to 'requires improvement'. Among other changes:
- The rating for being responsive was modified from 'requires improvement' to 'good'
- The rating for being safe and well-led changed from 'inadequate' to 'requires improvement'
- The rating for being effective remained as 'requires improvement'
- The rating for caring remained as 'good'
Overall, CQC inspectors judged that the trust 'requires improvement'. The overall rating for Nottingham City Hospital has gone up to 'good', and the overall rating for Queen's Medical Centre remains as 'requires improvement'.
The trust pointed out that the latest CQC inspection found significant improvements in the triage unit and day assessment unit, with 96% of all pregnant women seen within 15 minutes of arrival. Staffing concerns previously identified have improved with enough midwifery and nursing staff to keep women and babies safe. All women the CQC spoke to provided "overwhelmingly positive" feedback on their care and treatment, the trust highlighted.
Improvements in the Levels of Care
Greg Rielly, CQC deputy director of operations in the Midlands, said: "When we inspected Nottingham University Hospitals NHS Trust, it was positive to see improvements had been made across both maternity services and the trust's leadership. It was clear that staff in all areas have been working hard to ensure changes are made so people can receive a better standard of care.
"At both maternity services, we saw an improvement in the level of care being provided to people and their babies since we last rated both services as inadequate. It is positive to see that the trust is now on an improvement journey to bring about better and safer care."
Mr Rielly said that staff in both maternity services were kind and understood the personal, cultural, religious, social, and mental health needs of each person.
"At our last well-led inspection, we had concerns around the values and behaviours of some members of the executive team and the negative impact this had on the wider trust," he said. "During this inspection, we saw a team that consistently led with integrity who were open and honest in their approach."
However, while the culture across the trust was improving and encouraged openness and honesty at all levels within the organisation, he said that some staff still didn't always feel able to raise concerns without fear of retribution.
"Leaders were aware of this and were working to create a workplace that is free from bullying, harassment, racism, and discrimination, so we hope to see an improved picture soon."
The CQC said it would continue to monitor the trust.
Welcoming the Findings
NUH NHS Trust chief executive, Anthony May, welcomed the findings of the report and said: "We are pleased that the CQC has recognised the improvements that colleagues at NUH have worked hard to deliver, both in terms of our maternity services, and in the leadership and culture of the organisation.
"I want to thank our teams who work tirelessly to make our hospitals a better place and take pride in delivering the best possible care for patients.
"Most importantly I hope the report provides confidence to local mothers and families who choose to give birth under our care, and that anyone who has had a poor experience can see the positive changes we are making, as well as listening to feedback and embedding improvements.
"I am clear though that further improvements are vital, and in some areas, we need to do more to rebuild trust within our community. We are committed to fostering a culture where our colleagues can continue to improve services and deliver the care we all aspire to."
Ockenden Review
NUH NHS Trust is currently the subject of the largest maternity care inquiry in the history of the NHS, with over 1700 cases being reviewed by senior midwife Donna Ockenden. The independent review was announced following the deaths and permanent brain damage of dozens of infants over a number of years at the trust's maternity services.
Last week, Nottinghamshire Police announced that it was opening a criminal investigation into the trust's maternity services, following a meeting with Ms Ockenden, while the CQC is currently considering launching a prosecution against the trust over three serious incidents which occurred in 2021.
As previously reported, NUH NHS Trust was fined £800,000 in January this year after pleading guilty to two charges related to the death of a female infant and the poor care of her mother at Queen's Medical Centre.
The CQC prosecuted the trust over admitted mistakes which led to Sarah Andrews and her baby Wynter Andrews not receiving safe care and treatment by its maternity services. Wynter died shortly after birth in September 2019.
An inquest the following year found that Wynter died from hypoxic ischaemic encephalopathy, which could have been avoided if staff had delivered her earlier.
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