Agenda item

The Director of Midwifery and Divisional Director of Nursing for Women’s Health (DMD) at BHRUT updated the Board on the Care Quality Commission’s (CQC) inspection of maternity services at Queen’s Hospital and King George Hospital.

The last inspection was in June 2018 and maternity services were rated as ‘good’ in all inspection categories. The CQC undertook an unannounced inspection of maternity services in June 2021 in response to concerns made by whistle-blowers. The recent inspection focused on the ‘safe’ and ‘well lead’ categories. The DMD assured the Board that BHRUT were already aware of the concerns and had already developed an action plan to address them.

The CQC were concerned that there was a disjoint between senior staff and the divisional management team and were also troubled that key members of the midwifery team were leaving the service. The CQC also questioned whether recent improvements in the service could be sustained as a result.

The CQC published its report on 1^st October 2021 and, whilst the rating for the ‘safe’ category was rated ‘good,’ the CQC downgraded BHRUT’s maternity services in the ‘well lead’ category from ‘good’ to ‘needs improvement.’ The DMD added that the CQC did not review BHRUT’s maternity services in the remaining categories of ‘effective,’ ‘caring,’ and ‘responsive’ and therefore they retained the ‘good’ rating from the June 2018 inspection. 

Maternity staff told CQC inspectors that there weas bullying in the department and an unpleasant culture. Staff also did not feel respected, supported, or valued.

The CQC also concluded in their report that the systems in place to manage performance were not always effective nor did they sufficiently identify risks and issues. Additionally, the CQC cited incidences that were not in compliance with the Health and Social Care Act 2008. The CQC ordered BHRUT to take action on six requirements and also identified additional requirements that it recommended BHRUT should undertake.

The DMD updated the Board on the action BHRUT would be taking to address the CQC concerns and highlighted the following;

·  Safety was discussed at every meeting and staff were encouraged to speak up about any risks they see, either to management or an independent guardian service;

·  Incidents were discussed on a weekly basis, to ensure that they were swiftly; addressed and lessons learned which were then disseminated;

·  Monitoring guidelines were being reviewed and updated;

·  BHRUT was a member of NHSE/I’s Maternity Safety Support Programme (MSSP);

·  An action plan was being drawn up with staff to improve the working culture and address the CQC’s report;

·  CQC Action Plan, and all other plans, would be fed into a master improvement plan which will report, via the Maternity Governance Process, to the BHRUT Board;

·   A Divisional Director for Women and Child Health was being recruited as was a second head of midwifery;

·  Additional staff had been recruited to the clinical leadership team;

·  Joint work was being undertaken with the Maternity Voices Partnership

The DPH noted that all the maternity units in Northeast London are facing pressures owing to a disproportionately high birth rate. The Board acknowledged this but conveyed their dismay that the CQC downgraded BHRUT’s maternity services in two areas. The Board also highlighted that adverse reports made it difficult to attract staff which added to the pressures.

However, the Board did emphasise their understanding of the challenges and pledged to support BHRUT in improving its services.

The Board noted the report.