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Queen Charlottes and Chelsea Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 16 December 2014

Queen Charlotte's& Chelsea Hospitalprovides maternity and women's and children's services. The hospital is a tertiary referral maternity unit with a nationally renowned centre for foetal care and the largest neonatal intensive care unit in the country. It has a labour ward with two fully equipped operating theatres adjacent to high-dependency care facilities. These are two of the eight core services that are always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection. The other six core services that are not provided by this hospital are: accident and emergency; medical services; surgery; critical care; end of life; and outpatients. These services are covered in the separate reports for Charing Cross, Hammersmith and St Mary’s hospitals.

The team included CQC inspectors and analysts, doctors, nurses, experts by experience and senior NHS managers. The inspection took place between 03 and 05 September 2014.

Overall, we rated this hospital as ‘good’. We rated the hospital ‘good’ for effective, caring and responsive services and ‘requires improvement’ for being safety and well-led.

We rated maternity as ‘good ‘and neonatal services as ‘requires improvement’.

Our key findings were as follows:

Safe:

  • Incidents were reported and learning took place from major and moderate incidents. However, learning from near misses and minor incidents did not always take place.
  • Nurse staffing levels were not in line with national guidance which impacted on care delivery.
  • Safeguarding policies and procedures were in place and appropriate action was taken to safeguard babies.
  • The neonatal mortality and morbidity meetings took place regularly but did not have representation from obstetrics or midwifery.

Effective:

  • Policies and procedures were based on national guidance. Care was delivered in line with best practice guidance.
  • Staff participated in a range of local and national audits. Action was taken on audit findings to improve patient outcomes.
  • New staff attended local induction programmes and there was an emphasis on staff development and continuing professional development.

Caring:

  • Staff were caring and treated mothers, babies and families with respect and dignity.
  • The bereavement midwife was available to provide emotional support to mothers, their partners and staff.
  • The neonatal unit had a consultant on duty for the week. Families expressed a view that this arrangement did not promote continuity. They felt that, for those babies who were in the unit for significant periods of time, a named consultant would be beneficial.

Responsive:

  • Capacity did not meet the demands for the service; this was due to high staffing vacancies in the neonatal unit resulting in cots being closed. In the maternity unit, midwife shortages meant that the service not always responsive to individual mother’s needs, and this resulted in a task-based approach to providing care that was not focused on the woman and baby.
  • Facilities were available for partners and parents to be resident.
  • Concerns and informal complaints were addressed proactively, reducing the number of formal complaints received about the services. Action was taken in response to complaints and information was disseminated to staff.

Well-led:

  • There were governance structures in place, including local risk registers. However, action to address identified risks was not always taken in a timely manner.

  • The units had a vision to improve their services. The new chief executive of the trust was visible and had already made a positive impact on staff morale by listening to their concerns and making them feel supported.

  • Neonatal staff were engaged in leading and participating in national research programmes.

We saw areas of outstanding practice including:

The focus on participating in and leading national research projects, including the evaluation of magnetic resonance imaging to predict neurodevelopmental impairment in preterm infants.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Review the staffing levels and take action to ensure they are in line with national guidance.
  • Review the capacity of the maternity and neonatal units to ensure the services meet demands.
  • Review the divisional risk register to ensure that historical risks are addressed and resolved in a timely manner.

In addition, the trust should:

  • Review the current training matrix for statutory and mandatory training and improve the recording system so that there is a comprehensive record of compliance which is consistent with local and trust-wide records.
  • Ensure that the risk management process within the neonatal division is suitably robust and fit for purpose to ensure risks are assessed, investigated and resolved in a timely manner.
  • Explore how staff can learn from minor incidents and near misses to avoid similar incidents occurring.
  • Considerthe neonatal service havingrepresentation at board level.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 16 December 2014

Effective

Good

Updated 16 December 2014

Caring

Good

Updated 16 December 2014

Responsive

Good

Updated 16 December 2014

Well-led

Requires improvement

Updated 16 December 2014

Checks on specific services

Maternity and gynaecology

Good

Updated 16 December 2014

At the time of our inspection, the risk of unsafe care because of inadequate midwifery staffing had been mitigated by prioritising the needs of women in labour. However, the quality of care on postnatal wards was sometimes compromised. The business case for additional staff had been accepted and recruitment to these posts was underway, but new members of staff had not yet commenced in post.

Care was delivered based on national guidelines and evidence. The service had an audit programme to assess compliance with best practice. Staff at all levels felt able to raise concerns and these were addressed. There was an embedded multidisciplinary approach to learning from incidents and complaints.

Specialist clinics assessed the needs of women with medical conditions and their care was provided by specialist and caseload midwives (a midwife who delivers one-to-one care for an agreed number of women). Women were encouraged to make a choice about the type of birth that was best for them and their babies. The community midwifery service provided local women with continuity of care.

There was a range of training and professional development opportunities for midwifery staff and trainee doctors. Staff were positive about their contribution to improving the quality of care and felt their efforts were recognised and valued.

Neonatal services

Requires improvement

Updated 16 December 2014

The national shortage of specialist neonatal intensive care trained nurses was impacting on the ability of the neonatal intensive care unit (NICU) to function at its full 42-cot capacity. A shortage of nurses had resulted in the department only being able to staff 24 cots. The division used a combination of National Institute for Health and Care Excellence (NICE), and Royal Colleges’ guidelines to determine the treatment they provided.

Parents were mostly complimentary about the care and treatment, although they felt there could be improvements and consistency with communication among the consultant group. Parents felt that staff across all disciplines were compassionate, understanding and caring. Where parents/carers had cause to complain, these complaints had been acknowledged, investigated and action plans generated to help improve services for the future.

The senior management team were cohesive and it was apparent that all those working in this division were passionate about influencing the care and treatment of neonates (new-born infants). However, there had been a lack of progress in addressing the risks identified in the division. Some risks had been with the management team for over five years; there was little or no evidence to demonstrate that these risks were being addressed in an effective way.