- NHS hospital
Queen's Hospital
Report from 26 August 2024 assessment
Ratings - Maternity
Our view of the service
Since the last inspection in June 2021, staff made some improvements in specific areas. Staff maintained consistently high compliance with safeguarding training. Multidisciplinary teams improved the delivery of handovers, and compliance with cardiotocography (CTG) monitoring increased. The service focused on diversity and equity, providing support for internationally educated midwives, which staff said improved inclusivity and their experiences in the workplace. Staff continued to store and manage emergency medicines safely. The service also began preparing for the introduction of an electronic prescribing system. Additionally, the service allocated more resources to emergency preparedness, and staff carried out drills, including baby abduction protocols, which inspectors noted had improved.
Despite these improvements, staff and leaders had not resolved several recurring issues identified during the previous inspection. Staff recorded risks on the service's risk register, and several key concerns, including delays in triage, medical staffing capacity, and medication safety, were acknowledged and actively monitored. Some risks, such as insufficient junior obstetric cover and consultant capacity, had been formally closed prior to the inspection following mitigation. However, during the inspection, concerns remained about the operational impact of these issues, indicating that improvements were not yet fully embedded in practice. Staff said they experienced delays in reviewing and closing incidents, which meant lessons from adverse events were not consistently embedded into practice. These gaps limited improvements in safety.
The service continued to face challenges with access and flow. At the time of our inspection, the service was experiencing high demand in both the numbers of attendance and acuity. Staff described ongoing triage bottlenecks, labour ward delays, and insufficient bed availability, all of which affected their ability to provide timely care. Staffing shortages, particularly in high-dependency units and triage, persisted. Staff reported that these pressures reduced care continuity, negatively affected their wellbeing, and limited their capacity to provide compassionate care. Inspectors observed breaches of patient dignity and confidentiality, including unsecured patient notes and overcrowded waiting areas, which staff had not fully addressed.
After the inspection, the CQC issued a Section 31 letter of intent, identifying significant risks. In response, the service took immediate actions. Leaders allocated dedicated medical staffing to triage to reduce delays and improve patient flow. Staff worked to address cleanliness issues and improve compliance with infection control and uniform policies, though challenges remained in high-traffic areas. Leaders revised governance processes, focusing on better documentation of leadership discussions and actions, although these changes were still being embedded. Staff increased monitoring of compliance with risk assessments, including venous thromboembolism (VTE) and CTG reviews. Audit data showed sustained compliance with national benchmarks, including VTE risk assessments averaging 98% and CTG `fresh eyes' reviews averaging 87.14% - above the national standard of 80%. While the trust's internal quality improvement target of 90% for CTG reviews had not yet been consistently achieved, evidence of ongoing improvement activity was present.
Staff and leaders acknowledged that while these measures were a step forward, sustained efforts were required to address the underlying issues that continued to affect safety, governance, and patient care.
People's experience of this service
Women who used the maternity services described feeling supported by staff who treated them with kindness and respect during their care. Interactions between staff and individuals were often described as reassuring and professional, helping women to feel more confident throughout their maternity journey.
Feedback highlighted that woman felt informed and involved in decisions about their care. Information was shared in a way that helped individuals understand their options, and staff made efforts to explain procedures clearly. While some expressed concerns about aspects of communication or waiting times at certain stages, the overall experience was described as positive, with women appreciating the dedication and attentiveness of staff.
The service was noted to consider women's diverse needs, and efforts were made to support people from different backgrounds and circumstances. Emotional wellbeing and privacy were generally promoted, and women reported feeling that staff listened to their concerns and provided appropriate reassurance and care.
However, some women reported variation in their experiences, particularly in relation to continuity of care and responsiveness at times of increased demand. These views indicated that while most experiences were positive, there were occasions where expectations were not fully met, especially during busier periods or transitions between different parts of the service.