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Medway Maritime Hospital Requires improvement

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Inspection report

Date of Inspection: 19 August 2013
Date of Publication: 2 November 2013
Inspection Report published 02 November 2013 PDF | 118.99 KB

Overview

Inspection carried out on 19 August 2013

During a routine inspection

This inspection was carried out to inspect only the Regulated Activity for Maternity and Midwifery Services provided by the Trust. We made the decision to look at this one area of the Trust after noticing a slight increase in the numbers of notifications of incidents which included ante and post natal women, and neonates.

In each area of the unit we looked to see if the service was safe, effective, caring, well-led, and responsive to people�s needs.

The inspection was carried out by a team of five CQC inspectors, one compliance manager, two pharmacist inspectors and four clinical advisors. These included a practice matron with theatres experience; a senior midwife with management experience; a hospital manager; and a consultant obstetrician. We visited the maternity wards, delivery suite, antenatal clinic, and three locations in the community, over the space of four days and one evening.

During the visit we talked with groups of staff including doctors, registrars, consultants, midwives and supervisors of midwives. We also talked with staff on an individual basis. We had conversations with 14 women receiving care, and talked with seven relatives.

We found that women were involved in decisions about the birth and where they wanted this to take place. However, there was no clear pathway for women to know how to register with the service when they found out they were pregnant. This resulted in delays for some women to access antenatal care.

All of the women that we talked with expressed their satisfaction with the standards of care they received and spoke highly of the midwives and other staff who attended to them. However, the management of care was affected by insufficient numbers of midwives, both in the hospital and in the community. This was particularly evident in the provision of post natal care, where midwives struggled to keep up with the demands on them.

We found that medication was administered appropriately, but some of the medication management had elements of poor practice. There was no pharmacy input for the maternity services.

Staff training programmes were available but were not completed satisfactorily by all staff. Midwives in the community were unable to access training easily due to ineffective IT systems. Hospital and community midwives said they did not have time to carry out on-going training programmes and felt unsupported in their job roles. Whereas junior doctors felt supported in their training and found the hospital a good place to work.

We found that systems of governance and management oversight were inadequate. There was poor communication between different directorates. The hospital did not have a service delivery plan for the maternity services, and had not taken into account the changing demographics in the area and how to meet the needs of women in the future. The electronic systems in use were unsupportive and did not serve the needs for the directorates to liaise competently with each other.