Queens Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that women were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked women’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question inadequate. At this assessment the rating has improved to requires improvement.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service did not have a proactive and positive culture of safety based on openness and honesty. Leaders did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

At the last inspection we found that staff did not report all incidents. This concern remained. Staff reported peoples individual incidents, for example a slip or a fall but did not report delayed or cancelled procedures. This was due to staff not being fully aware what constituted an incident, in line with Trust Policy. We found delays in induction of labours, caesarean sections and other elective procedures were not reported. We found there were delays to investigations and learning from incidents was not always embedded.

The service did not use the perinatal mortality review tools (PMRT) to learn lessons to improve care, reduce poor outcomes and improve women’s experience as cited in the warning notice at the last inspection. We reviewed 7 completed PMRT’s which failed to recognise risk or escalate concerns. Trust and national guidelines in relation to medical reviews and smoking cessation had not been followed. Delays in medical reviews on the pregnancy assessment unit and on labour ward were identified in several PMRT’s which were reported by the service in cases whereby the care may or likely had an impact on the outcome for babies. Due to the inaccuracy of the risk assessments women were placed on the incorrect care pathways to meet their needs. Small for gestational age babies (SGA) and fetal growth restricted (FGR) babies were not always identified as risk assessments were not always completed or risks managed in accordance with national guidance putting babies at risk of harm and poor outcomes despite repeatedly being identified through the cases and PMRT process.

The service did not work well with women and health system partners to establish and maintain safe systems of care. Staff did not manage or monitor women’s safety. They did not make sure there was continuity of care, including when women moved between different services.

At this inspection we found staff continue not to use an evidence-based, standardised risk assessment tool for maternity triage. Staff used a form to prioritise women accessing the Triage unit that prompted staff to assess if immediate, medium and low risk but there was not a clear framework to support clinical decision-making. At this inspection we found there had been no improvement in this area. On the first day of our inspection, the service had just commenced a telephone triage service based at the Royal Derby Hospital which would direct women to the most appropriate location for their needs. Due to the timing of this we were unable to identify the effectiveness of this process.

The service has still not implemented a formal handover process for example the ‘Situation, Background, Assessment, Recommendation’ (SBAR) process effectively to aid safe and effective communication of handover information. Managers still did not regularly complete audits to ensure staff shared key information to keep women safe when handing over their care to others. This formed part of our enforcement activity following our onsite inspection.

The service did not work well with women and healthcare partners to understand what being safe meant to them and how to achieve that. Staff did not concentrate on improving women’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They did not share concerns quickly and appropriately.

We were not assured the safeguarding training was in accordance with the intercollegiate guidance, as level 3 safeguarding training should take place 50% face to face and 50% online. During the factual accuracy process the service informed us they held action learning sets, and group cases discussions. To meet this requirement. However, we were not provided with evidence which stated how the service assured staff would attend the action learning sets and case discussions.

Staff reported that they were not well practiced in abduction procedures. The service did have an up to date policy in place for child abductions, however staff told us that they were not always involved in the drills or knew the frequency of these drills.

The service did not work well with women to understand and manage risks. Staff did not provide care to meet women’s needs that was safe and supportive.

Staff told us it was difficult to get doctors to review a patient if their condition changed or the midwife team disagreed with a person’s care plan. This would mean at times midwives were working without a doctor’s advice and therefore putting women at risk and possibly working outside the scope of their practice.

Following the last inspection in 2023 the CQC imposed urgent conditions on the location registration, to take immediate action to implement to ensure that staff were competent to review, interpret and escalate fetal monitoring traces. The service was supported by the NHS England Maternity Safety Support programme. Whilst we noted there had been improvements they remained variable and needed to be embedded.

The design of the environment followed national guidance. The maternity unit was fully secure. The service had two maternity theatres.

Following our last inspection the service had undertaken ligature risk assessments, and actions had been taken to mitigate risks.

The service monitored and controlled any potential risks in the care environment including facilities and technology.

The service did not ensure there were enough skilled and experienced staff to keep women safe. Although the service met the safe staffing numbers on most shifts the skill mix was variable. We saw occasions when there were multiple newly qualified midwives were on duty during their preceptorship period. The service could not be assured that every shift was staffed with midwives who had the experience, skills and competence to keep women safe.

As part of the previous enforcement action the service was required ensure that all staff at Royal Derby Hospital had completed annual mandatory fetal monitoring and PROMPT training. This had not been fully achieved. Compliance for as of November 2024, we saw evidence which showed, 94% of doctors, 92% anaesthetists, and 97% midwives had completed PROMPT training. Compliance for fetal monitoring training was 91% for doctors and 94% for midwives. Compliance for neonatal life support training was 97% for doctors, 94% for midwives. However, there was a separation between Obstetric doctors in post before 1st July 2024 from those that started in the Trust after 1st July 2024. We found rotational obstetric medical staff who commenced work on or after July 2024 compliance was at 60% for prompt and 68% for fetal heart monitoring. There was a plan in place to recover this position. Due to the seriousness of the concerns we found at the last inspection and the impact this has for women we would have expected the trust to expedite this training for all staff working within the service.

The service did not always have enough nursing and midwifery staff to keep women, birthing people and babies safe. The service reported maternity ‘red flag’ staffing incidents in line with National Institute for Health and Care Excellence (NICE) guideline 4 ‘Safe midwifery staffing for maternity settings. A midwifery ‘red flag’ event is a warning sign that something may be wrong with midwifery staffing. We observed and staff told us about delays in inductions of labour (IOL), were a frequent occurrence. We were told that staff were not always reporting these as they were told not to by leaders. We saw no reference to maternity red flags within published board papers; therefore, we were not assured the board had oversight of all aspects maternity staffing. During the factual accuracy process the service provided evidence that maternity red flags were reported as part of the biannual maternity workforce report. We are still not assured the board has full oversight of the staffing challenges within the maternity service.

The service assessed and managed the risk of infection. Ward areas were clean and had suitable furnishings which were clean and well maintained. Staff adhered to infection control principles, using personal protective clothing and handwashing techniques. Equipment and ward areas were cleaned after they have been used and labelled.

The service monitored the number of women who were readmitted within 6 weeks following their delivery, however we could not identify if these were related to post-partum infection. Evidence provided showed between April and November 2024, 75 women had been readmitted within 6 weeks of birth. We were not assured the service was investigating this and implementing processes to reduce the number of readmissions.

The service made sure that medicines and treatments were safe and met women’s needs, capacities and preferences. Staff involved women in planning. Staff followed systems and processes to prescribe, store and administer medicines safely. Staff completed medicines records accurately and kept them up to date. The medicines records we reviewed were clear and up to date. Staff had access to medicines used to respond to emergencies safely. On the delivery suite, staff had access to emergency trolleys and boxes to respond quickly to conditions such as pre-eclampsia, sepsis and cord prolapse

Staff reviewed each woman’s medicines regularly and provided advice to women about their medicines.

Patients had no concerns about their medication. They were given information about the medication that had been prescribed for them and staff administered on time.