Queen's Medical Centre

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities. Staff felt that immediate leaders, where in place, were supportive and that teams supported one another. Despite processes in place the staff reported feeling unheard and unaware of changes that had occurred because of speaking up about issues. Staff actively contribute to safe, effective practice and research. They spoke to immediate line managers when issues arose.

The key question of well led was not assessed on this inspection and the rating is based on our previous assessments.

We have not awarded this service a score for Well-led.

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

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

Leaders at all levels understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, leaders did not always demonstrate the ability to lead effectively. Staff told us that they felt supported by their colleagues about concerns or personal issues. However, many staff described frustrations of a lack of visibility of the maternity leadership. Once again staff reported they did not see senior leaders. Staff would expect them to have been more visible due to the increased scrutiny the service was faced with. Staff felt “abandoned” and that their concerns were not being heard or appreciated. We spoke with the director of midwifery and the head of midwifery during our inspection. Both senior leaders told us they split their time between the trust’s sites so they could be available to staff. However, their days were often filled with meetings etc.

Some band 5 midwives felt that they were not supported by experienced competent and confident midwives. We saw information on the walls of the department for a four-day development course for band 6 midwives. This claimed it would teach them how to manage some aspects of managing a team. Deputy ward managers had 6 hours allocated a month to manage the team. The director of midwifery told us that this would be increased in the event of a ward manager being absent for some time. However, this had not happened on the postnatal ward (C29). A new initiative meant that ward managers worked 50% of their time clinically and 50% undertaking management duties. Some managers felt that they could not achieve all management tasks due to this reduction in time spent on them.

We spoke to a team of doctors who told us that the consultant rota was better. However, there remained gaps in the registrar level and consultants had to “act down” to cover these. The obstetric clinical lead was based at a different NHS trust and outside of the region. Staff told us they had not met this individual and that they were not aware if they had not attended on-site meetings. The obstetric team reported they felt disconnected from the clinical lead and reported that when concerns were raised, they felt placated rather than heard, with no effective action taken to address the issues raised.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

Despite, the freedom to speak up team attempting to foster a positive culture where people felt they could speak up and their voice would be heard. People did not always feel they could speak up and that their voice would be heard. Staff were aware of the freedom to speak up process but those we spoke to had not used it. Staff were unaware of any changes made because of staff speaking up. Staff reported that they would use the trusts intranet to find out how to contact someone from the Guardians office if they wanted to speak up.

Staff were happy to speak up to their line manager who they trusted to raise the issues with their line managers. Staff also used the services of the professional midwifery advocates to raise issues. Due to the lack of management support on C29 staff felt that their voices were not being heard at a senior level. This sentiment was replicated across a number of areas we went to.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

Staff continued to receive information on changes by email. Some staff reported that there had been a lot of change but could not identify a change since our previous inspection. Staff were aware of the challenges in their areas and had adopted processes to seek to overcome these. We saw that there was ongoing research into third- and fourth-degree tears during labour and witnessed a midwife going to provide support and evidence for this research.

Staff commented that there was a lack of equipment to ensure that they could capture contemporaneous notes. Tablets used for taking notes and electronic devices to record observations were often broken or not available for each midwife. Some midwives commented that they would prefer their own tablet or electronic device.