20 July 2023
The first 2 pages of this report pertain to the hospital location, from page 3 the report focuses on the maternity service.
We inspected the maternity service at Queen Charlotte’s and Chelsea Hospital (QCCH) as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.
We will publish a report of our overall findings when we have completed the national inspection programme.
We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key question.
As a result of this inspection Queen Charlotte’s and Chelsea Hospital location overall rating has remained Outstanding.
Our rating of maternity remained Outstanding overall.
Maternity services at Queen Charlotte’s and Chelsea Hospital include on site and community antenatal clinics, maternity department assessment unit, delivery suites with birthing pool, transitional care, tertiary obstetric medicine (de Swiet Obstetric medicine unit), and a private maternity ward. The hospital is the maternal Medicine Centre for North West London.
The birth centre has seven birthing rooms, three of which have birth pools and ensuite facilities. From 1 April 2022 to 28 February 2023 there were 4,832 deliveries at Queen Charlotte’s and Chelsea Hospital.
The trust has two neonatal units which support the maternity services at both sites. QCCH has a level 3 neonatal intensive care unit (NICU) providing special care (SC), high dependency (HD) care, and intensive care (IC) for a range of circumstances. The QCCH NICU has 16 IC / HD cots and 8 SC cots.
How we carried out the inspection
We carried out an on-site inspection where we observed the environment, observed care, conducted interviews with patients and staff, reviewed policies, care records, medicines charts and documentation. Following the site visit, we conducted interviews with senior leaders and reviewed feedback from women and families about the trust.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
23 July 2019
We previously inspected maternity jointly with gynaecology, so we cannot compare our new ratings directly with previous ratings. Our rating of maternity services was outstanding because:
The service provided mandatory and maternity specific training in key skills to all staff. The majority of staff received up-to-date mandatory training. Compliance with core maternity specific mandatory training and skills, such as cardiotocography interpretation, was 98.6%.
The trust had clear systems, processes and practices in place to safeguard adults and children from avoidable harm, abuse and neglect that reflected relevant legislation and local requirements. Staff understood how to protect patients from abuse and the service worked collaboratively with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
- There was an effective system in place to assess, respond to and manage risks to patients. Staff could recognise and respond to signs of deterioration and emergencies. Staff completed and updated risk assessments for each patient.
The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. This was an improvement from the last inspection.
The service followed best practice when prescribing, giving, recording and storing medicines.
Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
Staff assessed and monitored patients regularly to see if they were in pain. The service performed better than the national recommendations and standards on the waiting time for epidurals and the average on women receiving obstetric anaesthesia during caesarean sections.
Managers monitored the effectiveness of care and treatment and used the findings to improve them. The service performed better than average on all outcomes in the 2017 National Neonatal Audit.
The service made sure staff were competent for their roles. Managers appraised staff’s work performance and meetings with them to provide support and monitor the effectiveness of the service.
- The midwifery and medical staff supported women that accessed the maternity service to live healthier lives and manage their own health, care and wellbeing.
Staff treated and cared for women with compassion, patience, dignity and respect. Feedback from people who used the service and their relatives was continually positive about the care they received and the way staff treated them.
- There was a strong, visible person-centred culture in the service and relationship between staff and patients was strong and supportive.
The hospital planned and provided services in a way that met the needs of local people. Between April 2018 and January 2019, 100% women had a named midwife whom they saw at their first appointment. Women might not see that midwife at every appointment but would see one of a small team at that clinic.
People could access the service when they needed it. Women were given a choice of times and dates for antenatal clinic appointments. There were clear pathways for all pregnant women to access the right services for their needs, with excellent access to specialist midwives.
Patient needs and preferences were considered and acted on to ensure services were delivered to meet those needs. Staff tried to arrange patient antenatal appointments together for the same day to meet patients’ commitments such as work.
- The service was responsive to parents who had suffered a loss, such as miscarriage, stillbirth or neonatal death. The services provided extensive support and resources to bereaved women and were committed to continually improving the care and services they provided for bereaved parents.
The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. Action plans were developed and monitored in response to complaints to prevent similar problems recurring.
- There was a high level of staff satisfaction across all disciplines and equality groups. Staff were proud of working in the service, spoke highly of the culture and the improvement they had made to the service since the last inspection.
The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups.
- There were inconsistencies in the monitoring of emergency equipment to ensure it was safe and effective for patient use.
- The midwife to birth ratio was 1:28 which was below national recommendation of 1:26.