The Care Quality Commission (CQC) has published a report following an inspection of the maternity services at the John Radcliffe Hospital, which is run by Oxford University Hospitals NHS Foundation Trust.
CQC carried out an unannounced focused inspection of the main maternity department in the John Radcliffe hospital, and also visited the Cotswold Birth Centre and the Horton Midwifery Led Unit in May, after receiving information of concern about the culture of the department.
The inspection looked at whether the service was safe, effective and well-led. Afterwards, the rating for maternity services went down from good to requires improvement. This inspection did not change the overall rating for the hospital, which is requires improvement.
Amanda Williams, CQC’s head of hospital inspection, said:
“We went in to inspect the maternity services run by Oxford University Hospitals NHS Foundation Trust to follow up on information of concern we received regarding the overall culture of the service. We found that most staff said that they were proud to work for the trust and that they felt respected and able to raise concerns without fear.
“Importantly, we found that there was an emphasis on learning and positive working relationships. Staff had regular multidisciplinary meetings to discuss the women and babies in their care. Rather than just focusing on those with poor outcomes, staff were encouraged to share learning from all cases. This meant that there was no ‘blame’ aspect involved in these meetings, which is very important in order to ensure that continual improvements are made.
“Staff wellbeing was also considered a priority by the senior leadership team. A wellbeing group was established during the COVID-19 pandemic to enable people to talk openly about issues that were concerning them. Staff were also encouraged to provide feedback, which could be anonymous, via a staff survey and a series of listening events was also held. This feedback was then used to create an action plan and improve the service. An award scheme was also used to celebrate staff achievements and hard work.
“However, although most staff said they were encouraged to be open and honest with people when things went wrong, some staff reported that they were not always comfortable raising concerns without fear of what would happen if they did. Additionally, although most staff felt they received support from their immediate manager, some said they felt that communication between senior management and staff was not always effective.
“We also had concerns that staff did not always undertake all the necessary risk assessments for women, particularly in relation to the risk of domestic violence.
“We have told the trust that they need to address our concerns, and we will continue to monitor the service to ensure that improvements are made.”
Inspectors found the following during this inspection:
- Managers did not always monitor the effectiveness of the service through local audit, and they did not always have effective governance processes.
- Some staff did not always feel respected, supported and valued.
- The environment meant that staff could not always respect women’s privacy and dignity.
- Staff did not always assess risks to women, and they did not always manage medicines well.
However:
- Leaders ran services well using reliable information systems and supported staff to develop their skills. They were focused on the needs of women receiving care.
- The service had enough staff to care for women and keep them safe. Staff had training in key skills, understood how to protect women from abuse.
- The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Staff provided good care and treatment and worked well together for the benefit of women. They advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
- Staff were generally clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.
- The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
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