The Care Quality Commission (CQC) inspected maternity services at Nottingham City Hospital and Queen’s Medical Centre, run by Nottingham University Hospitals NHS Trust, on 14 and 15 October 2020.
The unannounced, focused inspections were carried out to follow up on concerns raised to the commission about the safety of services.
Following the inspections, under Section 31 of the Health and Social Care Act 2008, CQC imposed conditions on the registration of maternity and midwifery services at Nottingham City Hospital and Queen’s Medical Centre. This urgent action was undertaken to prevent patients being exposed to the risk of harm. Imposing conditions means the trust must comply with the instructions set in order to drive improvements.
In addition, a warning notice was issued to the trust due to concerns found around the documentation for risk assessments and information technology systems. This notice gave the trust three months to make the necessary improvements.
During the inspections, several serious concerns were identified. For example, risk assessments which women were expected to have undertaken during their care were not always completed in line with national guidance. Staff did not always use a nationally recognised tool to identify women at risk of deterioration.
In addition, the service did not always have enough midwifery staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix but were limited to the resources available.
Following this inspection, maternity services at Nottingham City Hospital and Queen’s Medical Centre are rated Inadequate overall. The services are rated Inadequate for being safe, effective and well-led. Maternity services were previously rated Requires Improvement.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“During our visit to Nottingham University Hospitals NHS Trust’s maternity services, we were disappointed to find some serious concerns which were impacting on women’s care and safety.
“We found fundamental practice like adequately risk assessing women and babies, was not always done. We also found staff did not always complete growth charts which enable staff to identify possible growth problems
“Women's notes were not comprehensive and not all staff could access them easily. We found that there was a combination of paper and electronic records in use across the unit. The main electronic records system was only accessed by midwives and was not able to be accessed in the community by GPs or community midwives.
“When women transferred to a new team in the community, staff were unable to access their hospital records as there was no shared record keeping system. Managers told us, however, that plans were already in place to replace the current community records system with the same electronic system used in the hospital.
“Following the inspection, we placed conditions on the trust’s registration and issued a warning notice to ensure mothers and babies experience the safe, effective and personalised care they are entitled to.
“The leadership team is clear about the steps they need to take, and we will continue to monitor progress closely and will inspect again to check the necessary improvements have been made.”
The full reports will be published on CQC’s website tomorrow (Wednesday 2, December) at the following locations:
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