The Care Quality Commission (CQC) has published a report on the maternity services at Queen Alexandra Hospital, provided by Portsmouth Hospitals University NHS Trust.
CQC carried out a focused inspection in May to follow up on information of concern received about the safety and quality of the maternity services at Queen Alexandra Hospital.
The maternity service at Queen Alexandra Hospital provides consultant-led care and treatment for women with high risk pregnancy or medical conditions. The hospital’s Mary Rose Maternity Centre offers midwife-led maternity services to women with low risk.
The service was not rated during this inspection, therefore the previous rating of requires improvement remains.
Amanda Williams, CQC’s head of hospital inspection, said:
“When we inspected the maternity services at Queen Alexandra Hospital, we found that the service was generally being run well, but further improvements are needed.
“Some of the issues we found were related to restrictions and pressures on the service caused by the COVID-19 pandemic. However, we were concerned that although most staff described a supportive culture within the service, some reported longstanding cultural issues which meant they felt unable to raise concerns without fear.
“This needs to be addressed as a priority so that staff feel able to speak openly about anything that is concerning them without the fear of being blamed, and so lessons can be learned from incidents that occur. After the inspection, the trust confirmed it would address this, and we will monitor their progress.”
Inspectors found:
- The service leaders had the skills and abilities to run the service. They were beginning to understand the priorities and issues the service faced and were developing plans to improve
- Leaders and teams had started to use systems to manage performance effectively and leaders supported staff to develop their skills. Most staff felt respected supported and valued and they worked well together and were clear about their roles and accountabilities. They were focused on the needs of women receiving care and committed to continually improving services
- Staff used a nationally recognised tool to identify women at risk of deterioration and escalated them properly. Leaders were developing effective systems to identify and escalate risks and issues and take action to reduce their risk
- Managers investigated incidents and shared lessons with the whole team and wider service. When things went wrong, staff apologised and gave women honest information and suitable support
- The service provided care and treatment based on national guidance and evidence-based practice. Managers monitored the effectiveness of the service and made sure staff were competent
- The service controlled infection risk well. Staff used equipment and control measures to protect women, themselves and others from infection. The design, maintenance and use of facilities and equipment kept people safe. Staff were trained to use the equipment and managed clinical waste well. Records were stored securely.
However:
- Staffing levels were lower than planned due to staff sickness and staff shielding during the COVID-19 pandemic, and the service did not always have enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and provide the right care and treatment. To manage this risk, managers regularly reviewed and adjusted staffing levels and skill mix. Staff were redeployed within the unit when needed and when bank and agency staff were used, they were given a full induction
- Staff did not always feel respected, supported and valued by all managers. Midwifery staff said that staff shortages had affected morale. Staff did not always recognise and report all incidents and near misses. Some staff felt there was a blame culture and poor communication around incidents
- An electronic records system had been introduced in February and staff had been trained to use the new system. However, there was an outage with the national system during the inspection which meant there was potential for inaccurate record keeping, which could put women at risk. Staff said that they had raised concerns about this, but they did not feel listened to and the issue had not been escalated or recorded
- Staff had received training in emergency evacuation for birthing pools but, due to COVID-19 restrictions, they had not carried out any recent emergency evacuation drills to ensure that the training was fully embedded
- The service had a current baby abduction policy in place but had not conducted any recent abduction exercises due to COVID-19 restrictions.
- Not all trust policies contained all risk factors or were up-to-date and complete.
Full details of the inspection are given in the report published on our website.
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