Maternity services at The Royal London Hospital in Whitechapel have been rated as Requires Improvement by the Care Quality Commission. Previously maternity and gynaecology services had been rated as Inadequate.
Part of Barts Health NHS Trust, the unit delivers 5,000 babies each year, and the numbers are rising. At this unannounced inspection in June 2017 CQC inspectors concentrated on maternity services - gynaecology services were not inspected on this visit.
CQC’s key findings included:
Improvements had been made to staffing levels and there were enough midwives on wards during the day and at night. However, the number of clinical midwives was still below establishment.
Communication between managers and maternity staff and midwives, which had deteriorated at previous inspections, had improved.
Women who had given birth at the hospital’s birth centre were very happy with the way staff treated them, and appreciated the continuity of care they had from midwives. However, CQC received a mixed response from women and their partners. Some women and families CQC spoke with reported poor experiences that included not being treated with dignity and respect and having no continuity of care.
All of the clinical areas visited were visibly clean and well maintained, with display boards detailing cleanliness and safety information.
In September 2016 CQC followed up on serious concerns about baby security identified on inspection in July 2016. A system to ensure that all mothers and babies had name bands had lapsed only two months after implementation. During this inspection inspectors saw improvements had been made. All mothers and babies were wearing name bands and staff made twice daily checks which were recorded. Inspectors viewed three months of audit records which confirmed this.
Arrangements for governance and performance management did not always operate effectively. There remained inconsistencies in the way some data was collected and reported, which impacted on its accuracy and reliability.
Outstanding practice included the My Body Back maternity clinic which was set up with project volunteers for women contemplating pregnancy or who are pregnant. It was a charitable voluntary service for women who had experienced rape and sexual trauma. The clinic provided advice about pregnancy and birth by empowering women to develop their birth plans and strategies in preparation for labour and birth. The service had won an award for enabling miscarriage to be managed under local anaesthetic without needing to go to theatre. This reduced waiting times and uncertainty for women.
However, there were also areas of poor practice where the trust needs to make improvements. It must:
- Ensure all security systems and processes are properly used and staff are aware of their responsibilities in this area to ensure mothers and babies are kept safe from unauthorised access to the units.
- Ensure governance processes for monitoring and reviewing serious incidents are applied correctly so that serious incidents are addressed in a timely way in future.
- Ensure there are sufficient numbers of experienced midwives to supervise and support less experienced staff on labour and postnatal wards.
- Ensure that all relevant staff complete children and adult safeguarding levels two and/or three to ensure compliance with the trust target of 90% completion.
- Ensure that the level of consultant cover on the delivery suite meets the trust target of 98 hours.
In addition the trust should: assess demand for written information in languages other than English; take further action to address the perceived culture of bullying and harassment amongst midwives; take further action to improve cultural awareness of staff and take further action to ensure compliance with the trust’s target of 90% completion of mandatory training.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“There has been some improvement in maternity services at The Royal London, with one example of outstanding practice, which is encouraging."
“However, there are still improvements that can be made in the care provided to women in the maternity department and CQC will inspect again to ensure these improvements are carried out.”
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