The Care Quality Commission (CQC), has found improvements are needed in maternity at Dorset County Hospital, after an inspection in June which sees the service’s overall rating downgraded from good to requires improvement.
The service provides maternity services to the population of west and north Dorset, including Dorchester, Weymouth and Portland, and Purbeck, and is run by Dorset County Hospital NHS Foundation Trust.
This inspection was carried out as part of CQC’s national maternity services inspection programme. The programme aims to provide an up-to-date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement locally and nationally.
As well as the overall rating for maternity services declining from good to requires improvement, the rating for how well-led the service is has declined from good to inadequate. The safety of the service has again been rated as requires improvement. How effective, caring, and responsive the service is, wasn’t rated at this inspection.
As a result of the change in ratings in the maternity service, the overall rating for Dorset County Hospital at a location level has declined from good to requires improvement.
The trust’s overall rating at a provider level remains unchanged as good overall.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said:
“Our experience tells us that when a service isn’t well-led, it’s less likely it’ll be able to provide safe care to people, which is what we found in the maternity service at Dorset County Hospital.
“There had been a steep decline in the governance of the service since our previous inspection. Although leaders had the skills and abilities to run the service, they didn’t always seem to be aware of the issues until external agencies like CQC pointed them out. As a result there wasn’t enough action being taken to address them.
“One of the biggest issues was that leaders didn’t have the right data or systems in place to monitor, review and act on issues, especially around safety.
“Individual staff however, were risk assessing people appropriately and working to reduce or remove any risks found. We also found this picture reflected in other areas. Individual staff and teams were keeping things running, but there weren’t formal processes put in place by leaders which was a huge risk if individuals and teams moved on, or underperformed.
“We also saw that leadership and their responsibilities weren’t always sustainable or conducive to giving them time to provide strategic direction. There needs to be some consideration given to succession planning, and how the service would run long term in the absence of key leadership figures.
“It was concerning that the service wasn’t using a standardised way to ensure women and people using the service were seen in order of those with the most clinical need. There was a day assessment open from 8am – 8pm but a lack of standard triaging information for all staff put people at risk of receiving different care from day to night.
“However, the service performed well in the CQC maternity survey and women felt well cared for.
“We’ve told the trust where they must make improvements, and we’ll return to check on their progress. We’ll continue to monitor this service closely during this time to make sure people are safe.”
Inspectors found:
- Medicines weren’t managed safely. Inspectors found out of date medicines, and emergency medicines that weren’t easily available in standard doses and had out of date guidelines attached to them. Inspectors also escalated concerns about the availability of emergency blood pressure medicine to the trust on the day of inspection. Staff said the same safety issue had been raised approximately two months earlier which demonstrates a slow or no response from leaders
- Staff were not always up to date on mandatory training, including basic life support and safeguarding
- Action planning and progress tracking was under-developed. The risk register didn’t have a formalised management and monitoring process. Entries didn’t always contain dates for review or completion, actions being taken, or named people responsible however, there were plans in place to cope with unexpected events
- The service didn’t adequately monitor the incidence of pre-term births. The service had recognised issues with premature babies being born at the trust inappropriately, as there was not the right level of neonatal care provision available. This presented a risk to women, people using the service and their babies
- Service leaders chose to give up booked annual leave to facilitate the inspection and provide an accurate overview of the service. Without this, CQC wouldn’t have been able to gather the required information about the service. Inspectors found there was no consideration of succession planning to enable seamless provision of services and oversight of work in the event of absence of key leadership figures
- The service mostly had enough nursing and midwifery staff, but the actual staff numbers didn’t always match the planned numbers with a reliance on staff working bank shifts and overtime
- The service didn’t have enough medical staff with the right qualifications, skills, training and experience to keep women, people using the service, and babies safe from avoidable harm and to provide the right care and treatment. The medical staff rota wasn’t sustainable and relied on individuals rather than processes.
However:
- Leaders and staff actively and openly engaged with women and people using the service as well as, staff, the public, and local organisations to plan and manage services. They also collaborated with partner organisations to help improve services
- Staff understood how to protect people from abuse and the service worked well with other agencies to do so
- Staff felt respected, supported, and valued. They were focused on the needs of people receiving care.