By Samantha Jones-
The maternity service at Whipps Cross Hospital had inadequate staff to “keep women safe”, inspectors from the Care Quality Commission have found.
The health regulatory watchdog also found staff “did not always assess risks to women and babies in line with guidance” and that records were not always up to date.
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Staff also received training in key skills and “worked well together for the benefit of women”, according to CQC.
The report also said staff were mostly respected, supported, and valued, this does little to negate the lack of adequacy of staff to help ensure the safety of women.
The CQC also published damning reports outlining its findings from inspection visits made to maternity services at The Royal London Hospital, Barking Birth Centre and The Barkantine Centre, on the Isle of Dogs, in August. The regulator gave Barkantine its lowest rating – ‘inadequate’ – whilst it graded the maternity services at Royal London and Barking ‘requires improvement’.
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Significant Challenges
Nicola Wise, CQC head of hospital inspection, said: “Maternity services across England face significant challenges, but there are steps Barts Health NHS Trust can and must take to ensure all risks to mothers and babies are well managed while they are in its care.
“The trust has our findings and it knows where it must improve. We will not hesitate to take further action if people are at risk of harm.”
The regulator issued Barts with a warning notice requiring it to make “significant” improvements at Barkantine.
The centre, which saw 233 deliveries in 2020, “did not have sufficient leadership capacity to manage, monitor and improve the service”, inspectors wrote.
CQC said Barts proactively reduced its services at Barkantine to focus on addressing areas of concern following the inspection.
Among reasons given for the service’s grading included “significant failures” in performance management and audit processes.
Leaders had “little understanding or management of risks and issues”, according to CQC.
Inspectors wrote: “Staff did not always effectively assess, monitor and manage risks to people using services so there were missed opportunities to minimise harm.
“Leaders didn’t have a vision or strategy to provide safe and sustainable services at the birth centre.”
Barkantine also did not have adult emergency resuscitation equipment or safe equipment to evacuate a woman from a birth pool in the event of a mother collapsing, CQC said.
The Royal London in Whitechapel, where more than 5,100 babies were born between August 2021 and July 2022, saw its maternity service downgraded to ‘requires improvement’.
CQC said: “The service did not have enough staff to care for women and keep them safe.”
“Workload pressure” meant staff were not supported to develop their skills and some staff did not feel respected, supported and valued, inspectors found.
Medication was also not managed safely, according to the report.
Barking Birth Centre, based at Barking Community Hospital in Upney, was also rated ‘requires improvement’.
Challenges around staffing were mentioned by inspectors in its report on this centre too, which they said “affected the sustainability” of the service.
They found that women could not always access the centre due to “intermittent” closures and that staff satisfaction was mixed.
There were 121 babies born at the centre between March 2021 and April 2022 but monitoring of outcomes for women and babies who used it was limited, according to inspectors.
Ms Wise said the trust’s leaders need to develop plans to meet patient needs despite the staffing shortages.
“This should include developing a comprehensive understanding of the issues it faces, so it can tailor its response accordingly.
“The trust must also ensure all its maternity staff receive the right training to deliver safe care and treatment, and that it has the right policies in place to help staff fulfil their roles.”
But she admitted inspectors found instances of good practice across the trust’s maternity services.
These included “good engagement with women, the community and other healthcare partners to help shape care to meet people’s needs”.
A spokesperson for Barts Health NHS Trust said: “We are actively recruiting, including from overseas, and more than 70 new midwives are set to join our hospitals in the coming weeks.
“Despite the national shortage of midwives we are working to improve our services for pregnant women in line with the CQC recommendations.”
The visits took place as part of CQC’s national maternity inspection programme, the regulator said.
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