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April this year for providers came after a brutal winter, after a brutal 12 months. And with the prospect of spending the next five years working through the endless sea of patients waiting for treatment on the elective lists.

Some leeway, therefore, should be given to staff working under intense pressure. However, the Care Quality Commission report from the maternity unit at Northwick Park hospital in northwest London cannot be dismissed as frayed tempers.

The CQC has heavily criticised the unit’s leadership, downgrading the service – which is run by London North West University Hospitals Trust – from “requires improvement” to “inadequate”.

Inspectors heard “multiple allegations of bullying”, of staff afraid to raise concerns, consultants who went home instead of discharging mothers, and of staff routinely shouting at each other.

One midwife reportedly shouted at a patient who could not understand English. Another shouted at the inspection team, mistaking them for a colleague.

The inspection came after 13 serious incidents were reported in the year to March 2021, including eight perinatal deaths in five weeks in July and August.

An independent review of the issues at the maternity unit suggested five of the babies could have survived with better care, while better care may have made a difference in two more. 

The trust had put in a new leadership team at the unit with key posts filled in October and November last year, just before the full weight of the winter surge of covid broke on London. In fact, the new clinical director was temporarily redeployed in January to work on the covid response two months after coming into post.

LNHW has published a maternity improvement plan. It has to implement it and fast. Hopefully its staff will have sufficient breathing space to do so, with the worst burdens of the pandemic on acute services behind us.

How do you do?

ICSs now know what measures they will be judged on, following NHS England’s release of more than 70 metrics, which will determine the level of support and scrutiny systems receive.

A new system oversight framework for 2021-22 (PDF) confirms that systems, as well as individual organisations, will be put into one of four segments. Those in the fourth segment will be subject to a “recovery support programme”, which will replace the label of “special measures”.

Those in the third segment will also be subject to some mandated support.

Eligibility for a particular segment will be determined, in part, by a system, provider or commissioner’s performance within six “oversight themes” of quality, access and outcomes; preventing ill health and reducing inequalities; leadership; people; and finances.

Within the themes combined, there are more than 70 performance metrics for ICSs.