CQC makes snap inspection of maternity unit following death

The trust recently reported its fifth maternal death in 18 months.

Several internal investigations and a commissioner review have found no link between the four previous maternal deaths. The fifth has been referred to the coroner.

A group of staff who call themselves the “unhappy midwives” have raised concerns to the CQC about the leadership of the unit.

A CQC inspection last February rated the maternity unit as “good” and could not find any basis for the concerns raised.

The trust had already asked the London Clinical Senate to investigate the four previous deaths.

It made a number of recommendations for the trust, including:

• using an interpreter for women who may require one;
• a postnatal plan of care for women with blood loss of more than one litre;
• all staff should participate in multidisciplinary skills and drills sessions for the management of major obstetric haemorrhage; and
• training to recognise sepsis for all clinical staff.

The CQC inspected the unit in the middle of March. The inspection team was made up of seven clinical experts alongside inspectors, who asked for a “significant amount of documentary evidence”, according to the trust chief executive’s report to its March board meeting.

City and Hackney Clinical Commissioning Group recently held a meeting to review the London Clinical Senate’s report, which was attended by the local council, the CQC and NHS England.

A second similar meeting will take place in the near future to review the coroner’s investigation report into the fifth maternal death.

The trust plans to conduct a “deep dive” review of its maternity unit in May where board members can ask questions to the unit’s managers.

Professor Edward Baker deputy chief of hospitals said: “CQC undertook an unannounced focused inspection at Homerton University Hospital Foundation Trust to observe the provision of maternity services at the trust on 17th March. We will publish a report on our findings in due course.”