• Trust served with CQC warning notice over maternity services
  • Requirement notice served to address ‘staff competencies’ over CTG
  • Trust supported by Morecambe Bay to improve maternity care

A trust in special measures is working with Morecambe Bay Foundation Trust to improve its maternity services after regulators raised the alarm about patient safety.

Northern Lincolnshire and Goole Foundation Trust was issued with a Section 29A warning notice by the Care Quality Commission after inspectors raised concerns over delays in foetal heart monitoring, patient assessments and staffing levels.

Now, the FT is organising advanced training sessions to improve staff “competencies” in monitoring cardiotocography (CTG), traces, which measure a baby’s heart rate and mother’s contractions.

The trust is also receiving support from University Hospitals of Morecambe Bay FT, which is now rated good by the CQC after making major improvements in maternity services following a scandal over the avoidable deaths of 11 babies and one mother.

At a Northern Lincolnshire and Goole board meeting in Grimsby last week, chief nurse Tara Filby said: “We’ve had support from Morecambe Bay as we review our midwifery establishment… they are very keen to help us scrutinise staffing levels within midwifery and provide us with additional guidance.”

Last month, an HSJ investigation revealed babies were dying or being left with disabilities around the country because of a failure to properly monitor and respond to CTG readings.

Coroner David Hinchliff recommended midwives are assessed on knowledge of CTG traces when they qualify and undergo yearly refresher courses following the death of Billy Wilson three days after he was born at Pinderfields Hospital in Wakefield in November 2013.

However, the Nursing and Midwifery Council said it “did not consider it proportionate to prescribe requirements after initial registration in such detail”.

The North Lincolnshire trust was rated inadequate and placed in quality special measures in April after CQC inspections at Scunthorpe Hospital and Diana, Princess of Wales Hospital in Grimsby in November and December.

It had already been placed in financial special measures in March after forecasting a £30m deficit against a planned deficit of £12.2m.

The Section 29A warning notice was issued in January, ahead of the publication of the CQC report, after inspectors discovered the midwife to birth ratio was 1:32, meaning the trust was failing to meet the Royal College of Obstetricians and Gynaecologists guidelines of 1:28.

Root causes and lessons learned were not always identified following serious incidents, inspectors found. A requirement notice was also issued after the CQC found delays in commencing and escalating CTG.

In response, the trust is recruiting additional midwives alongside midwifery support workers and, in March, the midwife to birth ratio was 1:26 at Scunthorpe and 1:29 at Grimsby.

By April, 95 per cent of staff had undergone CTG mandatory training compared to 69 per cent in November 2016, and staff will attend advanced training “masterclass” sessions this year and in 2018. 

The trust has also introduced a policy of starting CTG within 30 minutes of women arriving at its antenatal day unit, escalation trigger guidance has been developed and spot checks are carried out alongside daily documentation checks to monitor compliance.