CQC upgrades 'inadequate' maternity unit

Walsall Healthcare Trust was given the new rating following a CQC focussed inspection in June this year. 

While the CQC praised the trust’s improved care it also highlighted a failure by ”service leaders” to prioritise what it called “the normality agenda” which has been a highly controversial topic within maternity since the Morecambe Bay maternity scandal report in 2015.

The improved rating for the trust followed concerns originally raised about the safety and culture of the trust’s department by the quality regulator in June 2017. As a result the trust was kept in special measures and handed warning notice over the care provided by its maternity service.

This warning included demands to improve monitoring, recording and escalating concerns for cardiotocography (CTG), which monitor fetal heart rates. The CQC also asked for improvements to the numbers of midwives with high dependency training; safeguarding training and overall staffing levels.

But this week inspectors said they had seen improvements in the trust’s service and noted the provider had made progress against all concerns it had previously raised.

The report also acknowledged the trust’s department had a “much more positive” culture but added: “some cultural issues remained with some pockets of staff.”

Richard Beeken, chief executive for the trust, said: “Our staff should be really proud of themselves for the way they have responded to last year’s disappointing rating and given the CQC greater confidence in our maternity services.

“We’re realistic about the work that we still need to do but this report shows that we are making significant progress and heading in the right direction.”

Among justifications for its rating of the trust the CQC also said: ”Service leaders did not sufficiently prioritise or support the normality agenda.”

The report added: ”Since our last inspection, the service had recruited a lead midwife for normality to promote active birth. However, we were not assured encouraging patients to have active births and developing the normality agenda was regarded as a priority.

”We saw little evidence leaders understood or supported normality. Since the closure of the midwife led unit (MLU), the service had lost some MLU staff who had been passionate about promoting normal births.”

The comment risks igniting further controversy around the “normal birth” debate which led to the Royal College of Midwives being forced to drop its national campaign in August 2017 amid fears it was promoting unsafe care in maternity departments.

In his report following the Morecambe Bay scandal in 2015 Dr Bill Kirkup highlighted the risks of midwives pursuing normal births at any cost as a factor in poor care leading to multiple baby deaths.

In July the Royal College of Obstetricians and Gynaecologists was criticised for “dangerous” recommendations made in a report about Walsall’s maternity services, which also appeared to support a normal birth campaign.

The CQC was approached for comment regarding its support for the normality agenda but did not reply before publication.

HSJ updated the story on 19 August with additional quotes from the CQC’s report.