Trust starved of capital cash for maternity censured by CQC

Following an unannounced inspection earlier in 2019, the regulator reported there were a lack of consultants in the maternity assessment units and assessments of women were being delayed because staff had to juggle managing telephones and patient care.

The inspectors found serious incidents were identified and investigated but “important improvements to keep women and babies safe were not yet underway, despite several weeks since the first incident occurred”. It did however find the service had enough midwives and learning from serious incidents was shared with staff.

Details of the incidents that led to the inspection were not included in the CQC report.

The hospital is currently rated “requires improvement” but maternity is rated “good”. The CQC has not changed the overall ratings.

The inspection found:

• The environment of the maternity assessment unit did not provide privacy for women, staff handovers or staff managing phone calls;
• Not all equipment used in the unit was within date despite previous concerns raised by the CQC;
• The waiting area within the unit was small and cramped and women could be waiting in this area for up to five hours waiting for a review from a doctor; and
• Fourteen incident reports were submitted between April 2018 and April 2019 for women waiting several hours for a doctor. Staff felt this number was lower than the actual figures due to midwives being too busy to complete reports.

Improvements the trust was told to take by the CQC included:

• Ensuring sufficient consultant presence in the assessment unit.
• Having clear escalation guidance for staff in the unit when medical staff are busy or unavailable.
• The physical environment of the unit should provide privacy for women and handovers.
• Ensuring abdominal pain guidance and pre-term labour guidance link with each other and include NICE guidance
• Notices relating to equipment servicing should be met.

University Hospitals of Leicester Trust submitted a capital bid for £367m in July 2018, which it wanted to use for a major reorganisation and improvement of its maternity services. This would have involved bringing maternity and neonatal services together from Leicester General and the Royal Infirmary.

However, the bid was not included in the capital projects authorised following last autumn’s budget and by new prime minister Boris Johnson earlier this month. 

Ian Scudamore, consultant obstetrician at Leicester’s Hospitals, described the report as “very helpful”. 

He added: “In response to their recommendations we have made our policies clearer for staff to improve the way in which senior assessment and advice is provided to women presenting to our maternity assessment unit. Also, we are shortly going to carry out some building work at the Royal Infirmary to improve the privacy and reception area in the maternity assessment unit; a plan that was already in progress to improve the service before the CQC visit.”