A struggling trust in the West Midlands was threatened with enforcement action over the staffing levels and culture in its maternity service, HSJ has learned.

Walsall Healthcare Trust received a warning in June from the Care Quality Commission that it could face enforcement action over concerns that the regulator had about “staffing and culture in maternity”.

Trust board papers, published last week, said: “Since the last board meeting we have received a warning of potential enforcement action from the CQC with regard to their concerns about staffing and culture in maternity.”

They added that the CQC has since said it will not pursue enforcement action after receiving the trust’s improvement plan. The plan said the trust would ask the Royal College of Obstetricians and Royal College of Midwives to conduct an external review of the services.

The papers also said the regulator received comments from staff that “alluded to a bullying culture”, particularly in relation to midwifery.

The trust’s nursing director, Rachel Overfield, said during the board meeting that the service has had a “lack of a stable leadership team, with no head of midwifery for most of the year and limited clinical leadership”.

The trust is rated inadequate by the CQC and in June 2016 a review by the Royal College of Paediatrics highlighted concerns over staff shortages in the neonatal unit.

The improvement plan includes:

  • formal HR processes for four consultants;
  • continuing the restructure and new recruitment in the midwifery leadership;
  • strengthening medical leadership through seeking a new clinical director and appointing a new (internal) deputy clinical director; and
  • commissioning support for clinical team building.

The measures in place for tackling staffing issues are focused on releasing midwives’ time and include:

  • transferring responsibility for staffing maternity theatres from midwifery to surgery teams;
  • shifting activity from midwifery led units to the delivery suite until “at least early September”; and
  • using registered nurses to provide post-operation care for women recovering from caesarean sections on postnatal wards.

Walsall Healthcare was approached for comment.

In a statement Ms Overfield said: “The Trust has been in regular contact with the CQC who have now formally advised us that no immediate enforcement action will be taken. The CQC took this decision after considering our robust action plan and following the correction of a number of factual inaccuracies.

“The Trust Board papers had been compiled ahead of this decision and a verbal update was given at last week’s Trust Board meeting.”