Mid Cheshire Hospitals NHS Foundation Trust told to make improvements in maternity services

The Care Quality Commission (CQC) has rated maternity services at Leighton Hospital as requires improvement, following an inspection in September.

Maternity services at Leighton Hospital in Crewe are run by Mid Cheshire Hospitals NHS Foundation Trust and were inspected as part of CQC’s national maternity services inspection programme. The programme aims to provide an up-to-date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement locally and nationally.

The overall rating for maternity services at Leighton Hospital has declined from good to requires improvement. The rating for well-led has gone down from good to requires improvement. They have also been re-rated as requires improvement for how safe they are.

The inspection didn’t rate how effective, caring, and responsive the service was. 

Following the inspection, the hospital’s overall rating has declined from good to requires improvement. The overall rating for Mid Cheshire Hospitals NHS Foundation Trust remains as good.

Carolyn Jenkinson, CQC’s deputy director of secondary and specialist care said:

“When we inspected maternity services at Leighton Hospital, we were disappointed to find the care provided was not at the level women, people using the service, and their babies have a right to expect.

“We found that leaders had the right skills and abilities to run the service, but didn’t always understand the issues the service was facing or take action when they needed to make improvements. There were delays between some incidents being reported and staff also weren’t always reporting incidents when they should. In addition, Leaders weren’t always taking timely action to address and review issues when they were found. This included occasions where people had experienced bleeding after giving birth.

“We found the service didn’t have enough medical or midwifery staff to match the planned numbers working. The lack of staff had led to delays when people needed planned and emergency caesarean sections. Leaders hadn’t taken steps to address these problems, even though it was putting women, people using the service, and their babies at risk of harm.

“We found that staff were doing their best and were focused on the needs of people using the service despite these challenges.

“Since the inspection last year, the trust have provided investment and made improvements to the maternity service. We’ll continue to monitor the service, including through future inspections. If we’re not assured that the trust has made improvements, we will not hesitate to take further action to keep people safe.”

Inspectors found:

• Staff weren’t all trained to use the equipment properly, or in procedures like evacuating the birthing pool and safely accessing blood from the fridge when people needed it.
• Leaders weren’t always monitoring the service effectively to see when risks came up or addressing issues when they should have. Ligature risk assessments hadn’t been completed since 2018 and were only updated after it was raised during the inspection.
• The service did not have enough surgical theatre capacity to care for people when there were two obstetric emergencies at the same time, although this had been raised as a risk before leaders had not taken steps to address this.
• The design and layout of the triage area in maternity services didn’t always keep people safe. The waiting area was separate from where people were assessed by clinical staff. Although there was a camera viewing the waiting area, staff couldn’t see if someone was unwell and their health deteriorated while in the waiting area. There was also a lack of space to assess people and when it was busy this had led to delays.
• Medicines weren’t always kept at the right temperatures and fridges that were used to store babies’ milk weren’t always monitored.
• Staff weren’t all up to date on mandatory training including training to identify and protect people from abuse, however staff were aware of how to report safeguarding concerns.

However:

• Leaders were generally visible and approachable to people using the service as well as staff.
• The service engaged well with the local community to plan and make improvements and worked with the local Maternity and Neonatal Voices Partnership on their strategy.
• The service handled complaints well and when things went wrong, staff apologised and provided women and people affected with suitable support.

The report will be published on CQC’s website on Friday 19th April.