The Care Quality Commission (CQC) has again rated maternity services at Basildon University Hospital and Southend University Hospital requires improvement following inspections in March last year.
Both hospitals are run by Mid and South Essex NHS Foundation Trust.
These inspections were prompted in part by concerns raised to CQC about the safety and quality of care being provided to people, as well as to follow up on concerns found at previous inspections.
As well as both services being re-rated as requires improvement overall, they have also been re-rated requires improvements for being safe, effective, and well-led. They have both been rated good for being responsive. Southend University Hospital’s maternity services has been re-rated good for caring.
Inspectors only looked at specific areas of concern for caring at Basildon University Hospital’s maternity services, therefore it remains unrated.
Basildon University Hospital and Southend University Hospital’s overall ratings, remain unchanged as requires improvement.
The rating of the trust overall remains unchanged as requires improvement.
Hazel Roberts, CQC deputy director of operations in the East of England, said:
“When we inspected maternity services at Basildon University Hospital and Southend University Hospital, we were concerned to find gaps in staffing levels, which could impact the safety of women, people using the services, and their babies.
“There were some shortages of permanent staff at both hospitals, however leaders had put systems in place to reduce risks to people. Although, there was still a lack of medical cover for triage at Southend, which had led to delays in people being seen by medical staff. Southend also lacked a dedicated triage telephone line staffed by a midwife
“This meant people’s needs couldn’t always be identified and met as quickly as possible, putting them at risk. Leaders were aware of these issues and had plans in place to address them.
“When things had gone wrong, leaders had investigated and taken action to improve people’s care. However, we found some of these investigations took a long time, delaying improvements. It was positive to hear that staff were open and honest with people when safety incidents happened, and felt safe raising concerns to leaders, but staff at Basildon didn’t always feel encouraged by leaders to do so, as leaders hadn’t always replied to them. Additionally, staff at both hospitals said senior leaders weren’t always visible on the wards.
“However, women and people using maternity services at both hospitals told us that staff treated them with kindness, listened to them, and respected their privacy and dignity at all times.
“Our inspectors saw several positive interactions where staff took the time to make sure people’s needs were met in line with their preferences, and they were responded to quickly when people were in pain or distress.
“We shared our findings with the trust, so they know where improvements had to be made and where there is good practice to build on. We will continue to monitor these services closely, including through further inspections, to make sure these improvements are made and people are kept safe.”
Inspectors also found:
- Staff at Basildon said there wasn’t always enough fetal monitoring equipment to keep women, people using maternity services, and their babies safe. Some equipment was overdue testing to ensure it was ready if needed
- Staff reported a lack of hot water in some areas in Southend’s maternity services, preventing people from taking showers and choosing to have water births. This was a risk to people’s health, safety, and welfare and leaders were acting to fix this
- Leaders didn’t always have clear oversight of the quality of people’s care, as some audits were inconsistent at Basildon, and some leaders did not always attend weekly oversight meetings at Southend
- Some policies at Southend were out of date and did not reflect current best practice, including on reducing risks to people’s safety from low staffing levels.
However:
- People’s care plans and risk assessments were comprehensive and person-centred
- People were involved in decisions about their care. During this inspection, inspectors heard a woman was not happy with a treatment plan advising a caesarean section. In response, the medical team explained both the risks of having the surgery and the risks if they didn’t proceed and gave her time to make her decision
- Using feedback from staff and people using the service, the trust was working with stakeholders to improve the quality of and access to care for people more likely to experience barriers. For example, the trust was working with their local maternity and neonatal voices partnership to inform improvements to care for people from ethnic minority groups.
Due to a large-scale transformation programme at CQC, these reports have not published as soon after the inspection as it should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish the reports falls far short of what people using services and the trust should be able to expect and CQC apologises for this. While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services will not have been affected and acted on appropriately. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.
The reports will be published on CQC’s website (Basildon University Hospital) (Southend University Hospital) in the coming days.