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Concerns remain about the safety of maternity services at a trust in Kent where a baby died three years ago, despite “green shoots” of improvement, according to regulators.
The Care Quality Commission has rated maternity services provided by East Kent Hospitals University NHS Foundation Trust as “requires improvement” following its latest inspection.
“Despite these green shoots of improvement, there was still work to be done especially in antenatal services”
An antenatal clinic in outpatients was found to be poorly maintained, meaning midwives were sometimes left to assess women potentially at high risk rather than a doctor.
Inspectors also found junior midwives working alone in day care, despite lacking the experience or knowledge to escalate complex emergency situations.
The CQC made unannounced visits to Queen Elizabeth the Queen Mother Hospital in Margate, and William Harvey Hospital in Ashford, on 22 and 23 January, and again on 4 and 5 February.
The inspections took place after concerns were raised about the safety of maternity services at the trust, including at the inquest this January into the death of baby Harry Richford.
He died at Queen Elizabeth the Queen Mother Hospital in 2017. A number of other families had also subsequently come forward with concerns, noted the trust.
It was announced in February this year that NHS England and NHS Improvement had asked Dr Bill Kirkup to carry out an independent review into the circumstances of maternity deaths at East Kent.
In its latest report, the CQC said that, overall, maternity services across the trust remained rated as “requires improvement”.
Services were rated “good” for being effective, caring and responsive to people’s needs and again “requires improvement” for being safe and well-led.
The CQC said it had issued the trust with two notices, relating to improvements needed with regard to the governance and the provision of the safe care and treatment in its the maternity services.
“We know we have much more to do. We are already acting on the CQC’s recommendations”
Dr Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said the regulator found “a number of improvements had taken place” at both hospitals since its last inspection in May 2018.
“Our inspectors found a team committed to learning and continually improving the department. The service had a vision for what it wanted to achieve and a strategy to turn it into action,” he said.
He noted the trust had recently implemented additional cardiotocography training for staff and aimed to ensure a safer outcome for babies.
Duty of candour had improved with the head of midwifery and senior maternity leadership having strengthened the way in which they communicated incidents with families after serious incidents.
But Dr Acheson said: “Despite these green shoots of improvement, there was still work to be done especially in antenatal services.
“At William Harvey Hospital, the antenatal clinic in outpatients was poorly maintained. Staff in day care did not always report incidents, which meant managers could be unaware of avoidable events.”
He added: “Our inspectors found junior midwives, without the experience or knowledge to escalate complex emergency situations, working alone in day care.
“After our inspection the trust told us they were reviewing rosters to ensure there was always an experienced midwife on duty and staff could contact a senior midwifery co-ordinator to escalate concerns.”
He also said that the CQC had found that, because the risk to women was not effectively managed in antenatal services, midwives sometimes had to review and assess women, who may be at high risk.
“Midwives told us that a senior doctor was sometimes available in clinic. However, it was usually a junior doctor with limited experience in obstetrics that would review and discharge,” he said.
The trust is also currently being supported by the system regulator, NHS Improvement, through its Maternity Support Programme.
Trust chief executive Susan Acott said: “The improvements and positive work cited in the CQC’s report is a testament to the hard work put in by the maternity and obstetric teams.
“We know we have much more to do. We are already acting on the CQC’s recommendations, and have improved staffing levels in the antenatal triage and day care service,” she said.
“Encouraging maternity staff to report safety concerns or risks so that trends can be identified and rectified swiftly is necessary”
She added that trust had appointed a maternity governance lead to co-ordinate the review and improvement of the service’s internal governance processes.
“We will continue to make improvements and make sure positive changes are thoroughly embedded, so local families can have absolute confidence in their care,” she said.
But the Royal College of Midwives said that safety must be an “absolute priority” and, combined with effective leadership, be the basis for which all maternity care is delivered.
RCM chief executive Gill Walton said the college was “disappointed” to see the same issues that were flagged in 2015 by a Royal College of Obstetricians and Gynaecologists review remained.
“There is an urgent need for actions to be completed, so safety is not compromised and this needs to happen at board level within the trust.
“Ensuring midwives and maternity support workers have adequate time off to attend all training is crucial if safety is to be improved,” she noted.
“Training highlighting the need for escalation is not only important for junior midwives, but for all maternity staff,” said Ms Walton.
“The lack of continuity in antenatal care is a clear safety risk. Ensuring safe staffing numbers are met will improve continuity of carer which in turn will improve continuity in antenatal care.
“Also, medical cover in triage and day assessment maternity areas will enable midwives to escalate high risk women quickly to medics.”
She added: “Encouraging maternity staff to report safety concerns or risks so that trends can be identified and rectified swiftly is necessary.”