The Care Quality Commission (CQC) has told Somerset NHS Foundation Trust it must make improvements to its three maternity services and has taken action to protect people, following inspections in November.
Maternity services at Musgrove Park Hospital, Bridgewater Community Hospital, and Yeovil District Hospital, were inspected in November 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 Musgrove Park Hospital maternity services has decreased from good to inadequate. The rating for how well-led it is has decreased from good to inadequate. How safe it is has declined from requires improvement to inadequate. This was a focused inspection and the areas of effective, caring and responsive retain their previous ratings of good.
Following the maternity services inspection, the overall rating for the Musgrove Park Hospital has also decreased from good to requires improvement.
Yeovil District Hospital maternity services have been rated as inadequate overall, as well as for being safe and well-led. This was the first time maternity services had been inspected as part of Somerset NHS Foundation Trust.
CQC has issued a warning notice at Musgrove Park Hospital and Yeovil District Hospital to focus the trust’s attention to maintain rapid and sustained improvement in the care of people using the service.
It is the first time Bridgewater Community Hospital’s Mary Stanley Birth Centre, a midwife-led unit, has been rated. The maternity service has been rated as requires improvement overall, and for being safe and well-led.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist care said:
“When we inspected maternity services at Somerset NHS Foundation Trust, we found a deterioration in the quality of care being provided across maternity services at all three of the locations they provide them from. We also had particularly significant concerns with the care being provided at Musgrove Park Hospital and Yeovil District Hospital.
“Leaders weren’t supporting staff to learn from incidents or make improvements when things went wrong. Incident data seen by inspectors also didn’t always match up with information provided to the trust’s board. Leaders also weren’t effectively monitoring how the services performed, or taking action when risks needed to be escalated.
“At Musgrove Park Hospital, we found poor systems and processes for assessing women and people using the service who needed medical attention. Staff weren’t using a standard method to assess and prioritise people based on clinical need when they arrived, which meant that people were being assessed differently based on the individual who saw them.
“At Yeovil District Hospital, we were concerned that staff weren’t always cleaning their hands when entering clinical areas to care for people, and they weren’t always following the trust’s uniform policy to help reduce spreading germs. Leaders also weren’t monitoring whether staff were complying with their hand hygiene policies.
“There were high rates of staff sickness at Bridgewater Community Hospital and poor staffing levels meant the birth centre and home birth service had to close for five months between February and July last year. However, the trust had taken steps to recruit more midwives. They should also review how to ensure the service is sustainable for local women and people.
“Despite these issues, across the trust we found staff were keen to improve the services and some of the problems were out of local leaders’ control. At Musgrove Park Hospital, inspectors noted the buildings were in poor condition and required regular maintenance which posed an ongoing challenge for the quality of maternity services they were able to provide.
“We have told the trust where we expect to see significant improvements and will continue to monitor them closely while these improvements are made. We will return to check on their progress and won’t hesitate to take action if women, people using the service and their babies are not receiving the care they have a right to expect.”
At Musgrove Park Hospital, inspectors found:
- Staff weren’t always completing mandatory training or meeting the trust’s targets for training, and leaders lacked good management of this issue. Gaps included training to manage when unborn babies had reduced movements, managing when unborn babies had growth restrictions, and safeguarding training to identify and protect people from abuse
- The service did not control infection risk well and the environment was unsuitable. For example, inspectors found single use emergency equipment out of its packaging, and medical equipment that was out of date and coated in dust
- There was a lack of emergency equipment across the service. For example, there wasn’t enough equipment to resuscitate babies in an emergency. Inspectors also found one of their current resuscitation machines for babies had a broken wheel and was unusable
- There wasn’t always enough midwifery staff to keep people safe
- Fridge temperatures weren’t always monitored, and the contents weren’t always checked. Inspectors found expired breast milk in one fridge. The trust was aware of issues with the current fridges and freezers, but there was no mitigation plan in place before they could replace them
- Staff couldn’t access up-to-date policies and procedures to support them in their roles.
However
- The service engaged well with the local community to make improvements and plan services
- Staff had a positive work culture and were committed to improving the service.
At Yeovil District Hospital, inspectors found:
- There was not enough emergency equipment to safely care for babies. However, leaders ordered more equipment following the inspection
- The service did not always control infection risk well. Not all staff adhered to hand hygiene principles when entering clinical areas prior to administering care. Audits were not used to monitor hand hygiene and cleaning at the service
- The service did not always have enough medical staff, such as consultants, to keep people safe
- Leaders didn’t have effective governance systems to manage risks, issues, and how the service performed
- Staff hadn’t all completed necessary training to protect women and people using the service from abuse
- There was a lack of meaningful conversations and information regarding maternity services at executive board level.
However
- Staff worked well together as a team to cover areas where women and people using the service needed support
- The service engaged well with the local community to make improvements and plan services.
At Bridgewater Community Hospital, inspectors found:
- Leaders weren’t monitoring waiting times to ensure people could access emergency services when needed and if they received treatment within national targets
- Equipment was not always maintained safely. Much of the electrical equipment was overdue safety tests, which meant there was a risk that staff could use faulty equipment or that equipment posed a fire risk
- Leaders didn’t have effective governance systems to manage risk, issues, and how the service performed. Lessons weren’t always learnt following incidents
- The birth centre did not have a vision or strategy and there was a limited approach to engagement with local people about their services.
However
- Staff had training in key skills and worked well together for the benefit of women, people using the service and their families.
- Staff understood how to protect people from abuse, and managed safety well.