INSPECTORS have told the trust in charge of Worcestershire Royal Hospital to improve its maternity service after whistleblowing concerns about the safety of the department prompted a visit by the Care Quality Commission (CQC).

A focused inspection was carried out on December 9 in response to whistleblowing concerns and information received about the safety of the maternity department, particularly around midwifery staffing levels, risk and incident reporting, and governance, and the findings were published this morning (February 19).

The CQC found that staffing levels were often lower than planned, with midwives reporting that this led to them being frequently moved within the department.

Midwives also said morale was low due to longstanding staffing issues, and that they felt their concerns and views were not being considered by management.

Any staffing shortages should have been reported on an incident reporting system, however, staff told inspectors that they did not have time to do this and assumed that senior staff would do it.

In addition, there was no clear process to identify if staffing gaps had been left vacant or filled by bank staff.

The service’s managers were aware of these issues and held meetings to listen to staff concerns and formulate their response.

Inspectors also saw areas of good practice, including evidence that healthcare professionals from different disciplines worked as a team to support each other to provide good care for women and babies.

Staff understood how to protect women from abuse, and they implemented infection prevention and control measures effectively.

Following the inspection, the maternity service’s overall rating went down from 'good' to 'requires improvement'.

It was rated requires improvement for being safe and well-led, and good for being effective. Inspectors did not assess the service for whether it was caring or responsive at this inspection.

As this was a focused inspection, it did not alter the trust’s overall rating, which remains Requires Improvement.

Professor Ted Baker, chief inspector of hospitals at the CQC, said: "When inspectors visited the maternity department at Worcestershire Royal Hospital, they found areas where improvements were needed.

“We fully appreciate that hospitals are facing a particularly challenging time currently. However, it is crucial that women get the safe and personalised birth experience they are entitled to and that midwifery staff feel supported and valued in order to achieve this.

“The service must ensure that any risks are identified, and safety incidents are correctly shared and reported to reduce their impact.

“Staff should never feel that their concerns are not listened to and we are pleased service managers have initiated meetings to listen to staff with a view to taking action in the problem areas.

“Inspectors were impressed with how staff actively and openly engaged with women, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for women.

“We have reported our findings to the trust leadership, which knows what it must do to bring about further improvements and ensure it maintains any already made.

“CQC’s immediate focus will be on supporting the trust to keep people safe during the Covid-19 pandemic, working with NHS England and NHS Improvement to ensure additional support is in place where needed.”

The trust has been told to make improvements in several areas of its maternity service, including:

• The service must seek and engage with staff for feedback to make any improvements without delay when they are identified.

• There must be a process for monitoring if substantive staff working bank shifts worked additional hours to ensure no staff member is working excessive hours.

• Senior leaders must have oversight of staffing, in order to deal with concerns.

• Staff must recognise and report all incidents and near misses; and learning must be shared effectively from incidents.

• The service must assess, monitor and mitigate the risks relating to the health, safety and welfare of patients; including ensuring the risk register reflects all risks.

Vicky Morris, chief nursing officer at Worcestershire Acute Hospitals NHS Trust, said: “The safety of mums to be and their babies is, and always has been, the absolute priority for everyone working in our maternity service.

“Managing maternity services through the Covid-19 pandemic has been extremely challenging for all our staff and we thank them for their commitment and dedication during what has been a very difficult period.

“We were pleased that the report reflected the success of our efforts to redeploy colleagues to maintain safe staffing levels and the valuable support from our medical team.

“We were already taking action to address the midwifery staffing issues which are described in the report before the inspection was carried out, and we have continued to make progress since the inspectors visited us in December.

“We have run a very successful recruitment campaign for midwives and once the next round of recruitment is completed next week we should have filled all our vacancies and recruited an additional 10 midwives to further strengthen our workforce.

“We are also continuing to actively engage with all our staff. Our regular briefings with colleagues across all sites, which had been introduced before the inspection, give everyone in our teams opportunities to ask questions, raise concerns and be kept up to date with the further improvements we are putting in place.

“Those improvements include positive progress in improving our performance on mandatory training and recruiting this additional staff will support our efforts to make sure that colleagues have the time they need to all complete any required training.

“We have also strengthened local leadership for our countywide maternity team, recruiting two Matrons – one for inpatient services and one for community services.

“The reduction in the overall rating of our maternity service from Good to Requires Improvement is disappointing, but we believe that the actions we have already taken, and the plans we have in place for the immediate future, will help us to further improve the quality and safety of the care we provide, despite the continuing challenge of providing maternity services in the Covid pandemic and beyond.”