Maternity services at Leighton Hospital must improve say inspectors

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

Maternity services at the Crewe site 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.

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.”

What 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.

What did the hospital have to say?

Scott Malton, Chief Nursing Officer for Mid Cheshire Hospitals NHS Foundation Trust said:

“As a Trust we continue to ensure that the safety of those in our care remains a top priority. Over the last six months since CQC visited our maternity services we have delivered our planned investment of over £1 million to continue to improve the quality and safety of services for our local population but also for our dedicated team of staff.

“The maternity service has made significant strides forward in recent months, we have invested in our people, recruiting additional members to our midwifery team as well as employing extra members of staff to free up time to enable our midwives to focus on delivering babies and supporting our local mums. We have also expanded services, bringing in additional members of staff to support work in our maternity theatres, alongside making improvements within our maternity triage and waiting rooms.

“We are incredibly proud of our dedicated staff, whose hard work, professionalism and commitment to caring for our local population is shown each and every day. As Chief Nursing Officer this pride extends to every single person who works at Leighton Hospital and is part of Mid Cheshire Trust.

"I do want to acknowledge the work of our maternity team, whose care for our local population was shown in the report, where inspectors identified that the service engaged well with the local community to plan and make improvements and worked with the local Maternity and Neonatal Voices Partnership. This focus on our local population was mirrored in the positive feedback we have heard through the recent CQC inpatient survey, where our results were better than most trusts in several key areas including mental health care, involving patients in decisions, hospital room cleanliness, and overall care for patients.

"We recognise that there is still more work to do, and we will carry on our journey of continuous improvement to provide the very best level of safe quality care for our community."

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