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Nottingham hospitals maternity services move out of ‘inadequate’ rating for first time since 2020

By Anna Whittaker, Local Democracy Reporter

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Maternity services at Nottingham’s hospitals have moved out of an ‘inadequate’ rating for the first time in almost three years after the healthcare watchdog said improvements had been made.

Leadership at Nottingham University Hospitals Trust, which runs the Queen’s Medical Centre and Nottingham City Hospital, has also moved up out of the lowest rating to ‘requires improvement’.

It follows a new visit by inspectors from the Care Quality Commission in April.

The full report, published on September 13, found areas of “significant improvement” within maternity services and highlighted how the Chair and Chief Executive are changing the trust’s culture.

Some ongoing areas of concern at the time of the latest inspection included training levels, cleanliness of equipment and some staff feeling unable to speak up about concerns.

The report added the trust was not complying with its responsibilities for duty of candour, “creating a risk of potential fines, patient dissatisfaction, and negative publicity”.

‘Duty of candour’ is a professional responsibility to be honest with patients when things go wrong.

The overall individual rating for Nottingham City Hospital has increased to ‘good’ and the overall rating for Queen’s Medical Centre remains ‘requires improvement’.

Chief Executive Anthony May told the Local Democracy Reporting Service he was ‘reassured’ by the report and hopes the trust will reach a ‘good’ rating within the next three years.

Donna Ockenden is already leading the largest maternity review in NHS history at the trust.

Last week, Nottinghamshire Police also announced they are due to start a criminal investigation into failings in maternity.

Reacting to the report, Dr Jack Hawkins and Sarah Hawkins, whose baby Harriet died in 2016, said the rating was the “bare minimum of what the public should expect”.

The report said staff treated women with “compassion and kindness” and inspectors found “significant improvements” in the triage unit and day assessment unit which had previously been criticised by the healthcare watchdog.

Some concerns were raised about the “unsafe” storage of breast milk and medicines.

Director of Midwifery Sharon Wallis said that the issue was “resolved very quickly”.

Both hospitals were told they “must ensure staff carry out risk assessments to keep women, their babies and staff safe from potential abuse”.

Inspectors also found that maternity services “did not have enough substantive staff to care for women and keep them safe” – but this this had improved since the last inspection.

They also found electrical testing of equipment was “inconsistent” with many items “overdue”.

Under the ‘well led’ inspection, the CQC acknowledged that the trust had “undergone significant change of leadership” over the past year.

In the last inspection, the CQC found poor working relationships between certain members of the board.

Now, the watchdog says that the chair and chief executive had been “instrumental in empowering people to speak up”.

But “staff did not always feel able to raise concerns without fear of retribution”.

Mr May said: “Inspections are always a double-edged process. On the one hand, they’ve found some really positive things, on the other hand, they’ve pointed out some things that in truth, we already knew.

“None of it was a surprise and we need to continue our improvement to get beyond ‘requires improvement’ to ‘good’.

“In maternity services, we’ve got the momentum now and with Donna’s review and the police investigation, we need to make sure we focus completely on improving.”

“We do have a much wider maternity improvement programme which looks at all aspects of maternity including medicines management, equipment and the way we recruit and retain people.

“The things that the CQC spotted on the day, we responded to immediately.”

But Mr and Mrs Hawkins told the Local Democracy Reporting Service they still had concerns.

They said: “We’re concerned that had it not been for families fighting so hard, this wouldn’t have happened.

“The things that they aren’t doing seem crucial like basic staff training and cleanliness of equipment.

“We are concerned about the legal obligation to abide by the duty of candour.

“Not a single family we’ve been in contact with who has had a terrible event have said that NUH has been open and honest with them.

“We have been contacted very recently by people who have suffered appalling harm.”

Director of Midwifery at NUH Sharon Wallis said she was “really pleased” with the report.

She said: “If we could’ve graded ourselves, we would’ve said ‘requires improvement’ too.

“The CQC visits are completely unexpected, we get a call to say they are 10 minutes away. There isn’t any opportunity to make things look shiny and nice.

“Given the context we are working with the maternity review, it was a pleasant surprise.”

Ms Wallis highlighted that the ‘caring’ section of the report was rated ‘good’.

She said: “I would urge women to look at the report because it is a fair reflection of where we have improved and the things we still need to do.

“Nottingham is absolutely on the up, and that’s what we want for our women and families to have confidence and trust in us again.”