By Anna Whittaker, Local Democracy Reporter
The healthcare watchdog has raised more concerns with maternity units at Nottingham’s Queen’s Medical Centre and City Hospital over an increase in stillbirths and issues with triage services.
The Care Quality Commission (CQC) reinspected Nottingham University Hospitals Trust’s maternity services from March 1 to 4 2022, having already rated them as ‘inadequate’ in a previous visit last year.
On March 21, the trust then received a warning notice – issued when care “falls below what is legally required” – in relation to the care women receive within triage services and how they are monitored while admitted.
The trust overall had received a separate warning notice in 2021 after its leadership was rated ‘inadequate’.
Triage is an area where advice and assessment are given to pregnant women.
The CQC wrote a letter to the trust after the inspection stating that “women attending triage were not consistently reviewed within 15 minutes” at both hospital sites.
The letter also highlighted “increases in stillbirths” at City Hospital but said that “no apparent rationale had been established”.
Further improvements must be made by 16 May.
The CQC’s notice was discussed by the trust’s board during a meeting on March 31.
Director of Midwifery Sharon Wallis said the team were “disappointed” with the CQC’s comments on triage but added that mothers who aren’t seen within 15 minutes are seen “within 16, 17, 18, 20 minutes”.
She added that from April, the triage service will be separated physically from the day case area, which is hoped to bring about improvements.
The triage staffing has also been increased from two midwives to three each day.
CQC inspectors also found that some midwives “may have been acting outside of their competency in respect of reviewing scans” and that “there were some residual cultural issues, but there appeared to be improvements”.
The inspectors also noted both Queen’s Medical Centre and City Hospital had made a number of improvements in areas including record keeping and handovers and almost all patients and relatives “were very positive about their care”.
A full report and rating is expected to be published by the CQC in April.
Associate non-executive director Serbjit Kaur questioned why the increase in stillbirths wasn’t picked up in the board’s update.
Medical Director Keith Girling responded: “This is a complex area.
“We’ve got no suggestion from the national team from the information they have seen that there is an underlying concern around stillbirth or neonatal death.
“We have to think about how we report this in a way that is appropriate and proportionate.
“When the CQC first came to us, they identified a significant number of issues around patient safety. Fetal heart monitoring was very much part of incident reporting at the time. We knew women were coming to harm because that was not being done well.
“We went on to have incidents relating to jaundice and the postnatal pathway. We have seen improvements in both of those areas.”
Ms Wallis said that there have been “fluctuations” in the stillbirth rate but said it is “absolutely a focus for us”.
She added that stillbirths statistics include miscarriages and situations where a woman decides to continue with pregnancy where there is a low chance of survival for the baby.
She told the board members that the trust’s improvement plan is made up of 300 actions.
She said: “We are all frustrated with the pace but the context is significant sickness and we’ve still got vacancies.
“Our improvement plan is vast, it has 300 actions. Having a specific focus on triage has really motivated [staff].”
Rupert Egginton, Acting Chief Executive, added: “There were a lot of notable improvements that they [the CQC] described to us.
“They are significant because they talk to some of the areas that they previously described as failings including fetal heart monitoring which was a concern previously.
“It’s great to see those things. Every single day the team described how good the leadership was within the service and quoted Sharon [Wallis] specifically.
“Nonetheless, there are also areas that were for us to note where there were less positive observations.
“Subsequent to the visit, the CQC contacted us and asked that we improve through their warning notice system in a number of areas.
“There is of course much to do in maternity services given where we are coming from.”
Mr Egginton also referenced the Ockenden review into the Shrewsbury and Telford Hospital NHS Trust maternity services, which concluded that more than 200 mothers and babies could have survived if not for failings.
Mr Egginton said: “We’re in receipt of that report and clearly we need to go through that and bring our reflections on it back to future board meetings.
“The overall observation is that maternity services across the NHS have much to do to bring services up to the standards people want.
“Here in Nottingham, we have our own challenges in that regard.”
Chair of the board Nick Carver added: “‘It is unarguable from CQC evidence that you’ve made significant improvements, it is unarguable that there is more to do and it is unarguable that we want to go faster.”
