The trust at the centre of a maternity scandal does not have enough midwifery staff to keep women and babies safe, a Care Quality Commission inspection has revealed.
East Kent Hospitals University Foundation Trust relied on community midwives to fill slots at its acute unit, with some of them working 20-hour days after being called in to help cover and feeling outside of their competence.
The trust had suspended a midwife-led unit and diverted women in labour to other hospitals – and when the CQC raised the understaffing issue at its inspection in July, it suspended its home birth service. But the CQC found that the number of midwives and maternity workers on duty rarely matched planned numbers and managers rarely calculated staffing numbers accurately, with some elements of the workload not being factored in.
Lack of staff meant there was a risk to the safe assessment and monitoring of women and babies at the trust’s William Harvey Hospital in Ashford. Unqualified staff were having to deal with telephone queries from women who needed advice and support.
Amanda Williams, head of hospital inspection at the CQC. said: “After we raised concerns about unsafe staffing levels, the trust responded swiftly and produced an action plan focused on driving improvements and asked the newly appointed interim director of midwifery to review the challenges the service faced.”
An independent investigation is currently underway into the trust’s maternity services, following the death of seven day old Harry Richford in 2017. An inquest into his death found numerous failings in his care and the trust later admitted failing to ensure safe care for him and his mother Sarah. It was fined £733,000 in a ground-breaking prosecution by the CQC.
But today’s report – which was prompted by information passed to the CQC raising concerns about the quality and safety of services - highlighted issues around leadership and culture at the trust’s units at the William Harvey Hospital and Queen Elizabeth, the Queen Mother, Hospital in Thanet.
The report said: “Leaders were not always aware of the risks, issues and challenges in the service [at the QEQM]” and it did not have an open culture where staff felt confident in raising concerns. “The executive leadership team did not have a full understanding of the day to day pressures and risks faced by the maternity service,” it added.
Infection control risks were not always controlled well and the inspectors also criticised the design of premises which did not always protect women’s privacy and dignity. A review of the home birth service had found “gaps in skills, knowledge and lack of equipment” and there was a lack of oversight of the workload of some midwives, the report continued.
However, the trust managed safety incidents well – although staff did not always report them. especially around staffing issues. “Staff felt continually reporting short staffing had not improved the situation, so they had stopped reporting this,” the report said. Staff at the William Harvey felt “undermined and belittled for raising issues around fatigue and safety,” the report said, and many felt unsafe in their working environment.
There was also a backlog of incidents to be investigated for which the trust did not supply an expected timeline.
As it was a focused inspection, the “requires improvement” rating for the trust’s maternity services was unchanged. A separate inspection of the trust’s services for children and young people saw the overall rating improve from “inadequate” to “require improvement”. The trust was served with three requirement notices around its maternity services.
Sarah Shingler, the trust’s chief nursing officer, said: “We are pleased that the CQC has recognised the hard work and commitment of staff and the significant improvements that they have made for children, young people and their families.
“We continue to work hard to support our midwives’ well-being and help them provide a safe, high-quality service for women and babies. This includes a £1.6m investment to fund an additional 38 additional midwives with 26 already in post.”
As of September had 264 midwives in post, although this includes the 26 Ms Shingler mentioned. Overall the increase on previous levels is around 15 per cent.
The trust said it was improving support for its community midwifery teams, had brought in extra temporary staff and was recruiting more midwives.