Inspectors rate Bedford Hospital maternity services ‘inadequate’ demanding significant improvement

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Newborn baby

Following an inspection in November 2020, the Care Quality Commission (CQC) has warned Bedfordshire Hospitals NHS Foundation Trust that it must make significant and immediate improvements to the maternity services at Bedford Hospital and has served the trust with a warning notice.

Routine inspections were put on hold in March 2020 as a result of the Covid-19 pandemic.

However, inspectors returned to the hospital on 5 November 2020 to carry out an unannounced focused inspection of the maternity services, after staff raised concerns about the safety of the service which could lead to risk of harm to patients.

At the CQC’s last inspection of the maternity service in August 2018, several concerns were identified, and the service was rated Requires Improvement overall.

It was then served with requirement notices for regulation breaches.

Following the April merger of Bedford Hospital and the L&D, the maternity services within the Bedford site are now under a new executive director team.

‘Inadequate’ and ‘Requires Improvement’

At the November inspection, the overall rating for the service changed to Inadequate, safe and well-led also changed to Inadequate and the rating for the effectiveness of the service was revised to Requires Improvement.

CQC also issued the trust with a warning notice in relation to its maternity and midwifery services and put conditions on the trust’s registration.

The conditions required Bedford Hospital to ensure that staffing is effectively assessed, reviewed and escalated to maintain safe staffing in the maternity unit by 1 December 2020.

It was also required to report the results of audits undertaken, as well as action taken to reduce the risk of reduced staffing, by 14 December, and on a monthly basis thereafter.

CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said: “We rated Bedford Hospital’s maternity services Inadequate overall due to concerns about staffing levels, insufficient training for staff and a poor culture amongst employees. Many of the concerns we had during this inspection had previously been highlighted in 2018.”

The CQC took urgent action to ensure that people using the services were not exposed to a risk of harm and served a warning notice setting out a number of actions the trust must take in order to comply with its legal obligations.

“We also imposed urgent conditions on the trust’s registration as a result of our concerns about staffing,” said Professor Baker.

“The trust was given two months to rectify the issues and make the required improvements.”

Bedford Hospital (Photo: Dr Robert Oakley)

Improvements have been made

“I am pleased to report that under the leadership of the new executive team, the trust is taking these extremely seriously,” said Professor Baker.

“We recognise that some of the planned improvements have been delayed as a result of the impact of the Covid-19 pandemic, however, since our inspection, the trust has positively engaged with CQC, NHS England and NHS Improvement, and other stakeholders, and a comprehensive improvement plan has now been put in place for the service.

“Many of the improvements have already been made and staff have responded positively to these. We will continue to monitor and work closely with the trust to support it in embedding these further.”

How the service rated

The service was rated Inadequate for the following reasons:

• The service did not always have sufficient staff with the right qualifications, skills, training and experience to provide the right care and treatment and keep women safe from avoidable harm
• Not all staff were up-to-date with their training; staff often missed training and worked though breaks as a result of staffing shortages
• In an emergency, the attendance of a consultant was not always immediate
• Staff did not always complete risk assessments for each woman and nationally recognised tools to identify women at risk of deterioration were not always used
• Although staff recognised incidents, they did not always have time to report them, posing a risk of harm to patients
• Inspectors found out-of-date policies which meant staff may not be using current evidence-based guidance in the delivery of care and treatment
• Although leaders were aware of the challenges the service faced, they did not always address concerns in a timely fashion and did not have processes in place to effectively improve the quality of its maternity services and standards of care
• Staff did not always feel supported, respected and valued, they were not encouraged to raise concerns to leaders and when they did, their views were not always listened to or acted upon

However, there were processes in place to ensure that equipment was checked daily and clinical waste was managed well. Infection risk was also well controlled, and medicines were well managed.

Both the premises and equipment were visibly clean, staff knew how to protect women from abuse and the service used monitoring results to improve safety.

You can read full details of the inspection in the report published online here.

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