Agenda item

The University Hospitals of Leicester submits a report on the outcome of the CQC inspection of maternity services.

Members will be asked to note the contents of the report.

The Chief Nurse presented the item, and it was noted that:

·       The CQC have been undertaking a national thematic review of maternity services across England and visited UHL at the end of February and beginning of March. The inspection was conducted over three days to review the safe and well led domain. 

·      The rating for both Leicester General Hospital and Leicester Royal Infirmary reduced from good to requires improvement overall and St Mary’s Birth Centre remained good overall.

·       UHL take the findings of the report seriously and are committed to improving maternity services. Whilst the inspection highlighted UHL maternity services are not at the standard expected, many of the issues identified by the CQC were areas known and actions to improve underway.

·      The key theme throughout the report concerns not enough staff members for safety – this is not unique to Leicester but is a national issue. Improvements are being made locally however to recruit, since April 2022, 35 neonatal nurses have been recruited as well as five midwives and another 24 due to join the service. UHL have also strengthened the leadership of maternity services. 

·       UHL continue to deliver improvement plans and the service is in a different place to when it was inspected. The CQC have been invited back to review the progress.

In response to questions and comments from Members, it was noted that:

·       Recruitment is improving locally despite national challenges. The midwife vacancy rate does remain static - additional posts have been created to provide promotion and a senior team 24/7 to provide safety across the unit. There are 48 vacancies in midwifery services. New consultant posts have been created in the medical teams which have been fully recruited to. Nine additional junior doctor posts have been created to support the medical team with most now recruited. There are no vacancies in maternity support workers. The neonatal vacancy rate is around 8% with issues around qualifications and speciality for senior nurses but exploring how internationally trained nurse qualifications can be recognised.

·       The CQC have changed the inspection regime and whilst it was a planned inspection it does not give much notice to change ongoing issues. UHL were cited on many issues within the report and have improvement plans in place and an improved leadership team.

·       Many issues highlighted as part of the warning notice have been resolved – there is a reverse RAG rating which is considered at three approval panels with the ICB also providing oversight and signing off assurance in relation to actions.

·       Two identified actions remain difficult to solve and are not unique to Leicester, including staffing and induction of labour. A better oversight is in place to manage demand and capacity of inductions. A pop-up maternity assessment unit has also been created to support induction with estate options being considered but likely to be long-term plan. Assurance was provided that choice of induction is not being superseded.

·       There is a national shortage of midwives and vacancies are not associated to financial savings. A rolling recruitment exercise is underway to recruit to all vacancies.

·       Additional posts have been created for middle-grade doctors along with further recruitment of additional consultants. The team have been requested to undertake modelling to further increase the number of hours doctors are available on site seven days a week. UHL are also working with the University to appoint a chair of obstetrics to work on maternity safety. 

·       The CQC have been invited back to review progress, but this is unlikely to be until the New Year. Regular engagement meetings take place to update on the warning notice and feedback has been positive.

As part of discussions the Chair invited youth representatives to make comments and it was noted in response that:

·       In order to support young mums, priority is given to those vulnerable to ensure continuity of care both anti-natal and post-natal. This ensures a woman or birthing person is able to see the same midwife or group of midwives throughout pregnancy and post-natal.

·       Leicester is one of sixty maternity services that requires improvement or inadequate. UHL has been rated requires improvement with the safety domain at Leicester General and Leicester Royal Infirmary inadequate. It has been recognised that this is not good enough and being taken seriously to learn and improve.

AGREED:

·       The Commission noted the report.

·       Members comments and concerns be noted by health partners.

·       The item to remain on the work programme for the Commission to be kept updated on progress with the improvement plan.