CQC downgrades maternity services at Birmingham University Hospitals

The Care Quality Commission (CQC) has called for urgent improvements following inspections of maternity services at University Hospitals Birmingham NHS Foundation Trust.

An inspection of maternity services at Birmingham Heartlands Hospital and Good Hope Hospital were carried out in February as part of CQC’s national maternity inspection programme. The trust delivers over 8,700 babies and has 150,000 outpatient appointments every year across three sites.

Inspectors looked specifically at whether services were safe and well-led at each hospital. Following the inspection, the overall rating for maternity, as well as the ratings for safety and leadership at Birmingham Heartlands Hospital, went down from ‘requires improvement’ to ‘inadequate’.

The overall rating for maternity at Good Hope Hospital went down from ‘good’ to ‘requires improvement’, the safety category remained at ‘requires improvement’, and the rating for leadership went down from ‘good’ to ‘inadequate’.

Following this inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements at Birmingham Heartlands Hospital.

The overall rating for the trust remains as ‘requires improvement’.

Carolyn Jenkinson, Deputy Director of Secondary and Specialist Healthcare, said: ‘When we inspected maternity services, it was concerning to see a deterioration in the standard of care being delivered. We saw areas where significant and urgent improvements are needed to ensure safe care is provided to women, people using this service, and their babies.

‘At both maternity services, leaders need to mitigate the negative impact of understaffing. Frequent staff shortages meant people didn’t always receive timely treatment which could place them and their babies at risk. It also affected staff morale and wellbeing as many reported they couldn’t take breaks.

‘Over the past year the trust reported examples where women and people using the service had experienced a delay in their care and treatment. This needs to be addressed to ensure timely treatment is given to prevent any harm or risk to people and their babies.

‘However, we did also see some positive areas of care, including how well staff worked with external charities to support people who needed additional help. The maternity service employed a midwife who specialised in female genital mutilation and leaders were proud of the work she’d done to support and educate people in the community.

‘Leaders recognised that the instability of the senior midwifery leadership team had impacted staff morale and several posts had been recruited to, including the director of midwifery, so we hope this helps the trust focus on making swift progress to improve care.

‘We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made in the maternity service so people and their babies receive safe and appropriate care.’

Inspectors found the following during this inspection:

At Birmingham Heartlands Hospital:

• The environment was not well maintained and in parts, not fit for purpose due to the lack of sufficient and suitable waiting space for women and birthing people
• Women and birthing people were not always assessed and reviewed in a timely manner in the Pregnancy Assessment Emergency Room
• Managers didn’t always investigate incidents thoroughly or in a timely way
• Systems to manage performance were not always used effectively

At Good Hope Hospital:

• It wasn’t always clear if action had been taken or followed up following the reporting of risks
• The service provided mandatory and maternity specific training in key skills to all staff but didn’t ensure everyone had completed it
• Staff knew how to make a safeguarding referral and who to inform if they had concerns
• Women and birthing people could reach call bells and staff responded quickly when called

Image: Christian Bowen