Watchdog finds Countess of Chester maternity services ‘inadequate’ and in need of improving

The Countess of Chester Hospital has been told its maternity services are inadequate and need improving to keep women and babies safe.

The Care Quality Commission (CQC) published its latest report which found the hospital’s maternity services had deteriorated since its last inspection.

The report follows an unannounced inspection of acute services provided by the hospital in February and March.

The CQC inspected urgent and emergency care, medicine, surgery and maternity services at the Countess of Chester Hospital.

The hospital provides services to around 30 per cent of the North Wales population covered by Betsi Cadwaladr University Local Health Board, mostly people from the Flintshire area. Welsh patients represent one-fifth of the workload of the trust.

Following the inspection, the CQC issued the trust with two warning notices, the trust said it is “implementing the necessary actions.”

The warning notices call on the trust to make “significant improvements” in the quality and safety of healthcare provided in maternity services.

Improvements are also required in “governance systems relating to referral to treatment processes, implementation of the electronic patient record system and around the management of incidents, complaints and patient deaths.” The CQC report states.

On Midwifery staffing, the CQC reported found “the service did not have enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment.”

The reports notes: “Midwives in differing clinical areas told us they frequently worked over their contracted hours and missed breaks which they were not paid for due to staff shortages and high patient acuity.”

“We found 21 incidents affecting 13 patients. Five of the patients required an unplanned hysterectomy with an unplanned return to theatre. One of these was classified as severe harm, two classified as moderate harm and two classified as no harm in relation to an unplanned hysterectomy.”

“This means that the trust could not be assured that it recognised and addressed incidents that were significant.”

“The service had not consistently reported incidents to external stakeholders. The Care Quality Commission were only made aware when a whistle blower contacted us.” The report states.

On leadership, the CQC report found that “senior leaders demonstrated the necessary knowledge and skills.”

“However, there were several new appointments to the board and the plans the board had developed had not yet had time to evidence their impact or sustainability.”

“Not all senior leaders were visible or approachable in the organisation. Leaders were not always fully sighted on risk within the trust or acted upon it in a timely way.”

Karen Knapton, CQC’s head of hospital inspection, said: “While we found kind and caring interactions from staff to patients across the services we inspected, the trust has work to do to ensure people consistently receive the safe and effective care they have a right to expect.

“This was particularly evident in its maternity service, which we rated inadequate due to issues including a lack of staff and suitable equipment to keep women and babies safe.

“The trust didn’t learn from safety incidents to avoid them happening again and while some reviews were taking place, they weren’t effective in ensuring safe care and treatment in this service.

“Medical care, surgery and urgent and emergency care had enough staff, but some lacked the training for their roles, and poor management of patient records increased the risk of people coming to harm.”

She added: “Since the inspection, the trust has started to address the issues we raised. It’s also receiving additional support from NHS England and NHS Improvement to make improvements. We will continue to monitor the trust closely and will inspect it again.”

The report did recognise positive outcomes in a number of areas, with the CQC noting:

• The Trust’s urgent and emergency services maintained a ‘good’ performance in terms of its provision of effective and caring treatment
• Staff treated patients with compassion and kindness across all the core services inspected
• Staff understood how to protect patients from abuse
• A reduced observed rate for perinatal mortality at the Trust (for September 2020 to March 2021)

Dr Susan Gilby, Chief Executive at the Trust said: “The CQC’s report identifies a number of key areas for further improvement and development that are required at the Trust, as well as recognising the work which has taken place to embed a culture of compassionate care and treatment across the Trust’s services.

“The report illustrates where more progress must still be made to ensure the Trust can provide the highest quality of treatment to the local community, which we are committed to delivering. In our Maternity Department, we have implemented and are continuing to develop measures to ensure we can consistently provide patients with the safe and effective care they have a right to expect.

“Despite unprecedented pressure, the Trust’s urgent and emergency services were able to maintain a ‘good’ performance in terms of its provision of effective and caring treatment, which is a testament to the professionalism and commitment of our staff.

“We are now working hard across the Trust to implement the CQC’s recommendations, so we can continue to make improvements and deliver increasingly high-quality care to our communities in the future.”

• The full report can be found here: https://www.cqc.org.uk/provider/RJR