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CQC finds East London maternity unit still 'requires improvement'

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Regulators have told Homerton University Hospital Foundation Trust that its maternity services still “require improvement”, after its latest inspection found problems remained since its last visit.

At the most recent inspection, in October and November, the Care Quality Commission found a lack of “robust” observational checks of babies and the need for a more “consistent” system to embed recommendations from serious incidents.

This followed a previous visit to the trust in March last year, which was triggered by five maternal deaths over 18 months.

”Examination of baby records during this inspection showed continued inconsistent compliance with completion of observations ”

CQC report 

At the time of the original visit, the regulator told the trust to take “urgent action” over a number of issues including a lack of incident reporting, poor standards of cleanliness, unsafe drug administration and storage, and staffing below the levels recommended in midwifery guidelines.

In its latest report on the maternity services, the CQC said the cleanliness and hygiene of the unit had improved “significantly” and that systems for assessing and monitoring the quality of the service were also strengthened.

But it found there was still a need to improve governance structures and reporting systems to make certain learning from incidents was embedded and to ensure a robust system for checks of babies was in place.

Inspectors found the trust’s baby observation sheet had not been amended since its last visit, when it was reported as not being completed properly.

“The chart did not have all the expected standard parameters to safely identify a deteriorating baby, such as tone and colour which are often early indicators of an unwell baby,” said the CQC report.

“Examination of baby records during this inspection showed continued inconsistent compliance with completion of observations against the pre-set frequency of observations,” added the report.

”We have found some real improvements… However, we still have some concerns regarding the need for robust observational checks of babies”

Mike Richards

In addition, the unit was still yet to implement a specific early warning chart for neonates that had been in development by the trust for at least nine months.

However, the CQC noted that outstanding midwife vacancies had been filled, including nine newly qualified, since the previous inspection.

But inspectors were also told by senior staff that no increases in establishment had been requested or offered in that time. At this latest inspection, the regulator found a 1:30 midwife to mother ratio.

Midwives told inspectors the trust made “every effort to use agency staff known to the service” and that changes in demand were often dealt with by transferring community midwives to the delivery suite.

Mike Richards, CQC’s chief inspector of hospitals, said: “On our last inspection, we identified a number of issues, and we told the trust that urgent action must be taken to address these concerns and minimise the risks to mothers and babies.

“I am pleased to report that we have found some real improvements in the care and welfare of women using maternity services, and in the standard of cleanliness and infection control,” he said.

“However, we still have some concerns regarding the need for robust observational checks of babies, and a more consistent system to absorb the recommendations from serious incidents,” he added.

Homerton University Hospital Foundation Trust’s chief executive Tracey Fletcher said she was pleased inspectors had recognised the organisation’s improvements.

“Whilst we are moving in the right direction, we also recognise that we still have more work to do in areas such as strengthening our governance protocols and embedding good practice procedures. We will continue to work with our colleagues at City and Hackney clinical commissioning group and elsewhere to make further improvements which benefit our mothers and babies,” she said.

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