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Special measures trust brings in Morecambe Bay to help tackle maternity concerns

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A trust in special measures is working with Morecambe Bay NHS Foundation Trust to improve its maternity services, after regulators raised the alarm about patient safety.

Northern Lincolnshire and Goole NHS Foundation Trust was issued with a Section 29A warning notice by the Care Quality Commission, after inspectors raised concerns over delays in foetal heart monitoring, patient assessments and staffing levels.

“They are very keen to help us scrutinise staffing levels within midwifery”

Tara Filby

Now, the trust is organising advanced training sessions to improve staff “competencies” in monitoring cardiotocography (CTG), traces, which measure a baby’s heart rate and mother’s contractions.

The trust is also receiving support from Morecambe Bay, which is now rated “good” by the CQC following major improvements in maternity services in the wake of the high profile scandal there over the avoidable deaths of 11 babies and one mother.

At a Northern Lincolnshire and Goole board meeting in Grimsby last week, chief nurse Tara Filby said: “We’ve had support from Morecambe Bay as we review our midwifery establishment… they are very keen to help us scrutinise staffing levels within midwifery and provide us with additional guidance.”

Last month, an investigation by Health Service Journal revealed that babies were dying or being left with disabilities around the country, because of a failure to properly monitor and respond to CTG readings.

The North Lincolnshire trust was rated “inadequate” and placed in quality special measures in April, after CQC inspections in Grimsby in November and December at Scunthorpe Hospital and Diana, Princess of Wales Hospital.

The Section 29A warning notice was issued in January, ahead of the publication of the CQC report, when inspectors discovered the midwife to birth ratio was 1:32, meaning the trust was failing to meet the Royal College of Obstetricians and Gynaecologists guidelines of 1:28.

Northern Lincolnshire and Goole NHS Foundation Trust

Lincolnshire hospital trust appoints new chief nurse

Tara Filby

Root causes and lessons learnt were not always identified following serious incidents, inspectors found. A requirement notice was also issued after the CQC found delays in commencing and escalating CTG.

In response, the trust is recruiting additional midwives alongside midwifery support workers and, in March, the midwife to birth ratio was 1:26 at Scunthorpe and 1:29 at Grimsby.

By April, 95% of staff had undergone CTG mandatory training compared to 69% in November 2016, and staff will attend advanced training “masterclass” sessions this year and in 2018.

The trust has also introduced a policy of starting CTG within 30 minutes of women arriving at its antenatal day unit, escalation trigger guidance has been developed and spot checks are carried out alongside daily documentation checks to monitor compliance.

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