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Trust commits to maternity service plan after CQC warning over ‘bullying’ culture

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A struggling trust in the West Midlands has drawn up an action plan to tackle staffing levels and culture in its maternity service, after being threatened with enforcement action.

Walsall Healthcare NHS Trust received a warning in June from the Care Quality Commission, latest board papers have revealed. It was warned it could face enforcement action over concerns that the regulator had about “staffing and culture in maternity”.

“We have received further feedback from the CQC regarding serious concerns with staffing and culture in maternity services”

Richard Kirby

The documents, published last week, said that since the trust’s last board meeting in July it had “received a warning of potential enforcement action from the CQC with regard to their concerns about staffing and culture in maternity.”

The papers added that the CQC had subsequently said it would not pursue enforcement action, after receiving the trust’s improvement plan.

The plan said the trust would ask both the Royal College of Obstetricians and Royal College of Midwives to conduct an external review of the services.

The board papers also said the regulator had “captured” comments from staff during its inspection that “alluded to a bullying culture”, particularly in relation to midwifery.

The trust’s nursing director, Rachel Overfield, highlighted her “disappointment” at the slow pace of recent efforts to tackle the problems in maternity.

“The CQC who have now formally advised us that no immediate enforcement action will be taken”

Rachel Overfield

During the board meeting on 3 August, she said that the service has suffered from a “lack of a stable leadership team, with no head of midwifery for most of the year and limited clinical leadership”.

In his report to the board, trust chief executive Richard Kirby said: “Since our last meeting [in July] we have received further feedback from the CQC regarding serious concerns with staffing and culture in maternity services.

“We have responded to this with a maternity improvement plan that aims to ensure we have safe staffing in the short-term and that we accelerate work to create a clinically-led, engaged and empowered culture in the team,” he said.

The improvement plan includes formal HR processes for four consultants, and strengthening medical leadership through seeking a new clinical director and appointing a new deputy clinical director.

In addition, the trust will be continuing the “restructure and new recruitment” in midwifery leadership, and commissioning support for clinical team building.

Meanwhile, the measures put in place for tackling staffing issues are focused on releasing midwives’ time.

They include transferring responsibility for staffing maternity theatres from midwifery to surgery teams, and shifting activity from midwifery-led units to the delivery suite until “at least early September”.

Rachel Overfield

Rachel Overfield

Rachel Overfield

Registered nurses will also be used to provide post-operation care for women recovering from caesarean sections on postnatal wards, said the trust.

The trust is currently rated as “inadequate” by the CQC and, in June 2016, a review by the Royal College of Paediatrics highlighted concerns over staff shortages in its neonatal unit.

In a statement, Ms Overfield said: “The trust has been in regular contact with the CQC who have now formally advised us that no immediate enforcement action will be taken.

“The CQC took this decision after considering our robust action plan and following the correction of a number of factual inaccuracies,” she told Health Service Journal.

“The trust board papers had been compiled ahead of this decision and a verbal update was given at last week’s trust board meeting,” she added.

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