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County Durham trust told to continue focus on improving maternity services

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Managers have been told to make further improvements to maternity services at Darlington Memorial Hospital although inspectors have praised the “drive” of new midwifery leaders.

The Care Quality Commission paid an unannounced visit to the hospital – run by County Durham and Darlington Foundation Trust – in September, focusing on safety and leadership.

“It did not always feel like midwives were deployed appropriated”

CQC report

The spot check followed external scrutiny of serious incidents and concerns about culture within maternity services.

Inspectors concluded services were generally safe and well-run but also found room for improvement and called for continued efforts to improve areas like staffing levels and culture.

“Overall, maternity services at Darlington Memorial Hospital are safe and well-led,” said CQC chief inspector of hospitals Professor Sir Mike Richards.

“We found that staff knew how to report incidents, and there is evidence that they are investigated appropriately,” he said.

However, inspectors highlighted ongoing issues relating to the culture in certain areas – particularly among the medical team with some doctors “not working as well with the rest of the team”.

“Overall, maternity services at Darlington Memorial Hospital are safe and well-led”

Mike Richards

The CQC told the trust it must take action to address “poor behaviours and performance”. However, inspectors did find evidence the culture was changing for the better with midwives reporting improvements since an external review.

“Midwifery staff said they had seen positive changes in behaviours since the external review amongst most of the medical staff,” said the report “They felt they had good working relationships and were able to call the consultants at any time during the day or night.”

Inspectors praised the newly-formed senior leadership team in maternity.

“The team was cohesive and that there was a real drive to improve the quality of the service,” said their report, published today. “The team were aware of the challenges and were able to articulate the actions required to take the service forward.”

They also said staff spoke positively about head of midwifery Joanne Crawford and “felt supported by their immediate superiors”.

The CQC urged the trust to implement recommendations from a review of midwifery staffing “to ensure the appropriate deployment of staff in the correct areas”.

Sir Mike Richards

Sir Mike Richards

Mike Richards

In 2015-16 the trust had a good ratio of one midwife to 24 births, compared to the official recommendation of 1:28.

“This meant there was sufficient staffing,” said the report. “However, staff we spoke with said that although they had the correct ratio, it did not always feel like midwives were deployed appropriately between the labour and post-natal wards.”

One issue was the fact midwives had to act in the scrub nurse role in the obstetric theatre, “which put pressure on the labour ward staffing” and was not in line with Royal College of Obstetricians and Gynaecologists’ standards, the CQC’s report said.

However, there were plans in place – following the review of staffing in May – to address this, as well as introduce “midwifery red flag events” and a labour ward acuity tool.

The report also shows women were not always receiving one-to-one care in established labour ranging from 96% receiving one-to-one care in August 2015 to 90% in April 2016. The average was 93% over the 12 months up to August 2016.

A trust spokeswoman said the organisation, which also provides maternity services at the University Hospital of North Durham, was compliant with Birthrate Plus staffing standards across the whole service but had reviewed shift patterns in clinical areas to ensure appropriate staffing at all times.

Developments included the introduction of 24-hour triage and assessment within the pregnancy assessment unit in order to increase one-to-one care in the delivery suite.

“The exercise has engaged the workforce to review how the rotas are developed”

Trust spokeswoman

The review had also helped ensure the “right staff are doing the right tasks”, said the spokeswoman.

An example would be midwives not doing administrative roles such as minute taking and arranging risk management meetings,” she said. “The exercise has engaged the workforce to review how the rotas are developed and staffing models are deployed to maximise high quality safe care.”

As part of efforts to boost leadership, the trust has appointed two acute matrons to work for the maternity service as a whole – each responsible for one of two hospital sites offering maternity services.

Their work will be supported by the appointment of new delivery suite managers, who are in the process of being recruited.

“The strategy is that both matrons and ward managers in all areas will provide visibility and leadership every day to ensure standards are driven and improvements sustained,” said the spokeswoman. “They will work in collaboration with the newly appointed clinical leads on each site.”

Overall she welcomed the CQC report. “We welcome the CQC inspection report, which concludes the trust’s maternity services are safe and well-led,” she said.

“The report provides a valuable opportunity to recognise the good progress the teams are making on our improvement action plans,” she said.

“This work is ongoing as we continue with further improvements to ensure our ladies and families receive high quality care,” she added.

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