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More staff and respect from managers improving Royal London midwife morale

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The Royal London Hospital’s maternity department has improved but could still do with more senior midwives, according to the Care Quality Commission.

Following its latest unannounced inspection in June this year, the CQC upgraded the overall rating of the service from “inadequate” to “requires improvement”. Part of Barts Health NHS Trust, the maternity unit delivers 5,000 babies each year.

“We found there was significant improvement with several staff telling us morale had improved”

CQC report

Inspectors found it had made progress in a number of areas since the CQC previously visited in 2016, including security and staffing, but also identified areas where more work was needed.

Midwifery staffing levels were identified as a major concern during a previous inspection but the CQC’s latest report shows that an increase in permanent staff and use of bank and agency staff to fill rota gaps had made a difference.

The trust said the number of midwife vacancies had reduced by 40%.

“Staff confirmed the increase in staff numbers and increased use of bank staff had reduced pressures and made the workload more manageable,” said the inspection report.

“Staff and managers told us the implementation of workforce retention strategies and an increased use of bank staffing meant they felt less pressured and had an improved work life balance,” it said.

While there were enough midwives on wards during the day and night, inspectors found the number of clinical midwives was still below establishment.

“This resulted in inefficiencies on the delivery suite and the postnatal ward and meant some women did not get timely care,” warned the report.

“We are all determined to build on these improvements to make the service even better”

Alwen Williams

Many staff raised concerns about the skill mix on shifts and lack of experienced midwives to support less experienced staff and manage complex cases.

One of the key action points for the trust was to ensure sufficient number of experienced midwives to supervise less experienced staff on labour and postnatal wards, said the CQC.

Inspectors also found that previously strained relationships between managers and maternity staff and midwives had improved along with staff morale.

At the previous inspection, they found midwives in the delivery suite and wards “did not feel respected or appreciated by senior managers”.

“Some staff felt their concerns were not listened to, and that management had little interest in their wellbeing,” said the report.

“However, on this inspection we found there was significant improvement with several staff telling us morale had improved and several staff told us they ‘loved coming to work’,” noted the CQC.

Other issues that had been addressed included concerns about baby security, with all mothers and babies now wearing name bands and staff making twice daily checks.

Women who had given birth at the hospital’s birth centre were “very happy with the way staff treated them, and appreciated the continuity of care they had from midwives”, said the report.

But it added that it “otherwise received a mixed response from women and their partners”, stating: “Some women and families we spoke with reported poor experiences that included not being treated with dignity and respect and having no continuity of care.”

As well as areas where there was room for improvement, inspectors highlighted two examples of outstanding practice.

One was the My Body Back maternity clinic for women who had experienced sexual violence. Set up with volunteers, the service provides advice to women contemplating pregnancy or already pregnant.

Barts Health NHS Trust

Damning report on care at major London hospital

Alwen Williams

Inspectors also praised efforts to enable women experiencing miscarriage to be managed under local anaesthetic – using manual and vacuum aspiration – without needing to go to theatre. “This reduced waiting times and uncertainty for women,” said the report.

Trust chief executive Alwen Williams said the department’s improved rating was “good news for our staff, local women, their partners and families”.

“I am delighted that improvements to morale and security have been recognised by the CQC and two areas of practice have been acknowledged as ‘outstanding’,” she said.

“We know there is still much to do and we are all determined to build on these improvements to make the service even better for our patients and staff,” she added.

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