Agenda item

In attendance for this item were:

Worcestershire Acute Hospitals NHS Trust – Vicky Morris, Chief Nursing Officer and Richard Haynes, Director of Communications and Engagement

The Chief Nursing Officer referred to the presentation slides included in the Agenda.  Addressing the Care Quality Commission (CQC) Report on Maternity following its unannounced inspection in December 2020, it was important to consider the context of Covid, which had been very challenging. The inspection came following whistle-blower concerns to the CQC over staff shortages. Maintaining staff levels was key and this had been particularly hard during September when staff had rightly been concerned. No safety concerns had been raised during the inspection and other positive feedback included excellent multi-professional team working, recognition of work already undertaken and staff being highly motivated to provide good care. Therefore, it was important to reassure Mums and families and also staff who were working really hard.

Concerns raised were staffing in particular reliance on bank staffing, documentation of escalation, incident reporting, mandatory training, poor completion of maternal early warning score and risk assessments and incomplete Birmingham Symptom Specific Obstetric Triage System.

The Chief Nursing Officer believed that there were established systems in place around staffing but they had not always been recorded. For example, routine ‘huddles’ took place to see whether staff needed to be moved around to fill any gaps, however actions taken to do this were not always documented, and this needed to improve. The concerns raised around accident reporting and mandatory training had sometimes been due to needing ‘all hands to the pump’.

However, the CQC had recognised the Trust as being well led for its leadership capacity, vision and strategy, culture, clear roles and responsibilities, managing risk issues and performance, use of data to support quality, public engagement, learning and training.

Actions which the Trust had put in place already included sustained focus on safety huddles and Chief Nursing Officer safety walkabouts, increased recruitment, training and governance to strengthen processes. 

Recruitment of 17 fulltime midwives and two team matrons was very positive. Staff engagement now also involved the Director of Midwifery and the leadership team was involved in six open meetings with all staff groups to formulate an action plan, discussion of the plan with staff at monthly briefings, and ongoing engagement events.

The collective response to the CQC report meant the Trust would continue to work closely with Maternity Voices Partnership (MVP) on co-production of a revised Induction of Labour pathway and MVP monthly Q&A sessions with the Director of Midwifery throughout the pandemic to support sharing of information and views. Another positive step was that partners were once again able to accompany mums to scans.

The Chairman invited discussion and the following main points were raised:

·       The Chairman acknowledged that pressures from Covid-19 must have made staffing particularly challenging.

·       It was encouraging to see the steps already taken by the Trust to address the concerns raised and HOSC members sought clarity on the timescale for this being reflected by the CQC rating. The Chief Nursing Officer explained that the Trust was required to submit an action plan to the CQC by 19 March, which would be submitted today, ahead of schedule. Monthly updates took place with the CQC, however the normal process to review a rating involved a follow up inspection, which she envisaged would take place as part of a wider visit to the Trust, when it was safe to do so.

·       A member expressed disappointment that a review of the rating required a follow up visit which may take two years, which the Trust representative acknowledged however, there were robust systems to follow up actions which would continue to be communicated to staff and families.

·       A member asked whether the Trust had acknowledged a perceived leadership failure and also expressed concern about the issue of documentation, and staff concerns, and the implications for women at a vulnerable point in their lives; what reassurances could be given to expectant mums? The Trust representative agreed it was absolutely important to accept where aspects of services had fallen short, and it had been recognised that although systems were in place to ensure safe staffing levels were met, this had not been properly communicated to staff, who were understandably anxious to provide the best level of care – this was being addressed by the action plan. Additionally, a new IT system was now being used, accessible by mums through an app, which avoided delays of a paper-based system.

·       When asked whether those leading a service which had been asked to improve were best placed to make the changes, the Chief Nursing Officer pointed out that the Trust accepted the areas where changes and improvements needed to be made, and had continued to ensure services were safe, as reported by the CQC.  She agreed it was important to feed back to staff about any concerns raised.

·       It was confirmed that the Trust had a Whistle Blowing Policy, and it was disappointing that staff concerns had not been raised within the organisation, and this was something leaders needed to ensure staff felt able to do, and to continue to facilitate, for example to build on practices such as the Chief Nursing Officer’s walkabouts and staff forums.

·       In terms of monitoring progress against the action plan, continual updates would be provided to the CQC and once there was evidence of full compliance, the Trust would ask for the rating to be reviewed.

·       The Trust’s Communications and Engagement Director reiterated his colleague’s comments and as part of senior leadership, he was in no doubt of the level of severity being taken in moving forward.