Agenda item

Copies of the CQC Inspection reports into Maternity Services at Darlington Memorial Hospital and University Hospital North Durham are attached for members information. (Appendices 1 and 2)

The Committee received a presentation from County Durham and Darlington NHS Foundation Trust regarding the CQC Inspection and Improvement Action Plan (for copy of presentation see file of minutes).

Copies of the CQC Inspection reports into Maternity Services in Darlington Memorial Hospital and University Hospital North Durham were circulated with the agenda for Members Information.

Sue Jacques, Chief Executive and Noel Scanlon, Director of Nursing, County Durham and Darlington NHS Foundation Trust were in attendance to deliver the presentation that provided Members with details of the ratings; context; positives; themes identified for improvement; actions taken since CQC’s fieldwork in March to keep patients safe and continuous improvement.

Councillor Earley referred to the culture of the organisation and the importance of the Trust being aware of when problems were going to hit you and asked if issues had been flagged up; if they had systems in place to monitor and act upon these issues and if they worked and were any “red flags” identified prior to the inspection.

The Chief Executive responded that they did have monitoring systems in place by way of a national staff survey that happened once a year in Quarter 3, that was broken down by teams.

In response to a further question from Councill Earley, the Chief Executive stated that nothing was flagged in terms of clinical outcomes. In terms of how staff felt about the shortage of midwives within the Trust, across the region and nationally this was where the issues lay as well as in the model of care. She stated that they engaged with clinical staff last summer to look at the plans that had been developed by the leadership team within the service to roll out continuity of care. On the back of that consultation, they modified quite significantly what they had put in place so that they now had birth rate plus which was an approved tool. The Trust had looked at the model they had and suggested a different way to utilise the staff they had to maximum effect. The consultation on the new model with staff closes this week and they would listen to what their staff were saying. The Trust did not want to lose the intense work that had already been undertaken within the service but would use the current consultation to review the service model moving forward. In terms of the region, out of seven trusts that had put forward Q2 staff survey results they were third out of seven for staff satisfaction in three of the key domains indicators and fourth out of seven for advocacy.

Councillor Stubbs asked for an understanding of the Trust Executive’s concerns around maternity services prior to the inspection and whether these had been reflected in the inspection findings.

The Chief Executive responded that they were not expecting the downgrading of the Maternity Services to inadequate from the inspection. She explained that the service was last inspected in 2018 and received a good rating and there were five items that they looked at. In the recent inspection they looked at two domains of Safe and Well-led. They knew that ratings across the country were generally going down but they did not expect to get the rating that they got. They had a number of ways of looking at clinical services and listening to staff that they had established in May before the inspection with a maternity quality approved framework that was looking at making improvements, so they knew there was things that they could do. They were very disappointed in the rating and the failings identified and stated that the report does acknowledge that they were in the middle of doing certain things and advised on the progress made. She advised that they would be re-inspected and they expect this would be the whole service including community services. She commented that they have amazing staff who deserved a better rating.

Councillor Stubbs asked how confident they were going forward and if they were fully aware of what would be included in the inspection based on the fact that they were not fully aware of what the outcome would be from the recent inspection.

The Chief Executive responded that they had put in place a Director of Quality who was currently working with maternity and her role was to give more backing with director level so the postholder had principal responsibility for ensuring that they understand the quality and outcomes and the way staff felt about them in combination with other mechanisms that were established. She commented that freedom to speak was a big part of the NHS.

Councillor Quinn stated that the rating was disappointing but now they could move forward and put things right. She then commented that the morale of staff would be low and asked if support was in place for staff and if there had been an impact on the mothers.

The Chief Executive responded that staff did not want to have the rating and staff welcomed the birth rate plus report that was published in August. She commented that different groups of staff were in a different place around the post optimal model of what they needed to do. The Trust wanted to maximise the use of staff within community and acute maternity services but they did not want to throw away the valuable experiences that those teams had brought. She advised that the current consultation would feed in their views and the Trust Executive Board would meet to determine what happens next. She stated that they would have an extra 49 members of staff in the team and doctors in the pregnancy assessment unit and additional administrative support. Additional staff were also going in overnight to help with cleaning activities and a lot of resources were going into the service. She commented that some staff who were intending to leave the service had stayed and the results of the consultation would go back out to staff to talk about the next steps to retain confidence with staff. They had teams within the organisation who worked on organisational development and change management and they focused a lot of those teams on the maternity staff in acute and community settings.

The Director of Nursing stated that it had been an emotional journey with the report. Staff had felt embarrassed by the findings but had started to dust themselves off and provided details of some of the challenges staff had faced. In terms of support for mothers, the community midwives were at the heart and they had structures in place that were beginning to stabilise and in the main there was positive stories.

Councillor Jopling referred to preparing for the next inspection and stated that if checks and balances were carried out and procedures followed, they should be ready for an inspection at any time. She stated that preparing for an inspection takes staff away from patient care which was the prime object of looking after patients and asked for reassurance that preparing for the inspection did not take anything away from patient care.

The Chief Executive responded that following the inspection they made some changes reasonably quickly and stated that the consultation closes this week. She continued that they had put in place additional resources to support maternity and the Director of Quality was working with maternity and stated that you could not carry out an inspection without involving staff. They were listening to staff and had put in more resources and they were preparing by addressing issues that CQC had raised and were focusing on that and ensuring that staff were not overwhelmed and the patient was always at the heart of everything.

The Director of Nursing stated that the inspection was about showing effective care and sated that they would be carrying out direct communication and provided details of examples of communication.

Councillor McKeon referred to the CQC report and asked for clarification on who the leaders would be and asked how long they had an issue attracting midwives and indicated that she did not realise that doctors were not on the maternity ward. She asked if this was common practice and asked what was in the plan a year before the rating came out versus the current plan.

The Chief Executive responded that doctors were in maternity services to help the maternity staff in the pregnancy assessment unit to supplement their work they put in additional F2 doctors during the day to alleviate pressures while they carried out recruitment. She confirmed that when the CQC talked about leaders this was every leader within the organisation but they did not speak to any leaders outside of the service at the last inspection as it was a limited inspection. She continued that when a full inspection was carried out, they looked at all domains of the service and speak to the board, non- executive etc. With regard to the recruitment of midwives they had carried vacancies for about three years, as well as vacancies in nursing staff which all became more evident during the pandemic. She stated that oversees midwives were in training before the inspection but commented that it takes quite a bit of time to bring those staff in. In May they had a workstream looking at screening and that workstream had concluded and they had another workstream looking at staffing that had not concluded but was generating some proposals to appoint from overseas and other ways of recruiting. They also had a workstream looking at continuity of care and a workstream looking at quality and IT systems which had resulted in a new system been implemented.

The Director of Nursing indicated that the culture between midwives and obstetricians had never been an issue for Durham and Darlington and stated that the relationships were strong and positive.

Councillor Kay indicated that they did not expect the rating that they received and asked what they expected and what was the gap. He stated that he was concerned about the report and was not reassured.

The Chief Executive responded that they had taken the rating very seriously and what they were seeing in these inspections were a number of ratings downgraded within the NHS generally. The Trust knew that they had some issues particularly around staffing but also that their clinical outcomes were good and were expecting a level of reduction in terms of rating but not to the levels that they saw. They had undertaken peer reviews of services and when they met with the ICB they had agreed with them that rather than being in a national programme for oversight whilst they undertake the improvement work, they would work closely with the ICB who had a regional midwife as part of their team to add an element of independent peer review which they did not have previously.

Resolved: That the information contained in the presentation be noted and a further update be provided following the re-inspection by the CQC.