Cambridgeshire maternity department had '87 red flag' incidents in 6 months, putting mums and babies' safety at risk

Jan 28, 2024

While safety 'required improvement' the leadership team were rated 'good'

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A maternity department in Cambridgeshire had '87 read flag' incidents over a period of six months which put women's safety at risk, the healthcare watchdog said. Hinchingbrooke Hospital's maternity department, in Hinchingbrooke Park, Huntingdon, was told it 'requires improvement' in regards to safety following a Care Quality Commission (CQC) inspection in April. However, the ward had made improvements in one area and was awarded a 'good' rating for how the team was led.

In a report published on Thursday, June 8, inspectors said staffing levels "did not always match the planned numbers putting the safety of women and birthing people and babies at risk". It continued: "On the day of inspection midwifery staffing should have been 12 midwives plus 1 supernumerary coordinator but it was 8 midwives plus 1 supernumerary coordinator. Staff told us when there were low numbers of staff it made them feel unsafe." It added: "Leaders recorded lack of staffing as a risk and produced bi-annual reports which were presented to the trust board to make sure they had oversight of the current workforce challenges.

"The service reported maternity ‘red flag’ staffing incidents in line with National Institute for Health and Care Excellence(NICE) guideline 4 ‘Safe midwifery staffing for maternity settings'. A midwifery ‘red flag’ event is a warning sign that something may be wrong with midwifery staffing. Leaders produced a bi-annual staffing report of staffing from October 2022 to March 2023 reporting 87 red flag incidents. These included 10 incidents of delays or cancelled time critical activity."

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The report also said that on 59 occasions, during the same period, the labour ward shift co-ordinator didn't have full oversight of the shift all the time. It said the ward manager "did not always have the resources to adjust staffing levels daily according to the needs of women and birthing people" and while managers did move staff around to plug gaps, "staff told us this was at short notice and meant they may be expected to work in areas unfamiliar to them"

Staff also told inspectors that sickness, annual leave, and maternity leave rates added further pressure on the service.

While there was a high use of agency works, managers requested bank staff familiar with the service and made sure all bank and agency staff had a full induction and understood requirements. The report said: "The maternity service made sure staff were competent for their roles. Band 5 midwives [were] placed on a detailed preceptorship programme to make sure they were trained and given exposure to all aspects of midwifery care.

"The education team and the professional midwifery advocate supported them to sign off their competency document before they were awarded a band 6 role. The service had recruited a cohort of overseas midwives and had provided them with a detailed induction which included supervised practice. Leaders had highlighted that a cohort of midwives needed additional fetal surveillance training which led to an extended induction time to improve safety in the service."

The department was praised for being 'well led' and received a 'good rating' from CQC in this regard. The report said leaders were "well respected, approachable, and supportive" and it said staff told inspectors that their line managers were supportive.

It added: "The executive team visited wards on a regular basis. Staff told us they saw the executive team regularly and spoke of how accessible and encouraging they were."

However, a recent staff survey showed only 44per cent of maternity staff looked forward to work and only 32pc felt involved in decision-making about changes that affected their working area. "Most staff were unhappy with their level of pay which reflects the national picture and many staff felt they could not achieve a good work-life balance," it noted.

Leaders were also praised for understanding health inequalities and how they affected treatment and outcomes for women and babies from ethnic minorities and disadvantaged groups in their local population. The report said: "They monitored outcomes and investigated data to identify when ethnicity or disadvantage affected treatment and outcomes, which they shared with teams to help improve care. They also developed and delivered a training programme to educate all staff on how to identify and reduce health inequalities.

"Staff said that it helped them understand the issues and provide better care. The service promoted equality and diversity in daily work. The service had an equality, diversity and inclusion policy and process. Leaders and staff could explain the policy and how it influenced the way they worked. All policies and guidance had an equality and diversity statement. Staff told us they worked in a fair and inclusive environment."

Inspectors also noted that there was an 'open culture' where families and staff could raise concerns without fear. The report said: "Since our last inspection the service had strived to achieve numerous improvements and the work was ongoing, in an environment that had been subject to structural building work. Which had delayed some aspects of improvement like the safe storage of medication in some areas and the underuse of the birth centre.

"The leaders were aware of the service safety actions in line with national requirements and had actions to address current shortfalls."

Hinchingbrooke Hospital's maternity department was one of two Cambridgeshire maternity departments recently inspected by the CQC. The other ward at Peterborough City Hospital in Bretton Gate, Peterborough, moved up to 'good' in both areas.

Jo Bennis, Chief Nurse at North West Anglia NHS Foundation Trust, which runs Peterborough City, Hinchingbrooke and Stamford & Rutland Hospitals, said: "I am extremely proud of our maternity and obstetric teams and the depth of work that has been undertaken in the past few years and would like to thank our staff for their fantastic support. I’m really pleased that the inspectors could see the dedication and determination of our staff to improve the care our women, babies and their families receive.

"We know there is still work to do for us to progress even further on our improvement journey. We will continue to work with our teams, service user groups, healthcare partners and communities to provide a high-quality maternity service."