CQC 'Inadequate' Rating for Shropshire Baby Deaths Hospital 

Nicky Broyd

November 29, 2018

Shrewsbury and Telford Hospital Trust (SaTH) which is at the centre of a maternity care scandal over avoidable baby deaths and injuries has been rated 'inadequate' overall by the Care Quality Commission (CQC).

It had previously been rated as 'requires improvement overall'.

The trust's chair said: "We will get this right."

Inspection Report

The inspection at The Princess Royal Hospital and Royal Shrewsbury Hospital took place between 21th August and 21st September, including unannounced visits.

The inspection report notes how staff reported a culture of bullying and harassment and how, at times, "we found a culture of defensiveness from the executive team".

The trust's 'disjointed' leadership was strongly criticised for focussing on long-term planning and not addressing how short-term problems would be overcome. Also:

  • Not all leaders had the right skills and abilities

  • Leaders were not always visible and did not work together as a cohesive team.

  • Staff did not have confidence in all members of the executive team

Professor Ted Baker, CQC chief inspector of hospitals, said in a statement: "While we found staff to be caring and dedicated, there is clearly much work needed at the trust to ensure care is delivered in a way that ensures people are safe.

"We remain particularly concerned about the emergency department and maternity services at Shrewsbury and Telford Hospital NHS Trust. We have already taken urgent action to protect people and we are monitoring the trust extremely closely."

Key areas for improvement included:

  • Ensuring sufficient and suitably qualified and trained staff are available to care for and protect people from the risk of harm

  • Keeping all environments safe for use

  • Reviewing and improving midwifery staffing levels to meet the needs of women and to keep women and babies safe

  • Taking account of the report from the Royal College of Obstetricians and Gynaecologists review of current practice in maternity services and formulating action plans to improve the service

  • Reviewing escalating processes around women who are at high-risk

  • Reviewing policy on reduced foetal movements so there is a clear and defined pathway for midwives and sonographers to follow

  • Ensuring complaints are addressed within the trust’s stated timescale

  • Doctors covering out of hours must have the capability and confidence to review patients at the end of life, including prescribing

  • All records must be safely and securely stored

  • Improving the rates of administering antibiotics within an hour of identifying patients with suspected sepsis

  • Ensuring best practice when preparing, administering, and storing medicines

Concerns were raised about A&E staffing levels. However, the trust recruited extra doctors to avoid suspension of A&E services overnight at Princess Royal Hospital in Telford.

Special Measures

The CQC alerted NHS Improvement earlier this month that it anticipated making a formal recommendation of special measures status when the report was published to give it time to get resources in place.

Dr Kathy McLean, executive medical director and chief operating officer of NHS Improvement, said: "The CQC’s inspection report is further evidence that The Shrewsbury and Telford Hospital NHS Trust faces significant challenges and needs intensive support to improve its services, which it is getting already through our special measures programme. This is what the local community has every right to expect and we know that the Trust’s leadership and frontline staff are committed to delivering it.

"Clearly The Shrewsbury and Telford Hospital NHS Trust is on a journey but it is heading in the right direction, having been able to secure sufficient middle grade doctors and nurses to allow its emergency department at the Princess Royal Hospital to remain open overnight.

"The safety and welfare of patients remains ours and the Trust’s top priority and so, we will work with them to ensure this progress continues."

Professor Baker from the CQC said: "We will continue to work with NHS Improvement with regard to the trust. This trust must take action to ensure it makes all improvements necessary to give patients the standard of safe care they should be able to expect. We will return to check on progress with those improvements."
 

'Doubling Down On the Need to Get Things Right'

There were some positive findings in the 112 page CQC report.

'Outstanding' practice was noted in the postnatal ward meeting high standards in caring for women and babies, medicine management, leadership, nutrition, hydration, cleanliness, safety, and record-keeping.

The trust issued a statement attempting to stress positive aspects of the CQC report: "Overall, 33% of categories were rated by inspectors as 'good', 19% were rated as 'inadequate', with the rest rated as 'requires improvement'." 

The trust also commented that it had become one of 20 trusts in England in the 'special measures' support regime.

Trust Chief Executive Simon Wright said: "You cannot be unaffected by a report like this. I’m sorry and disappointed that we have not made as much progress to tackle the issues and challenges that the Trust faces as we all want.

"But people should not lose sight of many things that SaTH does not just well but significantly better than many other trusts around the country."

He continued: "I know how hard staff are working, how passionate they are about what they do and the care they provide. We will take to heart the CQC’s findings just as we welcome the extra support that is coming with special measures, to double down on the need to get things right and improve for the people we serve."

The trust said it had strengthened its leadership team.

SaTH Chair Ben Reid admitted parts of the report were "a difficult read", but said: “We will get this right. There are tremendous successes here but also very real challenges. What the Trust needs now is stability."
 

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