Staff in tears, triage concerns and dirty equipment - Kettering General Hospital told to improve maternity services

Kettering General Hospital has been told it must improve its maternity services after a series of concerns were found.

Inspectors from the Care Quality Commission (CQC) said staffing levels for midwives didn’t always match planned numbers, putting women and babies at risk and leaving those at work crying ‘every day’.

They also found issues with cleanliness, with dirty equipment discovered on one ward putting people at risk of harm from infection, as well as issues with triage risk assessments and some women experiencing delays in care.

Hospital bosses say they take the recommendations of a report published today (March 7) ‘very seriously’ and have already taken action to address issues.

Maternity services at the hospital have been rated as ‘requires improvement’ after the inspection, which took place in October. They had previously been rated as ‘good’ in 2019.

Carolyn Jenkinson, the CQC’s deputy director of secondary and specialist healthcare, said: “When we visited the maternity services at Kettering General Hospital, it was encouraging to see leaders generally had the skills and abilities to run the service and were visible and approachable to both staff and people using the service. However, they didn’t always understand or manage the priorities and issues they faced.

“During the inspection, we found staff didn’t always manage cleanliness well. Staff completed tick box cleaning checklists, but there was nothing formal to show cleaning had been done. We also found half empty, unlabelled formula milk packs stored in the freezer, so people, their families, and staff wouldn’t know who it belonged to or how long it had been there. On one ward, we found dirty equipment, stained shower seats and debris left behind following refurbishment work in bathrooms. This put people at risk of harm from infection.”

Inspectors who visited the Rothwell Road hospital found that there were insufficient suitably qualified and competent medical staff for maternity triage and elective caesarean section lists.

The report said: "Staff on Rowan Ward told us they felt there were not enough midwives to provide safe care and low numbers of staff sometimes made them feel unsafe. One member of staff told us this impacted on staff morale and patient care, and staff cried every day because of staffing on the ward.

"Staff said the staffing establishment for the ward was three midwives, plus a ward manager. Staff told us one midwife would regularly be reallocated to delivery suite, thus leaving three midwives on duty including a supernumerary senior midwife to manage the ward. This meant there would be two midwives with two healthcare assistants, to provide care for 32 antenatal and postnatal women and babies, which was not safe.”

Staff members said they had ‘never seen staff turnover like it is now’.

One said: “I find myself dreading coming into work, and it impacts on patient care.”

Some women and people using the service experienced delays in care, with one new mum having a five-hour wait for sutures following a second degree tear.

Inspectors who visited the Rothwell Road hospital found there were several gaps in cleaning record books, windows and bathrooms were in a poor condition and that there were warning signs on the Rowan Ward about the presence of asbestos. Staff told them asbestos in walls had prevented or caused long delays in remedial works when needed, with one room on the delivery suite barred and awaiting repairs following asbestos removal.

The report said staff did not always complete all safeguarding records fully or in a timely way, or always follow triage processes to complete and update risk assessments.

There was no dedicated triage telephone line, triage arrival times were not always recorded and staff did not prioritise patients according to clinical need. Risks were assessed by midwives using their own experience and knowledge, which posed a risk that care may be inconsistent or not provided.

Hospital bosses say a new triage risk assessment process will be implemented by April this year.

The report also found that staff did not always store medicines safely, not all staff felt respected, supported and valued, and that the service did not always ensure duty of candour was carried out appropriately or in a timely way.

However, inspectors said the service provided mandatory training in key skills to all staff and made sure everyone completed it, meaning staff understood how to protect people from abuse.

The service used systems and processes to safely prescribe, administer and record medicines, was focused on the needs of women and people receiving care and all staff were committed to continually learning and improving services.

The CQC also noted that staff and leaders are compassionate and work hard, and that managers made sure incidents were investigated thoroughly and shared lessons learned – and when things went wrong, staff apologised and were compassionate, providing information and support.

A number of areas of outstanding practice were highlighted, including staff training and safety work during the pandemic, examples of quality improvements showcased at a major midwifery conference and work to improve the service’s safety culture.

Ms Jenkinson said: “It is clear that staff and leaders are compassionate and working hard, however, we have informed the trust where they needed to make improvements.

"We will continue to monitor the service closely, to determine whether the issues we identified are addressed so women and people using the service receive the safe care they have a right to expect.”

The CQC ordered KGH to take 14 actions to make sure it complies with legal obligations.

The hospital’s chief nursing officer, Jayne Skippen, said: “We take the recommendations of the CQC report very seriously and a lot of work has been taking place since the inspection to address some of the issues raised.

“These include improving our triage process, developing robust recruitment and retention plans to address staffing challenges, and employing a patient experience midwife to support statutory duty of candour.

“Our staff are absolutely dedicated to providing safe maternity services centred around the individual needs of each patient, and we are glad this was recognised by inspectors.

“We recognise our current estate needs refurbishment and this can make our wards and departments look untidy. I’d like to reassure the public that we consistently achieve and maintain our cleaning standards and score highly on our monthly inspection audits. We are also developing long-term plans to improve facilities for maternity services.”