If you care about our health services Sunday's meeting at Unity Centre is a must!

 

Quality Care Commission welcomes improvements at Northwick Park maternity services - rating improved from 'Inadequate' to 'Requires Improvement'

 From the Quality Care Commission

In October, CQC carried out an unannounced comprehensive inspection of the maternity department at Northwick Park Hospital, run by London North West University Healthcare NHS Trust*. This was to follow up on concerns identified during a previous inspection in April, when CQC told the trust to take urgent action to keep mothers and babies safe.

Following the October inspection, the overall rating for maternity services improved from inadequate to requires improvement. Safe, responsive and well-led remain as requires improvement. Caring remains good, and effective moved up from requires improvement to good.

Nicola Wise, CQC’s head of hospital inspection, said:

“I am pleased to say we saw a number of improvements in the maternity department at Northwick Park Hospital during our recent inspection.

“After our previous inspection, we were concerned there was a blame culture within the service which stopped incidents being escalated and improvements being made. This had improved, and staff are encouraged to give feedback and report incidents which are now being reviewed and learning shared, with improvements being tracked. We found a zero-tolerance policy regarding bullying and inappropriate behaviour, which was an improvement from our last inspection.

“Women using the service told us staff treated them with kindness. One person who had recently given birth, said that staff had gone above and beyond to provide safe care and treatment. They also respected people’s personal, cultural, social and religious needs. One woman who wore a hijab said that staff had respected them and their privacy regarding this.

“Following this inspection, we pointed out areas where further improvements need to be made. However, the interim leadership team is aware of the issues, and is committed to making the required improvements. Staff told us that senior managers were much more visible, and they were impressed by the change in approach from the leadership team, saying there was no longer a feeling of ‘them and us’. It is clear that leaders need time to fully embed the improvements in the maternity service and make permanent appointments to the team.

“We will continue to monitor the service to check that improvements are made and fully embedded, however, we recognise that all hospitals and healthcare professionals are under extreme pressure at the current time, and they need to be given the space to focus on delivering safe care to patients and supporting staff through this difficult period.”

Inspectors found the following during this inspection:

• The service did not always have enough midwifery staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Waiting times were longer for women across maternity services when staffing levels were low, though staff were encouraged to report delays as incidents. The birth centre was closed due to staff shortages. Staff shortages also impacted on home visits and clinics provided by community midwives
• Compliance with mandatory staff training was 84%, which did not quite meet the trust’s target of 85%, although it was an improvement
• The service had one never event in September. Never events are serious, largely preventable patient safety incidents. A swab was left inside a patient when they were being induced, even though two members of staff had signed a document showing that the correct number of swabs had been counted following the procedure. Learning from this event was shared across the trust
• The department’s policy was to admit women on their third call in 24 hours to explore any concerns. However, there was no system of recording the time at which women with concerns had previously called
• Some equipment on the resuscitation trolleys was out-of-date and cold cots** in the bereavement suite had been out of operation for two months, as the cooling system had failed, even though this had been reported to the trust
• Inspectors found an open trolley on the delivery suite which contained two drugs vials, presenting a risk that unauthorised people could have access to the vials
• One-to-one antenatal appointments with community midwives were not always being recorded. Inspectors also saw loose paperwork relating to patient assessments which could become detached from women’s notes so information could be misplaced
• Women who were attending the service to have their pregnancy terminated often had to wait for 45 minutes for their appointment in the same waiting room as women attending antenatal and postnatal clinics, which could be distressing for them
• Antenatal classes had been reduced as a result of the logistics of providing classes during the COVID-19 pandemic and staff availability, which meant women did not have access to information that could help them improve their health and wellbeing during pregnancy. Online classes had been planned, but these had not been implemented.

However:

• New interim leaders had the skills and abilities to run the service. The new managers understood and managed the priorities and issues the service faced. However, the trust needed time to embed this improved leadership and also to forge a period of stability by making permanent appointments to the leadership team
• In response to external reviews of the service, managers had produced a maternity improvement plan, which was reviewed and updated weekly
• There had been improvement in doctors, nurses and other healthcare professionals working together as a team to benefit women
• Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. It was easy for people to give feedback and raise concerns about the care they received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff
• Work was in progress to ensure staff completed and updated risk assessments for each woman and took action to remove or minimise risks
• The service had recently employed an audit midwife and a risk midwife to ensure monitoring of patient outcomes and benchmarking of service
• Work was in progress to monitor domestic abuse being assessed at all antenatal appointments
• The service had information boards which carried updates for staff on the maternity risk register. Policies and clinical guidelines were up to date and had dates for review
• The service made sure staff were competent for their roles. Managers appraised staffs’ work performance and held supervision meetings with them to provide support and development
• Staff understood and respected the personal, cultural, social and religious needs of women and how they may relate to care needs. 
  

On Twitter Cllr Ketan Sheth, chair of Scrutiny where he has done much to hold local NHS services to account, said: 

 Pleased to see the Care Quality Commission have upgraded London NW University Healthcare NHS Trust's Northwick Park maternity service to Requires Improvement and rated the service as Good for caring & effective. This is welcome progress for our local maternity service.

The full report is available HERE

 

Care Quality Commission finds 'poor culture' at Northwick Park's Maternity Department amidst multiple allegations of bullying. Emergency Dept more positive but the hospital still requires improvement

From the Care Quality Commission

The Care Quality Commission (CQC) has told London North West University Healthcare NHS Trust that it must make improvements at Northwick Park Hospital, following an inspection of the maternity service and the emergency department.

CQC carried out an unannounced focused inspection of the maternity service in April in response to information of concern received about the care of mothers and babies in the department. Following the inspection, the overall rating for the maternity service went down from requires improvement to inadequate. The ratings for the safe and well-led domains also went down from requires improvement to inadequate. The caring, effective and responsive domains were not rated during this inspection.

Inspectors also carried out an unannounced focused inspection of the emergency department to follow up on concerns regarding the quality and safety of the service and found that significant improvements had been made. At the time of the inspection in April, the department was under adverse pressure due to the COVID-19 pandemic. The emergency department was not rated during this inspection, so the previous rating of requires improvement remains in place.

The overall rating for Northwick Park Hospital remains unchanged and is requires improvement.

Nicola Wise, CQC’s head of hospital inspection, said:

“We were very concerned by our findings at Northwick Park hospital’s maternity department. There was a poor culture overall and there were multiple allegations of bullying amongst the staff. This is completely unacceptable. Nobody should have to work in an environment where they feel intimidated.

“Staff told us about one consultant who refused to help a junior midwife when asked, and other consultants who went home instead of discharging patients. We were also told about staff shouting at each other, and a midwife shouting at a patient because she could not understand English. A member of staff shouted at one of our inspectors, after mistaking them for a colleague.

“Some staff said they had raised concerns about the poor attitude amongst the senior management team, but that leaders did not listen. Other staff said they were frightened to speak out, for fear of repercussions, and some claimed they had been told by management only to say good things when asked. The knock-on effect of working in such an environment, is that when things go wrong, the fear of being blamed prevents people from raising concerns and reporting incidents, so lessons are not learnt and shared amongst the wider team.

“The executive leadership team is aware of the concerns our inspectors highlighted and we are assured that the team is implementing improvements while seeking support from stakeholders in the local healthcare community. We will keep a close eye on progress and will reinspect to ensure that improvements have been made and fully embedded.

“The situation in the emergency department was more positive. In general, it was well run, with enough staff with the right skills, qualifications, training and experience to keep people safe and provide the right care and treatment. However, nursing vacancies remain a challenge, although the leadership team was in the process of recruiting staff in order to improve the situation. We also pointed out a potential risk in the department that senior leaders were not aware of and need to address.”

Inspectors found the following areas of concern in the maternity department:

• The leadership team of the maternity service at Northwick Park Hospital had been recently established and because they had only been in post for a short time, the new team did not yet have a proper governance structure in place, and was therefore unable to provide assurance that they had the skills and abilities to run the service, or to implement meaningful changes that improved the safety of the service
• Not all leaders were aware of challenges to the service. Some did not know what was on the risk register and there were some longstanding issues that had not been addressed. Staff reported that not all leaders were visible, and they felt leaders did not act in a timely way to address the issues in the service
• The trust reported 13 serious incidents between March 2020 and March 2021, which included eight perinatal (baby) deaths over a five-week period, during July and August last year, which is a very high number over such a short period. The trust escalated this to the North West London Integrated Care System (ICS) for an external review and the trust had an improvement plan in place to address issues identified in the ICS report
• Doctors, nurses and other healthcare professionals did not always work well together as a team or support each other to provide good care. Most staff that inspectors spoke to had concerns about staffing levels and the high use of agency staff. Staff often had to miss lunch breaks as a result of insufficient staff cover
• The trust was unable to provide assurance that it had effective systems in place to ensure that medical and midwifery staff had the competence, skills and experience to safely care for, and meet the needs of, women and babies using the service
• Mandatory training did not meet the trust’s target. Although staff understood how to protect women from abuse, safeguarding training compliance was not always meeting the trust target and domestic violence assessments were not always documented
• Staff did not always complete and update risk assessments for each patient and did not always remove or minimise risks
• The service did not always manage patient safety incidents well. Incidents were not always reported in a timely way or lessons learned shared amongst the wider service
• During the inspection, concerns were raised regarding delays in the induction of labour for women and an allegation that some women were waiting more than 72 hours to be induced. The trust had completed an audit of patient records in April which showed that half of the women were induced within 48 hours, but the other half experienced delays.

In the emergency department, inspectors found:

• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service had enough medical staff to ensure safe care was provided at all times
• Staff felt respected, supported and valued and they were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff, could raise concerns without fear
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so
• The service generally controlled infection risk well. Staff wore the right personal protective to keep themselves and others safe from cross infection. Patients had an assessment of their infection risk on arrival at the department and staff allocated them to the correct areas
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service
• Patients could access the service when they needed and were able to access treatment promptly. The trust had significantly improved its patient handover and treatment time performance
• However, senior leaders were not aware of all the risks in the department. Staff were responsible for changing the filters on masks, but the leadership team did not monitor, or have oversight of this. In addition, patient safety checklists were not consistently filled all records that were reviewed.

Brent hospital proposals must come under intense scrutiny on Thursday

Days after NHS England announced an inquiry into why waiting times at Ealing Hospital and Northwick Park A&Es have the longest waiting times in the country, LINK, Brent's Scrutiny Committee on Thursday will be examining several important aspects of local health care.

Representatives of the North west London NHS Hospital Trust will be questioned about progress on the recommendations of the Care Quality Commission's (CQC) critical  report on Northwick Park Hospital.

The report LINK sets out the issues to be examined clearly:

CQC made specific recommendations for improvement at Northwick Park Hospital concerning A&E and related services. These are set out below:-

• Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care.

• Ensure that there are systems in place to assess and monitor the quality of services provided in A&E, critical care, surgery and maternity to ensure that services are safe and benchmarked against national standards.

•Review the coping strategies within A&E during periods of excessive demand for services.

•Empower senior staff to make changes to ensure that patients are safe in A&E in maternity.

•Review discharge arrangements in A&E and critical care to avoid re-admission to these areas.

Given the significant number of areas requiring improvement in the current A&E provision at Northwick Park Hospital reassurance is sought from the senior management concerning implementation of actions and the safety of the A&E services available to Brent residents.

Another area to be examined is the proposals from Shaping a Healthier Future and Brent NHS to close maternity and other associated services at Ealing Hospital. 

The committee is recommended to question representatives of the Brent Clinical Commissioning Group on:-

•the robustness of their modelling assumptions and assurance plan;

•the timescale for their implementation; and

•what contingency plans are in place in case any of the proposals turn out not to be possible or feasible

A puzzling aspect of the report LINK is the timing. This meeting is on November 26th and it looks as if key decisions on this issue are actually to be made by the CCGs on the same day:

The next stage of reconfiguration is the changes to maternity services and the inter dependent services at Ealing Hospital. Brent Clinical Commissioning Group is due to make a decision on delegating the decision on timing to Ealing Clinical Commissioning Group, along with the other CCGs across North West London, on 26thNovember 2014. Ealing Clinical Commissioning Group is due to make a decision on the timings of changes to maternity services, and the interdependent services at Ealing Hospital on 26^th November 2014.

One can only wonder if what the Scrutiny Committee thinks will have any impact given this timetable.

The report's authors reach a soothing conclusion:

The impact on Brent residents and NHS services of changes to maternity and inter-dependent services at Ealing Hospital is not expected to be significant. Local services have the capacity to receive additional activity from Ealing without causing a negative impact on accessibility for Brent residents

The final health report to be considered is on the future use of the Central Middlesex Hospital site LINK. Current proposals are:

•An elective orthopaedic centre.

•Mental Health inpatient facility relocated from the site at Park Royal.

•A GP and primary care ‘hub’.

•A Genetics laboratory relocated from Northwick Park Hospital.

•Relocation of rehabilitation beds currently at Willesden.

This is a crowded agenda with lots of 'suits' from Brent NHS Health, the Clinical Commissioning Group abd Shaping a Healthier Future attending.  At previous meetings the chair has seemed irritated by the searching questions posed by Cllr Mary Daly and tried to hurry through proceedings with so many of the scrutinised wanting to speak.

In fact Daly's interventions seemed based on the fact that, unusually, she is a councillor who has done her homework as well as being someone passionately committed to the health of local residents.

I hope that at this meeting, however inconvenient, she gets a fair hearing. I also hope, for the sake of the public, microphones are installed to get over the acoustic problem in the committee rooms as well as the suits' mumbling.

If all that Health material is not another there is a major and very interesting report  LINK by a Task Group on the Agenda.The Task Group, chaired by Cllr Neil Nerva, looked at promoting electoral engagement following the introduction of Individual Electoral Registration and is packed with information and ideas. The most innovative of which is the involvement of the campaign group Hope Not Hate.

Once again such a crowded and complex agenda raises the issue of the wisdom of reducing Brent Council's scrutiny committee to just one. This was a hasty decision made at the beginning of the administration with no prior consultation which took many Labour councillors by surprise.

These are decisions about vital issues, at the extreme perhaps a matter of life or death, and must have proper scrutiny.