Care Quality Commission inspectors who visited the Edmonton hospital say they were “deeply concerned” by what they found at the maternity unit

The boss of North Mid has vowed to make improvements after the rating for the hospital’s maternity services was downgraded by the Care Quality Commission (CQC).

Following an inspection in May, inspectors have written a report that rates the maternity unit at North Middlesex University Hospital as ‘inadequate’, after previously being rated ‘good’.

Saying they were “deeply concerned” by what they found, some of the issues raised by the inspectors included “poor leadership”, a higher-than-average rate of stillbirths, lack of record-keeping, and equipment not being properly maintained.

The CQC inspectors also reported that they’d received feedback from staff who told them they felt “bullied, intimidated and undermined by leaders”.

In response to the CQC report Dr Nnenna Osuji, chief executive of North Middlesex University Hospital NHS Trust, said they had “made significant improvements in all these areas in the six months since the inspection took place”.

As well as maternity services dropping from ‘good’ to ‘inadequate’ overall, the CQC has dropped the ratings for being well-led and for being safe to ‘inadequate’ as well. This year’s inspection didn’t rate how effective, caring, or responsive the service was. The overall rating for the hospital as a whole remains ‘requires improvement’.

Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “When we inspected maternity services at North Middlesex University Hospital we were deeply concerned to find both staff and women and people using the service being let down by poor leadership.

“Leaders lacked oversight of the issues we found, and we saw signs that a closed culture could be developing within the service, discouraging staff from speaking up to improve people’s care.

“For example, there was a process in place to assess people’s risks during triage, however staff were not using it, meaning they didn’t always prioritise the people who needed care the most urgently. We saw the trust had identified these poor risk assessments during triage in August last year, but little action was taken to improve this.

“While many staff were committed to improving the service, we found leaders didn’t always support them to do so. Staff told us leaders didn’t always take action when they reported incidents, and some midwifery staff told us they felt bullied, intimidated and undermined by leaders.

“Women and people using the service also told us of poor experiences, but we found leaders were not always using people’s feedback to drive improvements.

“The trust needs to take immediate action to ensure leaders are listening to their staff and the people using this service to drive improvement. We’ll continue to closely monitor this service, including through further inspections, and won’t hesitate to take action if we’re not assured people are receiving safe care.”

Since the CQC inspection six months ago, North Mid says it has “reviewed and revamped” its clinical assessment pathway for triaging patients, improved training for staff and also increased staffing levels – recently appointing 20 new midwives.

Dr Osuji said: “Today’s report reflects many of the national challenges that are facing maternity providers all over the country, resulting in two-thirds of maternity services downgraded in their CQC rating.

“I acknowledge the findings of today’s report, which focuses heavily on triage, training and staffing. We have made significant improvements in all these areas in the six months since the inspection took place.

“I am particularly proud that so many of our nurses and midwives who undertake placements with us during their training choose to return to North Mid after they qualify, with 20 new colleagues most recently this Autumn, increasing our staff base. We have also made some important changes to bolster our triage service.

“I realise that today’s publication will be difficult for our staff and local community. I am and continue to be proud of the good in North Mid’s maternity service, and am confident that the improvements we have made in the past year will continue, as part of our forward-looking focus. I hope that local families will be assured that we are taking every opportunity to continue to improve, and will use this report to go further and faster.

“I remain committed to working with staff, regulators and other partners to objectively evidence the standard of maternity care we deliver for our local community, and look forward to welcoming the CQC back very soon to demonstrate this.”

Addressing the report’s content about stillbirth rates, Dr Osuji added: “Any and every stillbirth is a tragedy. We strive continuously to reduce and mitigate any outcome of that nature. Based on the most recent data, our stillbirth rate is in keeping with maternity units of similar size and population demographics.

“Like all maternity services, we are working hard to reduce stillbirths and to address this and other inequities that unfairly impact our local community.”

Chief nurse Professor Lenny Byrne said: “Our local community has every right to expect that their local maternity service is going to keep them and their baby safe, and we are determined to live up to that expectation.

“This report from our regulator makes difficult reading – that’s beyond clear; but what matters most is that local people and the staff who serve them, live among them, and indeed are our local patients, can report that they get the care they need, that it’s safe, is carried out by trained staff, and that we listen to and take action on what we need to do better. I can assure our local population of our commitment to improving.”

The full CQC report will be published on CQC’s website in the next few days and will be available here.

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