The Edmonton hospital’s maternity unit was rated ‘inadequate’ by inspectors last year and has been struggling to address its action plan, reports Grace Howarth, Local Democracy Reporter

Enfield councillors have criticised the “little progress” made by North Mid to improve its maternity services.

The maternity unit at North Middlesex University Hospital NHS Trust has so far failed to make enough improvements since it was rated ‘inadequate’ by the Care Quality Commission (CQC) last year, a healthy and safe communities scrutiny panel heard last night (Wednesday 27th).

The Edmonton hospital’s maternity service was rated ‘inadequate’ by CQC in December 2023 following an earlier inspection in May.  

The trust received 26 ‘must do’ and eight ‘should do’ action points from the CQC on themes including lack of equipment, failure to complete risk assessments, staffing levels, poor documentation, poor culture, staff engagement and leadership. 

During the panel discussion, in response to the latest progress report put together by bosses at North Mid, councillors said not enough was being done to address the action plan on maternity care.

Labour panel member Eylem Yuruk said: “Unfortunately I’m sorry to say there’s really little progress.

“The report fails to address key issues such as medicines management, staff engagement, the organisation’s culture, staffing levels and risk assessments. 

“It is my view that the report is significantly lacking and unsatisfactory. There seems to be little progress on the identified issues and the actions I think are being implemented too slowly.”

Conservative panel members Lee Chamberlain and Edward Smith concurred, saying the report needed “more detail” and it contained “too much jargon” with Cllr Smith adding that readers may struggle to know “what’s going on” from its contents. 

However, Professor Lenny Byrne, chief nurse at North Mid, defended the trust’s work and said he wasn’t “entirely sure” what members wanted to see and so they were given “a summary” which indicated “where we are at” compared to the year before.

Dr Nnenna Osuji, North Mid’s chief executive officer, added she hoped the answers given during the meeting provided specificity.

She told the panel: “I would think the answers we have given should hopefully have addressed some of the questions quite specifically this evening. There’ll be a range of opinions, of course it’s quite a sensitive area. 

“There is a lot of oversight of this nationally, regionally, locally. So there is considerable improvement in the way we have articulated, it is not a single journey and we will continue to improve.”

Following the rating from CQC last year, the maternity unit underwent a change in senior leadership and, from July, was without a director of midwifery. Heather Gallagher, the new interim director of midwifery, has since been appointed and started earlier this month.

Cllr Smith questioned the trust’s confidence in the unit’s staffing levels and absences.

Heather said monitoring staffing metrics was “critical” for the trust and that staffing levels were measured against how many patients there were on any given day so “there’s numerous elements to ensure our midwifery staffing is safe”.

She said: “What I would articulate about our midwifery staffing is it’s constantly monitored and constantly overseen.”

Heather added that vacancy rates were “minimal” when compared to other organisations. 

Prof Byrne reported an 88.1% satisfaction rating among patients when asked if they’d recommend the unit to friends and family, and that staff had also recently said the culture in the department felt “different”. 

He added the unit’s staff had created a “formal committee” which had a seat on the trust’s ‘improvement programme’ as well as various other boards so they could “represent any concerns they have on behalf of the staff and tell managers what their wishes are”. 

But Labour panel member Chris James expressed doubts about the trust’s ability to complete its action plan in the timeline it had set, asking for clarification on how far along the service was in implementing it, with the report stating some actions were “closed” while some were still “open”. 

Prof Byrne said this was a consequence of the services having “short, medium and long term” goals and it being difficult to determine sometimes when to “step off”. He concluded that the expectation was for all actions to be “fully closed” by 31st December.

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