Agenda item

The Committee considered a report of University Hospitals of Leicester NHS Trust (UHL) regarding the outcome of the Care Quality Commission (CQC) inspection of maternity services at UHL. A copy of the report, marked ‘Agenda Item 7’, is filed with these minutes.

The Committee welcomed to the meeting for this item Danielle Burnett, Director of Midwifery, UHL and Jon Melbourne, Chief Operating Officer, UHL.

Arising from discussions the following points were noted:

(i)           The key findings from the CQC inspection were that UHL’s maternity services were understaffed and improvements needed to be made with regards to leadership within the services. However, UHL were now able to give assurances that a large amount of recruitment had taken place and maternity leadership had been strengthened including the appointment of a Director of Midwifery. In 2023 nine specialty doctors had been recruited and 57 new midwives had joined UHL. At the time of the CQC inspection there had been 48 midwifery vacancies in UHL. As 20 midwives had left UHL in 2023 there were currently 36 full time equivalent midwife vacancies.

(ii)         A member noted that UHL had been given advance notice of the CQC inspection of maternity services and yet the CQC had still found so many areas of concern which raised the question of why the issues could not have been addressed before the inspectors arrived. In response it was explained that improvements had commenced ahead of the CQC visiting but some of the issues took time to resolve such as recruitment and digital matters.

(iii)        A member questioned how maternity services at UHL had apparently deteriorated so quickly since previous CQC inspections of UHL. In response it was clarified that the CQC inspections of UHL’s maternity services in February and March 2023 were focussed on looking at the ‘safe’ and ‘well-led’ domains which was a different approach to previous CQC inspections. Therefore, the results of the 2023 inspections could not be directly compared with inspections from previous years. It was also pointed out that there appeared to have been a deterioration nationally across maternity services.

(iv)       A member acknowledged the improvements that had been made by UHL since the CQC inspection but raised concerns that these improvements had only been instigated because of the CQC inspection and would not have happened otherwise. In response UHL stated that action had already been taken prior to the CQC inspection such as the recruitment of Julie Hogg as Chief Nurse and reassurance was provided that improvements would have been made in 2023 regardless of the CQC inspection.

(v)         On 12th June 2023 UHL was notified that the CQC had formed the view that the quality of health care provided by the maternity services required significant improvement and a regulation 29A (warning notice) was issued to UHL. Accompanying the warning notice was a list of 64 actions which UHL was required to take and dates by which significant improvement in relation to those actions was required by. In response to a query from a member as to what the consequence would be if the action was not taken by those dates, UHL stated that this was a decision for the CQC but further regulatory action was possible.

(vi)       In response to a question from a member as to whether the CQC had given any indication of when they would be inspecting maternity services at UHL again it was explained that no specific indication had been received, but where Section 29a Warning Notices had been issued the usual timescale for re-inspection was 6 months. UHL confirmed that they welcomed the return of CQC as soon as possible as they believed that the action that had been taken had led to positive outcomes which CQC would be able to see.

(vii)      A member submitted that given the maternity services at St Mary’s Birth Centre had received an overall rating of ‘Good’ from the CQC, reconsideration should be given to the plans to ‘close’ St Mary’s Birth Centre. In response it was confirmed that there would be no change to the plans for St Mary’s Birth Centre. It was intended that the positive work taking place at St Marys would be replicated at Leicester Royal Infirmary and Leicester General Hospital.

(viii)    A member raised concerns that recent changes in visa rules could affect recruitment from abroad and suggested that UHL should look at midwifery apprenticeships. In response it was confirmed that this was already under consideration by UHL and links with both universities in Leicester were being explored and news regarding this would be publicised in the coming weeks.

RESOLVED:

That the contents of the report be noted with concern.