Under-review Nottingham maternity units no longer inadequate

By Dan Martin & Rob Sissons

BBC News

Maternity units where dozens of babies have died or been injured are no longer rated inadequate by a care watchdog.

Nottingham University Hospitals (NUH) NHS Trust is subject to the largest review of its kind in the UK after a series of failings.

Bereaved families said the report was a “small step”, and added “much more needs to be done”.

Dr Jack Hawkins and his wife Sarah, who both used to work for NUH, have campaigned for safe maternity services after their daughter Harriet died due to failings in 2016.

Responding to the CQC’s findings, Dr Hawkins said: “It is progress and we need to be positive about that, but our concerns are it is really the bare minimum that the public should expect.

“Some of the outstanding issues raised are critical to safety and very basic.”

Mrs Hawkins said: “‘Requires improvement’ still doesn’t mean safe and what all the families want is safe care.”

She added: “The families welcome that there may be some improvements, but we really want to stress that it seems like it is the bare essentials.

“The trust still requires improvement and that’s not anything to be celebrated.”

The CQC carried out an unannounced two-day inspection of the maternity units in April and has now released its findings, days after it confirmed it was investigating the deaths of three babies in the trust’s care in 2021.

The regulator has judged both hospital maternity units, and the trust’s overall maternity service, as requiring improvement but said it identified sufficient recent improvement to lift their long-standing inadequate rating.

Its latest findings come a year into a major review of the trust’s maternity failings by senior midwife Donna Ockenden, who is looking at the cases of some 1,800 affected families.

She previously led a review of maternity services at Shrewsbury and Telford NHS Trust, in which it was found that 201 babies and nine mothers could have survived with better maternity care over a 20-year period.

Her findings so far in Nottingham have triggered an inquiry by Nottinghamshire Police that will run alongside her own.

CQC Midlands deputy director of operations Greg Rielly said: “At both maternity services, we saw an improvement in the level of care being provided to people and their babies since we last rated both services as inadequate.

“It is positive to see that the trust is now on an improvement journey to bring about better and safer care.”

However, the CQC’s latest report said the trust’s maternity service “did not have enough substantive staff to care for women and keep them safe” and not all staff had training in key skills or assessed risks to women in a timely way.

Inspectors raised safety concerns about how medicines were managed and said not all equipment was cleaned between uses.

They also found storage of expressed breast milk was “unsafe”.

The trust was also “not always complying with its statutory responsibilities for duty of candour” – a professional responsibility to be honest with patients when things go wrong.

The CQC said further inspections would be carried out to ensure improvements in maternity continued.

The watchdog also assessed the NUH’s leadership, previously rated inadequate, which it said now “requires improvement”.

By Rob Sissons, BBC East Midlands health correspondent

Nothing in the latest CQC report can undo the enduring heartbreak for families who have suffered catastrophic loss and harm as a result of maternity failings in Nottingham.

The trust has welcomed it as an endorsement of its improvement plan and evidence that change is possible and being delivered.

Some will say: “About time.” For almost three years, its maternity services have been given the CQC’s lowest rating and there seemed little sustained progress.

The new rating may be seized on as a positive by the trust, but it is hardly a ringing endorsement and means significant improvement is still needed to restore confidence and ensure safety. The trust’s chief executive started last year and has promised to forge a new open, honest relationship with affected families and will work on a full apology.

The CQC report has some positives for front-line staff, who are rated good for caring. Retaining and recruiting such staff during a major review and police investigation is just one of many challenges the trust faces.

CQC inspections are, of course, a snapshot in time, but some families question why, in years when it was already clear some babies were coming to harm, local maternity services were rated good.

Influential midwife Donna Ockenden has already described the delivery of the necessary changes as “a marathon, not a sprint”. We must wait at least another year for her final report, which aims to uncover the depth and scale of what has gone so badly wrong in Nottingham.

The ultimate test for the trust is to continue to improve safety and culture at a time of unprecedented scrutiny.

In a statement, the Nottingham Families Maternity Group said the CQC report was a “small but crucial step in Nottingham University Hospitals’ journey to improve patient safety”.

The group said it continued to be contacted by families who had experienced poor care and added: “There is clearly much more that needs to be done.

“It’s concerning that the CQC have identified critical and basic issues that still require improvement. Issues such as staff training, oversight of women’s risk, and cleanliness of equipment.

“This improvement is the absolute minimum that the public should expect.”

NUH chief executive Anthony May said he was pleased the CQC had recognised improvements.

He said: “Most importantly, I hope the report provides confidence to local mothers and families who choose to give birth under our care, and that anyone who has had a poor experience can see the positive changes we are making, as well as listening to feedback and embedding improvements.

“I am clear, though, that further improvements are vital, and in some areas, we need to do more to rebuild trust within our community.”

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