As part of the Care Quality Commission (CQC) National Maternity Review programme, Harrogate and District NHS Foundation Trust (HDFT) welcomed the CQC’s inspection team to its Maternity Unit at Harrogate District Hospital in November 2022.
The inspection focused on two areas within Maternity Services – Safe Domain (patients are protected from abuse and avoidable harm) and Well-Led Domain (that the leadership, management and governance of the organisation assures the delivery of high-quality and person-centred care, that it encourages learning and innovation, and that it promotes an open and fair culture).
The CQC report summary found that:
“The service had enough midwifery staff to care for women and keep them safe. Staff had training in key skills, and worked well together for the benefit of women, understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to women in most areas, acted on them, and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Managers monitored the effectiveness of the service and made sure staff were competent for their role. Staff felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services. People could access the service when they needed it and did not have to wait too long for treatment and all staff were committed to improving services continually.”
Despite the positive findings, the CQC has reduced the overall rating of HDFT’s maternity service from Good to Requires Improvement. Whilst the well-led element remains Good, safety has been rated as Requires Improvement. There were two elements that the CQC highlighted for HDFT to take action on, both of which had action underway prior to the inspection; one related to the assurance of regularity of equipment checks in the unit, including some of the patient food fridge temperatures being too cold, and secondly the risk assessment/prioritisation of women accessing the Maternity Assessment Centre, which despite being a national issue for smaller units such as HDFT’s and having a local system in place meaning women did not have to wait to be seen as stipulated in the report, the CQC remained concerned about the potential risk. Three areas of outstanding practice were also identified in the report for wider learning by others across the NHS.
Jonathan Coulter, Chief Executive at HDFT said: “With such positive findings in the CQC report it is difficult to understand the resultant rating change and we do not feel it is a fair reflection of the maternity service we provide. The report describes a maternity unit which is fully staffed, with a positive culture, with staff that are competent, listen to women and are always seeking to improve. We are proud of our team for the dedication, professionalism and caring attitude that they show each day whilst supporting those in our care. We are disappointed the rating applied to the service overall and for the safe domain does not appear to reflect the findings in the report.
“Whatever the rating in this report, our response will be to focus on learning and improvement, as it is for any external or internal service review. As part of this focus on continually improving our services, we prioritise listening and learning to ensure we can provide the high quality care that our patients deserve. Listening to people who use our maternity services is so important, as we completely understand that peoples’ experience can differ. This is why, in addition to our own improvement work, we work in partnership with our Maternity Voices Partnership who provide another valuable way for us to hear the needs of those using our services.”
Jen Baldry, Independent Maternity Voices Partnership Chair, said: “We have a passionate and active group of people who work together to create Harrogate Maternity Voices Partnership. We recognise that the MVP is an essential tool for ensuring the maternity services provide the care that service users require by listening to women, birthing people and their families. We receive a lot of positive feedback from our community who praise the care they have had in the maternity department. We will continue to work collaboratively with the Trust to drive continuous improvement. We will take the feedback from the CQC report to help shape the work we do going forward.”
Emma Nunez, Director of Nursing, Midwifery, and AHPs at HDFT said: “We recognise that families may have concerns when they see the rating from the CQC. We would ask anyone who has questions following the publication of the report to contact us, so that we can discuss any concerns and provide reassurance and information to them of the quality of care provided within the unit.
“We would also of course welcome the CQC back into the unit at any time, so that they can see the level of service that we provide here in Harrogate”.