NHS watchdog downgrades another maternity unit over ‘blame culture’

Concerns about leadership, systems and ‘overall culture’

The CQC has downgraded multiple maternity units in recent weeks (Getty)

Another maternity unit has been downgraded by the Care Quality Commission following concerns over its culture and safety.

The watchdog has told Salisbury Foundation Trust it must make improvements following an inspection carried out in March after concerns were raised with it about the safety of services and the leadership of the unit.

The CQC downgraded the maternity unit from ‘good’ to ‘requires improvement’ and also downgraded its leadership from ‘good’ to ‘inadequate’.

In recent weeks the CQC has downgraded a number of maternity units in North London, Sheffield, Colchester and Ipswich amid concerns over safety, bullying, and staff shortages.

It has warned 41 per cent of maternity units need to improve on safety.

Amanda Williams, CQC’s head of hospital inspection, said: “Following our recent inspection of Salisbury District Hospital’s maternity services, we found that women and babies using the service received effective care and treatment which met their needs most of the time. But most of the time is not good enough.

“We have told the trust it must ensure there are effective systems in place to improve the quality and safety of the maternity service, and that risks are regularly assessed, monitored and mitigated to keep people safe.”

She added: “We were concerned about the leadership of the service, and the lack of systems in place to ensure that people were receiving good care. We also wanted to follow up on previous concerns we had about the overall culture of the maternity service which meant that staff were worried about being blamed for incidents that occurred.

“Because of this, there had been a reluctance to speak out, when staff should be encouraged to report incidents and share learnings, so that improvements can be made.

“This in turn had an impact on the safety of the service for patients. Although the trust had taken steps to address this, there was still more work to be done.”

She said if the trust did not take steps to make significant improvements the CQC could take more formal action against the trust.

Inspectors found governance and performance management systems were not operating effectively in the maternity unit which mean risks were not being identified or managed.

This included reviews of staffing levels in line with national guidance.

Safety concerns were not consistently identified or addressed quickly enough either, with work on a culture of blame progressing too slowly with little evidence of learning from incidents.

The CQC also examined the trust’s spinal service where it said improvements were needed in order to keep patients safe.

It found the service did not always have enough nurses with the right skills and qualifications and risk assessments were not always completed for patients and detailed records were not kept.

The trust said it had commissioned two external reviews of its maternity services looking at clinical and cultural issues.

Chief executive Stacey Hunter said: “We recognise that improvements in leadership and some of the day-to-day systems and processes are needed. I am able to reassure women that our maternity services remain safe. Providing high quality compassionate care is the team’s top priority.

“To address some of the areas of concern we have already taken action to strengthen the departments leadership. This includes £500,000 investment in additional midwifery roles to support the local risk management, training and governance processes. We have also taken the opportunity to establish a new director of midwifery.

“We are sorry that some of our processes failed to live up to the high standards rightly expected of us and pledge to do everything we can to ensure the maternity department is well run, has a happy and supportive culture and continues to deliver high quality and compassionate care."