Jessop Wing Sheffield: Maternity unit safety 'inadequate', as CQC finds too few staff and training breaches

Sheffield Teaching Hospitals was downgraded from ‘good’ to ‘requires improvement’ following the latest inspection by the Care Quality Commission (CQC), published today, Tuesday, April 5.

Its Jessop Wing maternity unit, where around 7,000 babies are born each year, was again rated ‘inadequate’ overall and for how ‘safe’, ‘responsive’ and ‘well-led’ the service was. Its ratings for ‘effective’ and ‘caring’ remained ‘requires improvement’.

Since the Jessop Wing was downgraded to ‘inadequate’ when it was last inspected in March 2021, inspectors found not enough had been done to address some of the concerns identified.

The report described how ‘bleeps’ for assistance often went unanswered, two in five women waited more than one hour to be triaged and have their care prioritised, staff shortages led to delays in administering pain relief, and one woman told how the pressure staff were under meant ‘basic dignity and care have gone out the window’.

In one shocking case, inspectors revealed how a woman had been left naked holding her baby in a dirty bed, unable to reach the buzzer or phone.

These are some of the key findings from the report:

TRAINING

The CQC found staff did not keep up-to-date with their mandatory training, with targets for training rates being missed.

There were 32 reports between April and September 2021 of staff not being suitably trained or skilled, though none of those cases resulted in any reported harm to patients.

STAFFING, WAITING TIMES AND RISK ASSESSMENT

The service did not have enough midwifery or medical staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment, inspectors found.

Red flag data showed that between April and September 2021, there were 20 occasions where midwives were unable to provide one to one-to-one care in labour.

The midwife to birth ratio for September 2021 was 1:32, which was below the national guideline of 1:29, though the trust said it was actively recruiting to meet the target ratio.

During the previous inspection, women were seen waiting for long periods on chairs, and in some cases having to stand, in the corridor before being assessed.

Although there was now a system in place to triage women, inspectors found the process did not work due to staff shortages and said their ‘concerns remained’.

Inspectors saw ‘several’ women who waited a ‘significant’ amount of time to be triaged, with the hospital trust’s own figures showing that 40 per cent of women waited more than one hour to be triaged and have their care prioritised.

Between April and September 2021, there were 273 red flags for delays in commencing or continuing the induction of labour.

The Jessop Wing had not closed to admissions in the three months prior to the inspection but 11 women had been transferred to other hospitals between July and September 2021.

SAFETY

Staff reported difficulties requesting additional assistance when women’s health was deteriorating. They said there were occasions when they would ‘bleep’ for help more than once before it arrived, and the emergency call buzzer sometimes had to be pulled after multiple ‘bleeps’ went unanswered.

Risk assessments were not always completed for women on arrival or admission, or regularly reviewed, which meant shift changes and handovers did not always include all necessary key information to keep women and their babies safe.

Between April and September 2021, 35 patient safety incidents were raised due to a lack of suitably trained or skilled staff, with ‘very unsafe staffing levels on labour ward’ recorded on one occasion.

CLEANLINESS, INFECTION CONTROL AND HYGIENE

Staff did not consistently use control measures to protect women, themselves and others from infection, inspectors found, though they said the equipment and the premises were visibly clean.

PAIN RELIEF

Several women said understaffing had led to delays in getting pain relief and antibiotics, with some reporting long delays in receiving analgesia during labour and postnatal care.

An independent review by Healthwatch found a number of women from a black and minority ethnic group were not being given the pain relief they requested.

DEATHS, CAESAREANS AND READMISSIONS

The number of caesarean sections was above the expected range, as was the number of women being readmitted, the percentage of births complicated by a significant obstetric haemorrhage, and the number of term babies with a five-minute Apgar score of less than seven.

The number of still births and neonatal deaths, however, was lower than the expected rate, at 3.65 per 1,000 births, compared with an expected rate of 6.9.

COMPASSIONATE CARE

Staff did not always treat women with compassion and kindness, respect their privacy and dignity, or take account of their individual needs, inspectors found.

Patients said staff did not always have time to interact with women and there was a lack of continuity with midwives.

One woman said ‘basic dignity and care have gone out the window’ and inspectors heard how another woman had been left naked holding her baby in a dirty bed, covered in bodily fluids, and unable to reach the buzzer or phone.

Most women, however, said staff treated them well and with kindness.

INVESTIGATING COMPLAINTS AND CONCERNS

The service did not always manage patient safety incidents well, inspectors found, with investigations being delayed and the lessons learned not always being shared widely enough.

“When things went wrong, there were concerns that there was a lack of transparency,” the report added.

Women were not always included in the investigation of their complaint and the CQC said there was not ‘a culture where staff could raise concerns without fear’.

Inspectors recognised that midwives and medical staff ‘made every effort, under difficult circumstances, to meet the needs and care for women and babies’.

But they said they were ‘not assured that leaders had the skills and abilities to run the service’.