A major London hospital’s maternity unit has been labelled ‘inadequate’ after it emerged staff were being bullied and shouted at amid a poor culture that was a risk for patient safety.
It is the fourth hospital to have its maternity unit downgraded by the Care Quality Commission in three weeks as the state of England’s maternity services comes under increasing scrutiny.
Inspectors said staff at Northwick Park Hospital, run by London North West University Healthcare Trust, feared speaking out and had been told by managers to only say positive things if they were asked.
There were 13 serious incidents in the year to March, which included eight baby deaths over a five week period during July and August last year which the CQC said was very high for such a short period. An external review has been commissioned.
Senior doctors and midwives were not working as a team with one consultant refusing to help a junior midwife when asked while staff described other doctors going home rather than helping to discharge patients.
During the inspection a member of the CQC’s own team was shouted at when a staff member confused them for being a worker at the trust. Inspectors were also told about staff shouting at each other and a midwife shouting at a patient when she struggled to understand English.
The regulator has ordered the NHS trust to make improvements to the service after the unannounced inspection in April, following concerns raised about the quality of care for mothers and babies.
The CQC has been taking a tougher stance on maternity services in recent months and has downgraded services at Sheffield Hospital and at Ipswich and Colchester hospitals. Last year the CQC said almost two fifths of maternity units needed to improve on safety.
Nicola Wise, CQC’s head of hospital inspection, said: “We were very concerned by our findings at Northwick Park hospital’s maternity department. There was a poor culture overall and there were multiple allegations of bullying amongst the staff. This is completely unacceptable. Nobody should have to work in an environment where they feel intimidated.
“Staff told us about one consultant who refused to help a junior midwife when asked, and other consultants who went home instead of discharging patients. We were also told about staff shouting at each other, and a midwife shouting at a patient because she could not understand English. A member of staff shouted at one of our inspectors, after mistaking them for a colleague.”
She added: ““Some staff said they had raised concerns about the poor attitude amongst the senior management team, but that leaders did not listen. Other staff said they were frightened to speak out, for fear of repercussions, and some claimed they had been told by management only to say good things when asked.
“The knock-on effect of working in such an environment, is that when things go wrong, the fear of being blamed prevents people from raising concerns and reporting incidents, so lessons are not learnt and shared amongst the wider team.”
Other key concerns included a lack of awareness among managers about key risks which had not been tackled.
Staff also raised concerns about staffing levels and a high use of agency staff with workers complaining they often had to miss lunch breaks because of staff shortages.
Staff failed to properly risk assess women and safety incidents were not well reported.
The CQC said there were concerns women were being made to wait too long for inductions with some waiting more than 72 hours. An audit showed half of women waited longer than 48 hours.
The CQC said the trust leadership was making improvements but it would be kept under close watch
The regulator also reviewed the trusts A&E department and found significant improvements.
Ms Wise added: “The situation in the emergency department was more positive. In general, it was well run, with enough staff with the right skills, qualifications, training and experience to keep people safe and provide the right care and treatment. However, nursing vacancies remain a challenge, although the leadership team was in the process of recruiting staff in order to improve the situation.”
In a statement chief nurse Lisa Knight said: “We recognise that we must make significant improvements in our maternity service, both to improve the care we offer our local communities, and to make it a better place to work. The recent CQC report reinforces the need to build a supportive and compassionate culture within the service. Under our maternity improvement plan, we have already undertaken a significant amount of work to make that cultural change, with further improvements both planned and underway.
“New leaders within the service are already working closely with the wider team to set clear standards of behaviour. The team will work with an external, specialist organisational development team to improve the culture, and are collaborating with the local maternity system who are providing support and guidance. New dedicated Speak Up Champions will support them to raise concerns should they need to do so. Following the inspection, we also made a number of immediate changes to our clinical processes and systems in maternity to improve our care.