Scarborough Maternity Services "Inadequate" in Latest Inspection

The Care Quality Commission (CQC) has published its report into services at York and Scarborough Teaching Hospitals NHS Foundation Trust following an inspection between October 2022 and March 2023.

The CQC inspected Emergency and Urgent Care, Medicine and Maternity in both York and Scarborough hospitals, and looked at the ‘well-led’ key question for the Trust overall.

The Trust’s overall rating is Requires Improvement, which is unchanged from the last overall rating in 2019. The report found that leadership across the trust is inadequate.

The CQC report says:

"We carried out this unannounced inspection of York and Scarborough Teaching Hospitals NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services.

We inspected Emergency and Urgent Care, Medical care, and Maternity services. We also inspected the well-led key question for the trust overall. We did not inspect surgery, critical care, services for young people and children, end of life care, out-patients, or diagnostics at this inspection.

In March 2022 we carried out an unannounced focused inspection of Medical care of the York Hospital following significant safety concerns we had received. Following this inspection, we issued a warning notice Section 29A under the Health and Social Care Act 2008 in regard to the standards of care provided on the medical wards. We suspended the rating of good for this service."

"At this inspection the trust rating of requires improvement stayed the same.

We did see improvements made as a result of our warning notice on the medical wards. Following our core service inspections  we sent the trust a letter of intent to take urgent enforcement action of serious concerns we found in maternity services and the emergency department at York.

Risks included identification and management of deteriorating patients, management of patients waiting within the  departments and medicines management, including controlled drugs in both core services. We also found that the mental health room in the emergency department was unsuitable, and the service did not control infection and prevention well.

We also raised concerns regarding assessing and responding to risk within the maternity services, for example the lack of available CTG machines to monitor fetal well-being.

We returned to reinspect these core services during the well led inspection. We found some improvement in the emergency department. However, we did not find similar improvements in maternity services and therefore imposed urgent conditions upon the service"

The report provides ratings for individual services and hospitals within the trust.

The ratings for Scarborough Hospital show that Maternity services have fallen from a previous rating of requires improvement to Inadequate in the latest inspection.

Maternity services at York Hospital were also rated as inadequate.

Simon Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:

“We welcome the CQC’s findings. As is the case across the NHS we have been under sustained pressure and this has impacted our ability to consistently provide the standard of care we all want, which is reflected in the concerns highlighted by the CQC. Nevertheless, we accept the CQC’s findings and recognise that we have much more work to do to make sure all our services are of the high standard that our patients and staff expect.”

“We were pleased that in giving a rating of ‘Good’ for the key question of ‘Care’, the CQC recognises the kindness and compassion of our staff who continue to put our patients first despite the most challenging of circumstances.

“I am also encouraged that the CQC found positive improvements against some of their previous concerns. This includes improvements in systems related to nutrition and hydration for patients on medical wards on both sites, and the impact that the introduction of our new electronic assessment system is already having on saving staff time and reducing risk.

“They also talked positively about the improvements to systems for managing demand within Scarborough emergency department, and it is fantastic to see that the overall rating for urgent and emergency care at Scarborough has been lifted to requires improvement.”

Dr Karen Stone, Medical Director, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:

“We continue to work with the CQC to address their recommendations and have plans to focus on the key priority areas where we know we need to continue to make sustained improvements.

“We responded immediately to the urgent findings identified at the time of the inspection, and in the months since the visits we have made positive progress against areas highlighted in the report.”

York and Scarborough Teaching Hospital NHS Foundation Trust provides a comprehensive range of acute hospital and specialist healthcare for approximately 800,000 people living in York, North Yorkshire, Northeast Yorkshire, and Ryedale. The trust manages three acute hospital sites and five community hospitals. There are Emergency Departments at York and Scarborough. There is a workforce of over 10,000 staff working across the hospitals and in the community.

The York Hospital is the Trust’s largest hospital. It has over 700 beds and offers a range of inpatient and outpatient services. It provides acute medical and surgical services, including trauma, intensive care, and cardiothoracic services.

Scarborough Hospital is the Trust’s second largest hospital. It provides acute medical and surgical services, including trauma and intensive care services

The York and Scarborough Hospital trust says there have been examples of improvements since the inspections took place include:

• Key leadership changes have taken place in the past 12 months, both at Board level and in the way our services are structured and managed.
• Both emergency departments will soon benefit from state-of-the-art new facilities that not only vastly improve the environment but also enable the new acute care model to be adopted which will reduce delays, speed up assessment and better support the flow of patients through the hospital. The York team, who were working in much-reduced temporary facilities at the time of the inspections, will move in July and Scarborough in Spring next year.
• Digital documentation system has been rolled out to all adult wards for recording assessments on admission, giving increased visibility and oversight of risk assessments and freeing up nursing time.
• The Badgernet system has been introduced in maternity, moving away from paper records and increasing the quality of documentation and risk assessments.
• Significant international recruitment of nurses, midwives and allied health professionals, with a lot of work done to welcome staff from overseas into the organisation, including cultural awareness weeks.
• Nursing establishment review completed, with the first stage of investments implemented. The ‘safe care’ tool with the red flag system is also being used to identify areas most in need, and this has daily oversight.
• The Trust has invested in patient services operatives, a new role supporting nutrition and hydration on wards and release nursing time to care.
• Plans have been developed for the recruitment and training of scrub nurses for maternity theatres, and the new maternity theatre pathways are being designed.
• A comprehensive maternity improvement programme is in place to drive forward the actions identified by the CQC.
• Feedback from staff to the CQC was welcomed and is informing the trust-wide culture and leadership programme to help develop a more open and inclusive place to work, building on the work with staff to develop the trust’s values and behaviours.

The full report is here

https://api.cqc.org.uk/public/v1/reports/73e115ea-6405-412a-ad88-7eb8ea65c5ac?20230630070641