Health board issued with formal warning to improve maternity services

NHS Tayside has been formally ordered to improve maternity services at Ninewells Hospital following an unannounced inspection by a health watchdog.

Healthcare Improvement Scotland (HIS) expanded its safe delivery of care inspections following a neonatal mortality review last year to “provide women, birthing people and families with an assessment of the quality of care” in maternity services.

It carried out its first safe delivery of care inspection in an unannounced visit to maternity services at Ninewells in Dundee between January 27 and 29 this year.

This was followed up with another unannounced visit on February 12 due to concerns, including that breastfeeding equipment was being cleaned in a sink with kitchen utensils, which had not been addressed at the time of the return visit.

In an inspection report published on Thursday, HIS said after the revisit “we were not assured that sufficient progress or improvement had been made with some of our concerns”, and it formally wrote to NHS Tayside to urge it to meet national standards for maternity services.

Concerns included “variations in oversight and governance observed in both the hospital inspection and maternity services, and a lack of oversight by senior managers within maternity services”, with other areas of improvement including “safe staffing, fire safety issues and the maintenance of the hospital environment”, according to HIS.

Inspectors formally wrote to NHS Tayside to urge it to meet national standards for maternity care (PA). PA Media

The maternity services inspection resulted in nine areas of good practice, three recommendations and 20 requirements, including guidance from the Royal College of Obstetricians and Gynaecologists.

The report said: “Staff also informed us once women confirmed they will attend the maternity triage unit, following an assessment carried out by a midwife, there is no process to follow up any women who fail to attend the triage unit, preventing welfare checks being undertaken.

“The Royal College of Obstetricians and Gynaecologists recommends recording details of all women who have been asked to attend maternity triage departments and that the urgency and timeframe for attendance is explained to the woman during the telephone triage. A requirement has been given to support improvement in this area.”

It also said “at the time of inspection we observed delays to the induction of labour process of up to 72 hours”, called for improved bereavement training, and warned that “staff training to support learning from adverse events was regularly cancelled due to staffing issues”.

HIS said NHS Tayside “responded with details of immediate improvement actions taken” following the formal letter, and that an improvement plan had been developed for both maternity and acute services at Ninewells.

An inspection of the acute hospital services was carried out on the same dates in January, and it found “poor compliance of hand hygiene”, with 10 areas of good practice, one recommendation and 14 requirements.

Donna Maclean, chief inspector of HIS, said: “During our inspection of the maternity services we saw staff providing compassionate and responsive care to women and their families, and women we spoke with were complimentary of the care provided.

HIS inspected maternity and acute hospital services at Ninewells (PA). PA Media

“We observed good teamwork including obstetricians, midwives and the health care support team, with open and supportive discussions at the multidisciplinary huddle within the labour ward. New members of the multidisciplinary team reported feeling able to discuss concerns and escalate any issues.

“However, as a result of concerns identified that required immediate improvement, we carried out an unannounced revisit on February 12.

“The concerns related to variation in practice to assessing women within maternity triage and to staff access and awareness of retrieval of emergency medication within the maternity triage department.

“During the revisit we were not assured that sufficient progress or improvement had been made with some concerns, and we formally wrote to NHS Tayside outlining areas of assurance required.

“These included variations in oversight and governance observed in both the hospital inspection and maternity services, and a lack of oversight by senior managers within maternity services.

“NHS Tayside responded with details of immediate improvement actions taken.

“Other areas for improvement include assurance of safe staffing, fire safety issues and the maintenance of the hospital environment.

“These areas for improvement were also included in the acute hospital inspection of Ninewells.”

Regarding the acute hospital inspection, she added: “Inspectors observed teams working hard to provide safe and effective care, which was reflected in the feedback from patients and their relatives. Senior managers were visible and aware of the current challenges and were proactively working to reduce any risks.

“Areas for improvement identified included processes in relation to fire safety training, and poor compliance of hand hygiene.

“Inspectors also observed that the current layout of older wards has impacted upon the provision of accessible showering facilities which can compromise patient dignity.”

NHS Tayside executive nurse director Simon Dunn said: “We will always embrace the opportunity to participate in improvement initiatives and receive feedback on the standards of care we deliver.

“Both of today’s reports highlight areas of positive, good practice and standards of care which our patients and their families have recognised as extremely positive, which our staff are delivering every day, and this is deserved recognition for our workforce.

“Importantly, the HIS reports bring forward areas for improvement and the opportunity for learning across our multi-disciplinary teams, including beyond Ninewells Hospital.

“Our clinical teams have taken on board all of the recommendations and developed action plans to address these. Safe standards of care are at the heart of everything we do and therefore we have ensured our action plans keep our patients at the centre of our improvement work.”