Our rating of the location stayed the same. We rated it requires improvement.
Summary of services at Worcestershire Royal Hospital
Worcestershire Acute Hospitals NHS Trust was established in April 2000 and provides a service across five sites: Worcestershire Royal Hospital (WRH); Alexandra Hospital (AH); Kidderminster Hospital and Treatment Centre (KHTC); Evesham Hospital (EH); and Malvern Community Hospital.
Worcestershire Acute Hospitals NHS Trust provides acute healthcare services to a population of around 580,000 in Worcestershire and the surrounding counties. The trust provides maternity services to women living across the county of Worcestershire. Outpatient maternity services are provided on the WRH, AH and KHTC sites. There are also six community midwifery teams and five continuity of carer teams based at various locations across the county.
The maternity service is managed through the trust’s women and children’s division. The current leadership structure includes a clinical director, a directorate manager, and a director of midwifery. Obstetricians, matrons, and senior midwives also support the senior leadership team.
The maternity service provides consultant and midwife-led antenatal, intrapartum and postnatal care. There are 62 inpatient beds, spread across the delivery suite, the Meadow Birth Centre, and antenatal and postnatal wards, transitional care unit and neonatal unit. Outpatient services include antenatal clinics, a maternity day assessment unit, a triage unit and screening services. Community midwifery services are provided at local children’s centres, GP practices or at the patients’ home address.
The consultant led delivery suite has nine delivery rooms plus a pool room, two dedicated obstetric theatres and a two-bedded recovery bay for post-operative women. The Meadow Birth Centre is the midwife-led birthing unit and consists of three low-risk birthing rooms each with birthing pools and the dedicated bereavement suite which had a garden area attached.
There is a 14-bedded antenatal ward with six beds for elective gynaecology patients, and a 35-bedded postnatal ward which includes a nine-bedded transitional care unit. The maternity service has an antenatal outpatient department and includes screening services, the early pregnancy assessment clinic and antenatal clinics.
Community midwives provide care for women and their babies both during the antenatal and postnatal period. They also provide a home birth service. The total number of home deliveries for 2020 (January to December inclusive) was 121, 2.5% of all deliveries for the period.
Due to the COVID-19 pandemic there had been changes in the way services were delivered. The Meadow Birth Centre had been reallocated as a specific COVID-19 area for women. There had been no community-based parent education or breast-feeding support sessions in line with social distancing advice. Women were directed to access reputable websites for guidance, or phone the community midwife for advice. The service had also temporarily suspended their tongue tie service.
From July 2019 to June 2020 the service reported 4,961 deliveries. This was a 4.5% decrease from the previous 12 months, where 5,195 deliveries were reported.
Activity:
- Caesarean sections rate was 29.9%
- Instrumental delivery rate was 10.7%
- Non-interventional delivery rate was 59.3% (-1.28% compared to the previous year).
- Midwives numbers 203.8 (in post) whole time equivalents (WTE) September 2020. Funded is 213 WTE midwives.
- Consultant obstetricians/gynaecologists numbers: 20.9 WTE September 2020
- There were no never events between December 2019 and November 2020 in maternity or gynaecology (NHS England and NHS Improvement)
- There were no current CQC maternity alerts under consideration by the CQC outliers panel.
- Ratio of births to midwifery staff: 22.4 July 2019 to June 2020.
- Ratio of senior midwives to midwives: 0.21 September 2020
- Four maternal deaths were reported to the Healthcare Service Investigation Branch (HSIB) since the start of 2018 (2 in 2019; 2 in 2020). [July 19, Nov 19, Mar 20, Dec 20]
We last inspected maternity services in June 2018. We rated the service as requires improvement for safe, and good for effective, caring, responsive and well-led. The service was rated as good overall.
During the 2018 inspection, we identified some concerns in the safe domain for the maternity service. These included poor compliance with safeguarding adults and children training for medical staff, maternity specific training compliance that did not meet trust targets; prescription charts were not always completed with patient’s weight or allergy status, which was not in line with national standards; poor compliance with cardiotocography trace peer reviews; and not all staff had received an annual appraisal.
We were concerned about maternity services at the trust following four whistle-blower enquiries we received between July and September 2020, and information we received from the trust. Therefore, we carried out an unannounced focused maternity inspection at Worcestershire Royal Hospital on 9 December 2020.
We inspected clinical areas in the service, including the delivery suite, Meadow Birth Centre, ante natal and post-natal wards, the antenatal clinic, and the maternity day assessment unit. We spoke with 19 staff, including service leads, midwives, medical staff, and student midwives. We reviewed 11 sets of patient records and 11 prescription charts and observed staff providing care and treatment to women.
Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. We carried out a focused inspection related to the concerns raised, this did not include all our key lines of enquiry. As a result of this inspection, we rated safe and well-led as requires improvement, and effective as good.
Overall the service was rated as requires improvement.
Following this inspection, we issued two requirement notices to the trust as we found improvement was required in several areas. We will make sure that the trust takes the necessary action to improve its services. We will continue to monitor the safety and quality of services through our continuing relationship with the trust and our regular inspections.