Maternity services at one of London’s biggest hospitals rated ‘inadequate’

Maternity services at a major south London hospital have been rated “inadequate” by the NHS regulator in a report which found that there are “not enough staff” to keep women and babies safe.

St George’s Hospital, in Tooting, has been told to make “significant improvements” to its maternity services following an inspection in March.

Inspectors described the delivery suite as a “chaotic environment without clear organisation or leadership”, and uncovered evidence that people had discharged themselves before being reviewed due to “long waiting times”. Women were also seen waiting “without privacy or any way to call for assistance”.

Jacqueline Totterdell, group chief executive of St George's, Epsom and St Helier University Hospitals and Health Group (GESH), said standards on the unit had fallen below the group's expectations and “immediate action” had been taken to address the concerns raised. The hospital is run by St George's University Hospitals NHS Foundation Trust, which is part of GESH.

St George’s is also a major trauma centre and one of the largest acute treatment NHS trusts in the country.

Last month, a report by the Nursing and Midwifery Council (NMC) warned that staffing shortages were having a “stark and sobering” impact on maternity care and leading to safety concerns.

Inspectors described facilities at the St George’s maternity unit as ageing and in “disrepair”. They saw areas were “dirty and poorly maintained” and raised concerns about “poor levels of tidiness” on the unit, where they found “cluttered environments, obstructed emergency equipment and doorways, and equipment stored in inappropriate places such as corridors and staff rooms”.

Birthing rooms did not have ensuite facilities, the report claimed, while other patients were forced to travel “some distance” to use the toilet due to a shortage of bathrooms on the unit.

The report also said incidents were regularly graded “inappropriately” as “adverse incidents” instead of “serious incidents”, including stillbirths. It said baby deaths in October 2022 were not discussed at Serious Incident Declaration Meetings (SIDM) until January 30, 2023, which was a “slow response”.

Staff did not have sufficient training in resuscitation, caring for people with disabilities or safeguarding children and young people, the report said.

Inspectors observed that from ethnic minority groups were “underrepresented in leadership roles and promotions”, while staff turnover rates were “high” at 21.5 per cent overall from December 2022 to January 2023.

Staff working on the unit described “waning enthusiasm, burn out, low morale and a negative impact on culture”. Meanwhile, executive leaders “failed to recognise the severity of issues faced within maternity”.

However, patients using the service described staff as “caring” and “friendly”.

The CQC added that a new maternity strategy had been put in place and staff said the workplace culture was improving. It said improvements had been made to equality in the hospital and the trust's Workforce Race Equality Standard (WRES) action plan was rated “outstanding” by the national WRES team.

The watchdog has served the trust with a warning notice following the inspection, demanding that it make “significant improvements”.

An action plan submitted in response by the trust will be monitored by the CQC.

The St George's trust's overall rating remains “requires improvement”.

Carolyn Jenkinson, the CQC's deputy director of secondary and specialist healthcare, said it was “concerning to see a deterioration in the standard of care being delivered”.

She said staff and people using the service were “being let down by leaders who failed to respond quickly, resulting in care that was unsafe, and in the delivery suite, also chaotic”.

Ms Jenkinson said: “When things went wrong, we saw staff were honest and supportive to people, but leaders were slow to respond and often logged incidents as causing less harm than they did. We saw some baby deaths weren't investigated as serious incidents and investigations didn't always take place in a timely way. This is unacceptable and put people at risk of avoidable harm from mistakes being repeated.

“Staff told us care often felt unsafe because there weren't enough of them, and we saw they'd reported numerous incidents in which people's safety was at risk. Staff said managers told them nothing could be done, but we found opportunities to reduce risks had been missed or ignored.

“We also found people were at risk of infection because ward environments were dirty and poorly maintained. Again, staff had raised many issues with the trust but some longstanding problems still hadn't been fixed.”

Ms Totterdell said: “We take the findings of this report extremely seriously and accept that the standards on our maternity unit have fallen below what we expect. We have taken immediate action to address the concerns raised by the CQC and we remain committed to making improvements to ensure those providing and receiving care in our department have the best possible experience.

“I would like to reassure those due to give birth in our maternity unit that it continues to be a safe and positive environment to give birth in, which has been recognised by the CQC national patient experience maternity survey that rated St George's as receiving the fourth highest patient satisfaction levels nationally in 2022, as well as being rated in the top three performing trusts in London for antenatal care.”

The Trust said it had recruited an additional 15 midwives, addressed cleanliness issues and improved the patient triage assessment process on the delivery suite.