Medway Maritime Hospital was described as "one of the most challenged" in the country
Kent's biggest maternity unit has today been warned to make urgent improvements amid "serious concerns" about treatment.
The Care Quality Commission has told Medway NHS Foundation Trust it must take immediate action to improve the safety and welfare of women giving birth at Medway Maritime Hospital in Gillingham.
Medway is one of 11 hospitals across the country in special measures after a report by NHS medical director Sir Bruce Keogh.
Now the CQC has issued three formal warnings to the trust following an unannounced inspection of its maternity and midwifery services in August, when the hospital failed to meet any of the six standards checked.
Inspectors found a shortage of midwives, lack of staff training, delays in care and poor communication.
The maternity unit is the biggest in Kent and has about 370 deliveries on average per month.
In 2011, a midwife-led unit, called The Birth Place, was opened and Medway saw a rise in the number of mums choosing to give birth at the hospital following the closure of consultant-led maternity services in Maidstone.
Inspectors visited Medway's maternity wards, delivery suite and antenatal clinic over four days and one evening, as well as three locations in the community. The team also met with expectant and new mothers.
In each area, the team looked to see if the service was safe, effective, caring, well-led, and responsive to people's needs.
The hospital has failed to meet national regulations in three specific areas: staffing, supporting workers, and assessing and monitoring the quality of service provision.
Maternity department at Medway Maritime Hospital in Gillingham
Adrian Hughes, regional director of CQC in the south, said: "While patients and relatives we spoke to said that the care they received was good, we have serious concerns about the care and treatment that women have been receiving in maternity and midwifery services at Medway Maritime Hospital.
"The report we have published today shows that the trust needs to deal with staffing levels as a matter of priority – and also to support the midwives who already work there better to perform their roles.
"We found that governance systems and management oversight of the services were not good enough, and this needs to change."
Among CQC's findings are:
- While women were involved in decisions about their birth and where it took place, there wasn't a clear pathway to follow to access antenatal care when they found out they were pregnant. This resulted in delays for some women in accessing this care
"We have serious concerns about the care and treatment that women have been receiving in maternity and midwifery services at Medway Maritime Hospital..." - Adrian Hughes, CQC
- There were insufficient numbers of midwives, both in the hospital and in the community which presented a particular problem in postnatal care, where midwives were struggling to keep up with demand due to lack of staff
- Inspectors found some poor medicines management practice
- Staff training programmes were available, but were not completed satisfactorily by all staff; midwives in the community were unable to access training easily due to ineffective IT systems, and hospital and community midwives said they did not have time to carry out on-going training programmes and felt unsupported in their job roles
- Systems of governance and management oversight were inadequate. There was poor communication between different directorates. The hospital did not have a service delivery plan for the maternity services, and had not taken into account the changing demographics in the area and how to meet the needs of women in the future
Mr Hughes added: "The treatment and care provided by Medway NHS Foundation Trust has already been identified by Professor Sir Bruce Keogh and his team as being of concern – and the trust has been placed in special measures by the Secretary of State on that basis.
"We are committed to returning to the trust in due course to check whether general improvements required by that process have been made.
"In the meantime, our inspectors will return unannounced in the near future to check that the hospital has made the changes required by the warning notices."
Medway Maritime Hospital in Gillingham
Professor Hasib Ahmed, clinical director for women's services at Medway Maritime said: "With the support of the new chief nurse, we are making positive progress with our midwifery recruitment, appraisal and mandatory training.
"We are also reminding staff of our local governance processes and systems which ensure that we continuously improve and enhance our maternity services to build on the excellent patient feedback we receive."