Maternity services at a scandal-hit Kent hospitals trust have been rated as "requiring improvement" by inspectors who found inexperienced staff were left to assess high risk women.
Both are run by East Kent Hospitals Trust and are at the centre of a baby death scandal.
A total of 26 baby deaths at the hospitals are currently being investigated by the Healthcare Safety Investigation Branch (HSIB).
The trust was rated Good for being "effective, caring and responsive to people's needs," but was also told to improve for being safe and well-led.
Overall, it was given a Requires Improvement rating from inspectors.
The trust was told it had shown signs of improvement since the last inspection in 2018, but there is "still work to be done, especially in antenatal services".
CQC’s deputy chief inspector of hospitals, Dr Nigel Acheson, said: “We found a number of improvements had taken place in the maternity units at both William Harvey Hospital and Queen Elizabeth the Queen Mother Hospital since our last inspection of East Kent Hospitals University NHS Foundation Trust in May 2018, but some concerns remain, and we will follow up to make sure that these are addressed.
“Our inspectors found a team committed to learning and continually improving the department. The service had a vision for what it wanted to achieve and a strategy to turn it into action.
"The antenatal clinic in outpatients was poorly maintained..."
“The department had recently implemented additional Cardiotocography (CTG) training for staff and aimed to ensure a safer outcome for babies. CTG is a means of recording the foetal heartbeat and contractions during pregnancy.
“Despite these green shoots of improvement there was still work to be done especially in antenatal services.
“At William Harvey Hospital, the antenatal clinic in outpatients was poorly maintained. Staff in day care did not always report incidents, which meant managers could be unaware of avoidable events on the unit.
“Our inspectors found junior midwives, without the experience or knowledge to escalate complex emergency situations, working alone in day care.
"After our inspection the trust told us they were reviewing rosters to ensure there was always an experienced midwife on duty and staff could contact a senior midwifery co-ordinator to escalate concerns.
“We found that because the risk to women was not effectively managed in antenatal services, midwives sometimes had to review and assess women, who may be at high risk, rather than a doctor.
"Midwives told us that a senior doctor was sometimes available in clinic. However, it was usually a junior doctor with limited experience in obstetrics that would review and discharge.
“We fed our findings back to the trust and its leadership knows what it must to do to bring about improvement.
"The trust is currently being supported by NHS Improvement through their Maternity Support Programme. We will work closely with other stakeholders to monitor the trust’s progress. We will return at a later date to check on what progress has been made.”
Chief executive of the trust Susan Acott said: “The improvements and positive work cited in the CQC’s report is a testament to the hard work put in by the maternity and obstetric teams to improve the quality of services for women and babies in east Kent.
"This is about having absolute confidence that no more babies are going to die that should have survived, that no more parents are going to suffer tragedy like those I've worked with..."
“We know we have much more to do. We are already acting on the CQC’s recommendations, and have improved staffing levels in the antenatal triage and day care service, implemented a nationally-recognised safety system in that service, and appointed a maternity governance lead to co-ordinate the review and improvement of the service’s internal governance processes.
“We are determined to provide an excellent standard of care to every mother and child who uses our maternity service and we will continue to make improvements and make sure positive changes are thoroughly embedded, so local families can have absolute confidence in their care.”
Dover and Deal MP Natalie Elphicke said she doesn't want anymore parents to suffer the tragedy of losing a child at the hospital.
She said: “While I welcome any improvement, I am concerned that the CQC is still flagging serious issues around safety and leadership.
“I have requested a meeting with the CQC to discuss the findings in more detail – as well as spoken with the person leading the independent inquiry into baby deaths, Dr Bill Kirkup, to ensure that their investigation is as thorough as possible.
“Because this is about having absolute confidence that no more babies are going to die that should have survived, that no more parents are going to suffer tragedy like those I have been working with.
"No-one should be satisfied until safety and security for mother and baby is delivered in every case.”
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