Princess Royal Hospital maternity services rated 'requires improvement' after CQC inspection

The service, which is run by University Hospitals Sussex NHS Foundation Trust, was rated as requiring improvement overall and for being safe and well-led. The CQC rated the service as good for being effective, caring and responsive.

The inspection was carried out between October and December last year, at both Princess Royal Hospital and St Richard's Hospital in Chichester. The CQC said it was carried out to assess progress on improvements identified during previous inspections and to follow up on concerns raised by people, families and external partners about maternity care.

Gail Byrne, interim chief nurse at University Hospitals Sussex, said the trust ‘fully accepts’ the conclusion that further improvement is needed, and is ‘committed to addressing these issues urgently’.

Amanda Williams – CQC deputy director of hospitals, secondary and specialist care for the South-East – said the inspections found ‘ongoing pressures that were affecting women’s experiences’.

She said: "At both hospitals, women weren’t always seen within 15 minutes of arriving at the maternity assessment unit. Medical reviews didn’t always happen quickly enough and at St Richard’s Hospital, staff were unable to clearly see women waiting in the maternity assessment unit.

"At Princess Royal Hospital, equipment failures regularly forced the maternity operating theatre to close, causing delays to planned caesarean sections and increasing anxiety for women waiting for treatment. This sometimes caused women to be moved through public areas affecting their privacy and dignity.

"We were also concerned to hear staff at Princess Royal describe feeling tired and burnt out, with some saying their concerns about staffing weren’t always being listened to.

"Staff have valuable information that can improve women’s care, and leaders should use it to drive improvement.

"Leaders understand where improvements are needed and have plans in place to address these issues. Staff should be proud of the care they continue to provide under significant pressure, and we will continue to monitor both services closely to ensure women and their babies remain safe while improvements are made."

Following a previous inspection at Princess Royal Hospital, the CQC had identified a breach of regulations relating to staffing.

According to the latest inspection report, this breach remained unresolved.

Inspectors also identified two further breaches relating to safe care and treatment and the good management of the service.

One area of concern raised by the CQC was the maternity operating theatre.

The regulator said equipment failures ‘regularly forced the maternity operating theatre to close’, which it said caused delays to planned caesarean sections and increased anxiety for women waiting for treatment.

The CQC said this ‘sometimes caused women to be moved through public areas affecting their privacy and dignity’.

According to the report, the trust was also not consistently providing an environment that protected women's privacy and dignity when the main theatre was unavailable.

The regulator said women could be required to move through public corridors and lifts in these circumstances.

The CQC also said the trust was not ensuring all women received timely access to early maternity care.

According to the inspection report, nearly a third of women did not have their first midwife appointment before ten weeks of pregnancy.

The regulator also raised concerns about access to antenatal education.

The CQC said classes were limited to in-person weekend sessions and had restricted availability, which it said made it harder for women and their partners to prepare for birth.

The inspection report also said leaders had not ensured midwifery staff completed the required safeguarding training for vulnerable adults.

The CQC said this could potentially limit staff's ability to identify and support women at greater risk.

The regulator further reported that women were not always seen within 15 minutes of arriving at the maternity assessment unit and that medical reviews did not always happen quickly enough.

However, the CQC also highlighted positive aspects of care at Princess Royal Hospital.

The trust scored above the national average for treating women with kindness and compassion during labour and after birth, according to the regulator.

The CQC said specialist mental health and bereavement midwives were available to support women who needed extra help.

The regulator also said bereavement support for fathers and partners was available across all four maternity sites seven days a week.

According to the CQC, the trust had introduced ‘hope boxes’ for mothers facing separation from their baby at birth.

The boxes included items such as a blanket, teddy bear and memory cards, which the regulator said provided comfort at a difficult time.

Ms Williams said: "When we inspected maternity services at St Richard’s Hospital and Princess Royal Hospital, it was encouraging to hear women and their loved ones consistently describe staff as kind, caring and professional.

"Women told us they felt involved in decisions about their care. Their feedback reflected the dedication and compassion shown by staff every day, with many describing positive experiences throughout their maternity journey.

"We also saw strong support for families experiencing bereavement and for women with mental health needs. Specialist midwives were available for as long as families needed them, including during future pregnancies.

"Partners were also well supported, with the trust scoring well above the national average for involving them during labour and throughout a hospital stay."

The trust has now been required to provide the CQC with an action plan setting out how it will address the issues identified and improve outcomes for people using maternity services at both hospitals.

In response to the report, interim chief nurse Gail Byrne said: "We welcome these findings, particularly the positive feedback from women and their loved ones, and the inspectors' recognition of our maternity teams' compassion and dedication to their work.

“We also fully accept their conclusion that further improvement is needed and are committed to addressing these issues urgently. Since the inspection, we have increased theatre capacity and staffing levels, strengthened how we collect and monitor key safety information, and reviewed and updated policies and clinical guidance.

"However, we know there is much more to do. Listening to women and families, learning from their experiences and acting on what they tell us will remain at the heart of our commitment to providing the safe, compassionate and high-quality care every family deserves.”

The full inspection report for Princess Royal Hospital is due to be published on the CQC website in the coming days.