Agenda item

To consider the report.

Andy Heron, Chief Operating Officer of Somerset NHS Foundation Trust, introduced the report, joined by Sally Bryant, Directory of Midwifery and Deputy Chief Nurse, and Dr Claire Lovelock, Consultant of Obstetrics and Gynaecology, online. They outlined the areas they had fallen short in the CQC inspection of November 2023 and the changes they were making in response, including developing a fortnightly maternity and neonatal action group, strengthening the governance process, particularly around training, and purchasing more equipment.

During the discussion, the following points were raised:

• Were you surprised by the report? We were not entirely surprised – expecting requires improvement, but felt that there was positive feedback and good clinical outcomes. We are aware that the buildings work against the team providing the best possible care.
• There is a need to give staff the confidence that they are doing a good job.
• The report shows leadership failures.
• The inspection was given two days notice – can you explain how those were used? Gathering information together and performing last minute checks. The shortfalls were found in systemic issues and leadership failures, not something that is fixable in two days and are taking some time to fix.
• Concerned about the impact on staff. We are working in partnership with a service user group to co-produce the service. This is important to manage support for staff. Since publication of the report, only 4 families have come with PALS and asked for reassurance. We have increased communication with service users and staff and are guided them in the language we are using.
• There are nationwide difficulties in recruiting midwives with many retiring, has that had an impact? Not yet in Somerset, but the national picture it is likely to impact us. Want to improve before it does. One of our main challenges is recruiting obstetricians. There is a new multidisciplinary leadership team coming together to solve the problem.
• We would like to understand where the resources are focused on the areas in the report and the timescales for things to improve. We have a really robust and detailed action plan we are more than happy to share. We have had a formal review of it and have a follow up meeting with CQC to give them updates on the actions and prioritisation.
• Are you short staffed or fully staffed? Currently no midwifery vacancies. We have a birthrate flux model that we are predicting will recommend an increase in staffing, so will likely have vacancies in future. People regularly make contact to ask if we have midwife vacancies so in spite of the rating we still have a good reputation. We have 3 consultant level obstetric vacancies, one covered by long term locum and another by short term. Some gaps at registrar level for which we are recruiting. This will hopefully improve in August, but it is a national problem.
• What are the systemic issues that affect the staff to deliver adequate service? Governance – we had a significant lack of oversight over appraisals, training, and whether guidelines are up to date. We have focused a lot of effort on reviewing our governance and developing a process. We now have clear oversight on where we are with training, guidelines, and clinical outcomes.
• In Chard Community Hospital a ward has been converted to maternity outpatients, is this being pushed out to other community hospitals? We took advantage of space that wasn’t being used, and has grown into a hub that has supported integration. We do have community midwives in other hospitals, e.g. Minehead hospitals. Longer term plan is to develop hubs so that we can work closely with colleagues such as health visitors and GPs.
• What about the Mary Stanley unit? It is a birthing centre that has seen declining numbers of women choosing it. Since births there were suspended only one family has come forward to inquire and they were happy to use the alternative at Musgrove Park Hospital. We are doing work to understand the ask of the community and how to develop the services to deliver in the safest possible way.
• Would like the team to come back to see progress from the action plan.  Yes, we can come back in three months time.
• Would it be possible to do a mock inspection to improve things and deal with issues? We have a good working relationship with colleagues in Bath who recently received an outstanding rating – the director of midwifery has offered to come and visit and help scrutinise the work we are doing in response.