Derby & Burton Hospitals CQC rating announced

Maternity services at Derby and Burton’s hospitals have improved but concerns for patient safety remain, following a new but significantly delayed inspection.

The CQC has rated maternity services at Royal Derby Hospital and Queen’s Hospital in Burton as “requires improvement” – the third rating of four grades – increasing from the lowest score of “inadequate” they received in late 2023.

Two of four assessment categories, “caring” and “well-led”, are now rated “good” at Royal Derby, with the categories of “caring” and “responsive” rated “good” at Queen’s.

This updated checkup was carried out nearly a year ago in December 2024, 13 months on from the initial “inadequate” rating which had seen the watchdog enforce “urgent action” for change because it “believed a person will or may be exposed to the risk of harm if we did not do so”.

It now says: “The service had made some progress since the last inspection to reduce the risk within the service. The risk or potential risk to women’s safety was still a concern.”

Key issues include leadership continuing (at the time of the report) to not listen to concerns about safety or learn lessons, and staff being seemingly reprimanded for raising issues.

This includes delays for labour, C-sections and other elective surgeries not being reported under orders from leadership.

Issues were also found with staff not monitoring women’s safety sufficiently or ensuring continuity of care during handovers.

A key takeaway from the CQC was not of a shortage of staff but a shortage of experienced staff, saying: “The trust could not be assured that every shift was staffed with midwives who had the experience, skills and competence to keep women safe.”

The CQC found: “Staff did not feel they could speak up and that their voice would be heard. Staff gave examples where they witnessed staff raising issues with the executive team only to be suspended or be forced to move roles. As a result of this, staff are now afraid to voice their concerns with the executive team.”

The hospital trust makes clear that it had already made significant improvements as of December last year and has now made even greater steps since then, with the report now broadly outdated in key areas and many issues resolved.

It says, of the improvement notices placed on the trust, 50 per cent have been removed and it has applied to have the remaining 50 per cent lifted.

The trust’s compliance with national standards for keeping babies safe has improved from 33 per cent in September 2023 to 94 per cent as of this September, it says.

Meanwhile, an additional 27 newly qualified midwives joined the trust in September and it has appointed two extra consultants.

The CQC’s report details: “The service did not have a coordinated approach for the care they provided.

“We were concerned that the system in place to identify, escalate and manage women and birthing women and their babies who require induction of labour was ineffective and not in line with national guidance. Handovers of care were also ineffective.”

The CQC wrote: “Women and any family or carers with them were all positive about the staff treating them with warmth and kindness and providing effective care and treatment.”

“The service did not have a proactive and positive culture of safety based on openness and honesty. 

“Leaders did not listen to concerns about safety and did not investigate or report safety events. 

“Lessons were not learnt to continually identify and embed good practice.”

The report continued: “Staff told us it was difficult to get doctors to review a patient if their condition changed or the midwife team disagreed with a person’s care plan. This would mean at times midwives were working without a doctor’s advice and therefore putting women at risk and possibly working outside the scope of their practice.”

The CQC found: “We observed and staff told us delays in inductions of labour were a frequent occurrence. We were told that staff were not always reporting these as they were told not to by leaders.”

During its December 2024 inspection, the CQC observed an incident in which a baby’s heart rate trace had deteriorated, but staff “failed to act”.

It also witnessed staff improperly managing women who had not yet started labour or were unable to start, and were due to be induced, but could not due to staffing concerns.

The watchdog was told consultants would cancel c-sections without assessing the woman affected “potentially placing the person at increased risk of harm”.

It also witnessed a woman not prioritised for an induction of labour despite being at higher risk “placing the baby at risk of harm”, with numerous occasions in which lower risk patients were prioritised above higher risk patients.

The CQC found that between April and November 2024, 51 babies were born before a midwife arrived, with no evidence to show what had been done to reduce that issue.

Furthermore, it found “the service did not always provide women with all the information they needed to make an informed decision about their care”, finding “women were not making fully informed consent”.

A CQC spokesperson said: “During our inspection of UHDB’s maternity services at Royal Derby Hospital and Queen’s Hospital, we found pockets of improvement and the trust had taken action to meet some of the requirements of the warning notices issued at our previous inspection. 

“Families were happy with the care they received, and said staff treated them with warmth and kindness. 

“However, additional work was needed to address the culture and atmosphere among leaders and staff, improve communication between areas, report all incidents in line with policy and, fundamentally, to ensure people were receiving safe and effective care. 

“We acknowledge that the amount of time it has taken to publish the findings of this assessment falls far short of what people using the service and the trust should expect, and we sincerely apologise for this. 

“However, the report captures a snapshot of the care provided at the time we carried out our inspection and remains an accurate depiction of our assessment at that time.

“While the publication of our findings has been delayed, any immediate action that CQC needed to take to protect people using the service has not been affected.” 

Sarah Noble, the trust’s director of midwifery, said: “While we fully acknowledge there is more to do, these improved CQC ratings reflect that the hard work our teams have put into improvements over the last two years is making care safer for women and babies.

“Though the reports are from inspections last year, they show that we have been focused on the right changes – like increased staffing, better compliance with national maternity safety standards and training, new equipment, and improved processes for monitoring births and supporting women during induction and antenatal care.

“We have taken these reports seriously and will use the recommendations as further opportunities to improve and learn, in addition to the changes we have already put in place.

“We remain fully committed to continuing our work and delivering high-quality, safe, and personalised care for the women and babies we care for.”

Aaron Horsey, patient safety partner at the trust, whose wife tragically died while giving birth to their son, Tim, at Royal Derby Hospital in 2022, said: “The CQC inspection process provides a valuable opportunity for the trust to learn, reflect, and improve. 

“Since the inspection took place in late 2024, I have seen maternity teams at every level take that challenge seriously. 

“As a patient safety partner, I have been inspired by seeing the dedication of staff who have: Strengthened clinical responses, for example, through improvements in triage and management of postpartum haemorrhage (PPH); listened proactively to women and families through dedicated engagement and listening events; and acted to improve staff wellbeing as an essential part of safe and compassionate care.

“All of these actions have had a clear impact on the safety and experience of patients in their care. 

“It is clear that there is a way to go as the trust strives for the best. 

“I hope that our patients and their loved ones see the benefits of the efforts so far and that they continue to engage in building the system everyone deserves.”