Maternity services at Nottingham City Hospital and Queen’s Medical Centre remain rated inadequate overall following a recent inspection.
The Care Quality Commission has listed a number of concerns and issues with the Nottingham University Hospitals NHS Trust, following unannounced inspections at the trust in March.
Inspectors told the trust it must make "significant and immediate improvements" to its maternity services as it said women and babies may not be safe.
It comes as senior midwife Donna Ockenden - who led the Shrewsbury maternity scandal probe - was appointed to chair an independent inquiry into maternity issues at the trust.
Nottingham University Hospitals says it is working hard to make the necessary improvements but recognises it has "more to do".
ITV News Central has pulled together ten things that we learnt from the CQC report:
Women's access to services
The report says there were concerns around women’s access to services and the assessment of risk once they were seen.
Women were often waiting to be triaged longer than the trust's target of 15 minutes and risk assessments weren’t consistently being completed on arrival or admission.
Records showed there was also a declining performance trend in the 15 minute target.
Home births were being cancelled and women’s planned care and treatment was delayed due to staffing issues.
The overall rating for both Nottingham City Hospital and Queen’s Medical Centre remains rated requires improvement.
Maternity services at both sites remain rated inadequate overall, as well as for being safe and well-led.
Being effective has gone up from inadequate to requires improvement, being responsive has gone down from good to requires improvement and caring remains rated as good.
CQC has also issued the trust with a warning notice in relation to safe care and treatment around how they are managing observations, and with regards to the care women are receiving within triage services.
Not enough staff
The service did not have enough staff to care for women and keep them safe.
Not all staff had training in key skills. Staff did not always assess all risks to women, and inspectors were not assured staff acted upon concerns in a timely way.
Staff did not always keep good care records.
Medicines weren't always being well managed.
Some drugs that should be kept cold were found outside of refrigerators (which the trust did address on inspection) and some with a short expiry date when opened had not been dated.
Also, women’s weight was not always being recorded to ensure correct dosage.
Whilst there were pockets of good incident reporting, learning and some improvements, this wasn’t consistent.
Staff told us they didn’t always have time to complete forms, and they didn’t always receive feedback after they had reported incidents or receive information about learning being shared more widely.
Not all staff received training specific for their role on how to recognise and report abuse.
Due to the challenges COVID-19, compliance rates with this training was low.
Not all staff were aware of the baby abduction policy and hadn’t completed any baby abduction drills.
The director of midwifery had identified there was a staffing gap of 35 whole time equivalents (WTE).
However, to ensure the service has adequate cover for any staffing absences and training, a paper was due to be presented to the board requesting this be increased 60-65 WTE.
Making complaints and raising concerns
Staff generally felt confident to make complaints or raise concerns if they witnessed cultural concerns, and new processes to address these formally had been well received by managers and staff.
Some staff were still worried these wouldn’t be taken seriously but leaders were working to address this and promote a blame free approach to incident management.
The service had introduced morning multidisciplinary meetings to review the staffing and pressure of maternity.
When pressures were identified, this enabled actions to be taken to support staff.
Staff understood how to protect women from abuse and controlled infection risk well.
Overall, staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
They provided emotional support to women, families and carers. The service promoted equality and diversity in daily work.
The trust has introduced a 24/7 maternity advice line to support women throughout their pregnancy.
Sharon Wallis, director of midwifery at Nottingham University Hospitals, said: "Keeping mums and babies safe and providing them with high quality care remains our top priority, and we are committed to continuing our work with local families and healthcare partners to make the changes still needed.
"Our teams are working hard to make the necessary improvements but recognise we have more to do and are absolutely determined to speed up the pace of change and deliver quality services for women and their families."