Banbury's Horton Midwifery unit among those inspected after reports of concerns raised within JR Hospital's maternity services

The Care Quality Commission (CQC) report reveals a downgraded rating of requires improvement following an inspection of the maternity services at the John Radcliffe Hospital, run by Oxford University Hospitals NHS Foundation Trust.

The CQC carried out an unannounced inspection of the maternity department at the John Radcliffe Hospital, the Horton Midwifery-led unit in Banbury and the Cotswold Birth Centre in Chipping Norton in May.

The report showed the inspection occurred after the CQC had received concerns from a 'whistle-blower' related to the culture within the department, which included concerns of bullying and dysfunctional teams. The inspection looked at whether the service was safe, effective and well-led.

As a result of the inspection, the maternity services at the John Radcliffe Hospital were downgraded from good to requires improvement. The inspection did not change the overall rating for the hospital, which is requires improvement.

The OUH NHS Foundation Trust is working on a 'comprehensive' action plan to address these areas for improvement and concerns from the inspection.

Amanda Williams, CQC’s head of hospital inspection, said: “We went in to inspect the maternity services run by Oxford University Hospitals NHS Foundation Trust to follow up on information of concern we received regarding the overall culture of the service. We found that most staff said that they were proud to work for the trust and that they felt respected and able to raise concerns without fear.

“Importantly, we found that there was an emphasis on learning and positive working relationships. Staff had regular multidisciplinary meetings to discuss the women and babies in their care. Rather than just focusing on those with poor outcomes, staff were encouraged to share learning from all cases. This meant that there was no ‘blame’ aspect involved in these meetings, which is very important in order to ensure that continual improvements are made.

“Staff wellbeing was also considered a priority by the senior leadership team. A wellbeing group was established during the Covid-19 pandemic to enable people to talk openly about issues that were concerning them. Staff were also encouraged to provide feedback, which could be anonymous, via a staff survey and a series of listening events was also held. This feedback was then used to create an action plan and improve the service. An award scheme was also used to celebrate staff achievements and hard work."

Inspectors found the following during the inspection: some staff did not always feel respected, supported and valued and staff did not always assess risks to women, and they did not always manage medicines well.

Some of the other findings showed women’s privacy and dignity was not always maintained, there was no signage to indicate when rooms were engaged and staff did not use privacy curtains in the labour rooms on the Horton midwifery led unit in Banbury.

The inspection also showed the environment on the delivery suite and the birth centres were not 'homely and welcoming' and were not decorated in a 'sensitive way.' They were 'clinical and no 'home from home approach.'

“We also had concerns that staff did not always undertake all the necessary risk assessments for women, particularly in relation to the risk of domestic violence.

“We have told the trust that they need to address our concerns, and we will continue to monitor the service to ensure that improvements are made.”

However, the inspectors also found: leaders ran services well using reliable information systems and supported staff to develop their skills. They were focused on the needs of women receiving care.

The inspection also showed staff managed safety incidents well and learned lessons from them and staff provided good care and treatment and worked well together for the benefit of women. They advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

Dr Bruno Holthof, chief executive officer of Oxford University Hospitals, said: “On behalf of the trust board, I would like to thank all staff working in our maternity services for their positive approach to the CQC inspection in May and for everything that they do every day to look after the women and babies in their care.

“I am delighted that the CQC inspectors have publicly recognised in the report published today that our maternity staff provide good care and treatment and work well together for the benefit of women in their care, and also identified a number of other positive areas.

“However, it is important to acknowledge that the CQC inspectors also found significant areas for improvement and raised concerns which have resulted in the rating for our maternity services going down from ‘Good’ to ‘Requires improvement’.

“The Trust Board is working with the senior management team in our maternity services to develop a comprehensive action plan to address these areas for improvement and concerns. Completion of the action plan will be monitored through the trust’s governance processes and completion dates for key actions will be agreed.”