Date Published: 19 January 2010

Care Quality Commission calls for further improvements at Milton Keynes maternity unit – capacity remains a concern

Today the Care Quality Commission (CQC) said Milton Keynes Hospital NHS Foundation Trust must accelerate improvements to its maternity services and improve planning to meet long-term demand.

CQC said temporary measures are in place to ensure there are enough midwives to provide safe and effective care for mothers and babies.

However, these are not sustainable and CQC said the trust must concentrate on plans to recruit more permanent midwives and open more beds permanently.

It also said the trust must plan better for emergency situations, such as complicated births or staff shortages, and ensure that staff know what to do in these circumstances.

CQC checked progress in implementing recommendations made in 2008 by the previous regulator. It conducted inspections of the maternity unit in September, reviewed a range of documentation and interviewed staff.

CQC said the trust has made important progress, such as improved leadership, supervision and training and 24 hour access to a dedicated obstetrics theatre.

CQC referred to the death of two babies on the unit (June 2007 and May 2009). While the circumstances in each case were different, CQC said the trust must improve how it plans for periods of high demand and how it deals with emergency situations.

This means ensuring processes are followed to recognise complex or problematic cases early, involve consultants and supervisors and midwives at an early stage and provide swift back-up for midwives when necessary.

CQC acknowledged the trust's recent work to improve "contingency plans", drawing on advice from experienced midwifery leaders at other trusts.

The number of permanent beds remains at 30. A further 12 beds can be opened when needed, however they cannot be opened permanently due to lack of midwives.

CQC said the trust has not made sufficient progress in recruiting more permanent midwives. From July to September 2009, there were 17 vacancies out of 108 funded posts, compared to 21.7 vacancies at the time of the 2008 report. CQC was later informed that retirements during 2010 would further reduce the number of midwives.

The trust estimates that it will need about 150 midwives by 2013/14 in order to meet the rising demand.

In December and January, CQC worked with the trust, Monitor, NHS Milton Keynes and the strategic health authority to put in place temporary measures to ensure there are enough midwives in the short-term.

These include:

• Community midwives spending more time working in the hospital
• Better use of bank midwives
• Asking local GPs to offer mothers the option of giving birth in other nearby maternity units
• Working with the Oxford Radcliffe maternity unit to implement a shared rota of midwives from July

Roxy Boyce, CQC's regional director in the south east, said:

" There have been improvements, however they have not always happened fast enough. There is still more to do and we expect all of the recommendations to be implemented fully.

The fundamental concerns about numbers of beds and midwives remain. With one of the highest birth rates in the country, it is vital that the added pressure on maternity services is closely managed.

While we believe the trust has now made suitable arrangements to effectively manage demand in the short-term, the trust has not sufficiently planned for the added demand on its services. More midwives are needed if the trust is to open more permanent beds and deal with demand in the future.

But capacity is not just about numbers of beds and midwives. It about making sure that potential emergency situations are planned for and staff are equipped to deal with any circumstances that could arise. The trust has new policies in place and it must make sure that these are followed on the ground.

We want to see a trust that is determined to get it right for every mother, with zero tolerance of poor safety standards whatever the pressures. We will be watching very closely and will act swiftly if we believe, at any stage, that mothers or babies are at risk."

All NHS trusts are in the process of applying for registration with CQC. The regulator said it would carefully consider the evidence relating to maternity services in assessing the trust's application. CQC could make legal requirements of the trust as part of its registration.

CQC is working closely with the trust, NHS Milton Keynes and Monitor, the regulator of foundation trusts to drive further improvements and ensure demand is managed effectively.

CQC also today published a separate report on healthcare-associated infection at the Trust: CQC said the trust has rectified breaches of the hygiene code, which were identified in an inspection on 11 November. As part of its regular programme of inspections at NHS trusts, CQC visited the clinical decision unit, the stroke unit and the female general medical ward. It found two breaches of the hygiene code relating to cleanliness and decontamination. A follow-up inspection on 31 December found no breaches.

About the CareQuality Commission: The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. The CareQuality Commission inspects health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. It also protects the interests of people detained under the Mental Health Act. (Until 31 March 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.)

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