An NHS hospital where a woman bled to death in childbirth has been given an “urgent” deadline to keep patients at its maternity unit safe reports the BBC.
A letter seen by the BBC reveals the Care Quality Commission (CQC) found unsafe staffing levels at the unit at Basildon Hospital throughout August.
The CQC said the trust that runs it had until next Monday to implement appropriate measures.
The trust said it had a “robust improvement plan in place”.
The seven-page document, sent by the CQC on 7 October, puts the Mid and South Essex NHS Foundation Trust on notice that it has to “implement an effective governance system”, among other measures.
Consequences for missing the deadline were not stated, but the CQC said it was using its powers under the Health and Social Care Act to impose conditions on the trust’s registration.
The Act does allow the CQC to temporarily close health services.
The letter described how inspectors returned on 18 September and found the trust had still not dealt with serious failings it had been warned about in August, following an visit prompted by a whistleblower.
It highlighted that it did not accept that some of the problems had been addressed, despite assurances from the trust that they had been.
The letter continued “we were not assured that you effectively reviewed staffing and escalated appropriately to maintain safe staffing in the maternity unit”.
Findings from the latest inspection included:
- Only four shifts throughout the month of in August had safe staffing levels
- The CQC was told 20 midwives had been recruited, yet subsequent documents submitted by the trust did not support this
- Required safety meetings during shift handovers did not take take place
- Incidents affecting patient safety were inappropriately categorised, including one in which a woman who lost more than a litre a blood was graded “no harm”
- Babies were transferred to intensive care, yet graded as “low” or “no harm”
- Inconsistent guidance to staff on identifying the risk of post-partum haemorrhage.
A CQC visit in June found failings in six serious cases and rated the maternity unit inadequate.
Its August report said lessons had not been learnt following the death of Gabriela Pintilie in February 2019.
The Essex coroner said there had been delays, confusion and a lack of leadership after Ms Pintilie, 36, lost six litres of blood while giving birth to her daughter.
The CQC said in a statement it was now taking “action to protect the welfare of people using the service.”
Clare Panniker, chief executive for Mid and South Essex NHS Foundation Trust, said it had “taken action following [the CQC’s] initial feedback to make our services better”.
“We have a robust improvement plan in place, and continue to work closely with the CQC and our regulators as we make the necessary changes and are committed to improving the quality of maternity care,” she said.
The CQC letter said the trust had until 16:00 GMT on 9 November to implement the recommended changes.