Updated 13 September 2023
Nottingham University Hospitals NHS Trust was established in 2006 following the merger of Nottingham City Hospital and Queen’s Medical Centre. The trust has a budget of £1.589 billion, 90 wards and 1,700 beds across 3 main sites: Queen's Medical Centre, Nottingham City Hospital and Ropewalk House. The trust delivers district general services to 2.5 million residents of Nottingham, Nottinghamshire, and its surrounding communities. Specialist services are delivered to 4 to 5 million people from across the East Midlands and nationally for a handful of services.
With 18,600 staff, the trust is one of the biggest employers in the city with a central role in supporting the health and wellbeing of the local population.
Queen’s Medical Centre is where the Emergency Department, Major Trauma Centre and the Nottingham Children’s Hospital are based. It is also home to the University of Nottingham’s School of Nursing and Medical School. Nottingham City Hospital is the planned care site, where the cancer centre, heart centre and stroke services are based, and where some of the trust’s emergency admissions units are located. Ropewalk House is where the trust provides a range of outpatient services, including hearing services.
Between 25 and 26 April 2023, we inspected maternity services provided by the trust across 2 locations. We carried out an unannounced inspection of maternity services at Nottingham City Hospital and the Queen’s Medical Centre.
We carried out this unannounced inspection of maternity services provided by this trust because at our last inspection we rated the service overall as inadequate.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question between 6 and 7 June 2023. A financial governance review was also carried out at the same time as the well-led inspection, this was undertaken by NHS England and Improvement (NHSE). There was not a separate ‘Use of Resources’ assessment in advance of this inspection.
Following our last well-led inspection in July 2021 we served a Warning Notice under Section 29A of the Health and Social Care Act 2008. This warning notice served to notify the trust that the Care Quality Commission had formed the view that the quality of health care provided by Nottingham University Hospitals NHS Trust required significant improvement. We found significant improvement was required across the trust to ensure there was sufficient oversight of the quality of health care provided by the trust.
As part of this inspection, we followed up to the Section 29A Warning Notice. Following a review of all the evidence from this inspection and a review of additional information provided by the trust following our inspection, we are satisfied that some improvements have been made and the requirements of the Section 29A Warning Notice have mostly been met.
We did not inspect any other services at this trust at this time. We continue to monitor other services and will re-inspect them as appropriate.
Our rating of the trust stayed the same. We rated them as requires improvement because:
- We rated safe, effective, responsive and well-led as requires improvement, and caring as outstanding.
- We rated maternity services as requires improvement. In rating the trust, we took into account the current ratings of services not inspected this time.
- The maternity service did not have enough substantive staff to care for women and keep them safe; however, this had improved since our last inspection. Not all staff had training in key skills. Staff did not always assess all risks to women, and we were not assured staff acted upon concerns in a timely way. Staff did not always follow best practice to protect women, themselves, and others from infection. They did not manage medicines well.
- Not all equipment showed evidence that it had been cleaned between use and electrical testing of equipment was inconsistent with many items overdue and no clear oversight.
- Storage of expressed breast milk was unsafe. Managers monitored the effectiveness of the service; however, the outcomes were variable. Not all staff received appraisals.
- Although governance processes had started to improve, there were still further areas of improvement required to ensure effective oversight of the service. Leaders did not always effectively identify and mitigate risks to the service. Not all risks identified during the inspection had been identified by the service and mitigated effectively.
- The trust was not always complying with its statutory responsibilities for duty of candour.
However:
- Staff understood how to protect women from abuse. Improvements in the overall management of safety incidents was observed.
- Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent and that they worked well with others for the benefit of women. Staff advised women on how to lead healthier lives and supported them to make decisions about their care and had access to good information. Key services were available 7 days a week.
- Staff treated women with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They provided emotional support to women, families and carers.
- Services planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback, which was overwhelmingly positive.
- Feedback regarding service leads was positive and they used reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff were focused on providing a culture which focused on the needs of women receiving care. The service engaged with women and the community to plan and manage services.
- Women could access the service when they needed it. We saw significant improvements in the triage unit and day assessment unit.
- Executive leaders had the skills, knowledge, and experience to allow for the delivery of high-quality sustainable care.
- There was an improving culture of high-quality, sustainable care.
- People who used services, the public, staff and external partners were engaged and involved to support high-quality sustainable services.
How we carried out the inspection
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.