Midwives at an NHS trust were instructed to work double shifts without rest, resulting in them being awake for over 24 hours, according to a new inspection report by the Care Quality Commission (CQC).
Failures at John Radcliffe Hospital
The CQC found that Oxford University Hospitals NHS Foundation Trust, particularly the John Radcliffe Hospital, failed to triage pregnant women promptly and inaccurately reported delays in induction of labour as incidents. Inspectors highlighted that staff were being asked to work dangerously long shifts.
Community midwives raised concerns about the on-call system, as there were instances where they were called to work a 12-hour night shift immediately after completing a day shift. The report revealed that managers redeployed community staff to cover hospital shifts overnight during busy periods, leading to extended periods without rest for some healthcare professionals.
Staff reported being awake for more than 24 hours, which they felt impacted their wellbeing and patient safety. The CQC noted that this posed a risk, as evidence shows fatigue can cause mistakes leading to harm. Following the inspection, the trust provided assurance that community midwives called to cover the unit should only be called for a four-hour period, and if the shift occurs after midnight, the midwife is entitled to a compensatory rest period the following day.
Underreporting of Delays
Leaders at the hospital were not reporting all delays in induction of labour as incidents, recording only 32 cases, even though 206 delays over 24 hours were identified as red flags according to watchdog rules. The hospital did not treat all red flags as meeting the threshold for incident reporting.
Inspectors also found that staff did not triage women within the nationally recommended 15-minute timeframe, with only 36 per cent assessed on time, leading to delays and an increased risk of undetected deterioration. On the day of the inspection, the area was very busy, and one woman left the unit before being seen.
Inadequate Staffing and Privacy Concerns
The inspectors further noted that leaders failed to ensure adequate staffing and capacity, resulting in bereaved women being cared for in environments that did not meet required standards for privacy or dignity. Despite these issues, the CQC rated the overall maternity unit at John Radcliffe, and another at Horton General Hospital run by the trust, as good, up from requires improvement previously.
At John Radcliffe, the safety of maternity services was rated as requires improvement. Amanda Williams, CQC deputy director of hospitals, secondary and specialist care for the South East, acknowledged that some improvements had been made and that services were delivered by caring staff. However, she noted that John Radcliffe was a busy unit under significant pressure, and systems to keep women and babies safe did not always work consistently well under that pressure.
She highlighted that women were not always triaged in a timely way, and staff did not always have a line of sight to observe women at high risk. Additionally, while medical cover between 7pm and 8am was provided by the on-call team, there was no dedicated cover on the maternity assessment unit, leading to one woman leaving without being seen.
Response from Trust Leadership
Simon Crowther, interim chief executive officer at the trust, stated: 'We take these findings very seriously and we have already begun work to address them. It is important that we tackle these areas with urgency and embed the changes needed to build on the progress which has been made.' He thanked colleagues for their dedication to improving care.
