This inspection looked at maternity services at University Hospital Lewisham. The inspection included the hospital’s antenatal clinics, the day assessment unit, antenatal ward, the labour ward, birth centre and postnatal ward.

Most women we spoke with were happy with the maternity care they received. They said the staff were caring and explained what was happening. Women said they had enough information about their care and were able to make choices. We saw very positive feedback from women attending the birth centre.

Most staff said that communication and team working was good on the labour ward with effective consultant cover. We were told the unit ethos was to provide the best service possible. However we saw some examples of care on the antenatal and postnatal wards which was insensitive and unsafe. We also saw that confidential notes were not always stored securely.

Midwives had mixed views about supervision with some saying they had not received enough support. Staff spoken with praised the training for their job roles provided by the trust.

The trust had systems to monitor the quality of care. However we found that managers were not making active use of available information or staff engagement to monitor and improve the service.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

We spoke to staff and people during our visit at the hospital. People told us they were happy with the care they received and praised the nursing staff. People we spoke with also told us that they felt safe on the ward and also felt that their concerns and comments would be listened to and acted upon.

Patients we spoke with were mostly very positive about their experiences of care and treatment and said that staff listened to them. Patients told us they were happy with the care they received and praised the nursing staff. ‘I call them and they come, I couldn’t want better’, was a typical comment.

Patients we spoke to were happy with the food which was served. They were satisfied with the support provided during meal times, and the presentation and amount of the food served. “It’s always served hot”, “portion size is quite good” were some of the comments patients made about the food.

Our rating of services stayed the same. We rated it them as requires improvement because:

• We found some improvements had been made since the last planned inspection, in 2017, but, more work was needed to bring about the substantial improvements that were required.
• However, some of the improvements were too recent to assess their effectiveness.
• There were staffing shortages in most of the services we inspected and staffing levels were not always in line with national guidance. This was a problem at previous inspections but has worsened.
• Shortages of nursing staff were impacting on the effectiveness of end of life care, availability of link nurses, and it was not a seven day service.
• Medicines management remained a concern in surgery and at this inspection was also found to be a problem in the emergency department.
• In surgery not all policies and procedures had been reviewed in line with agreed timescales and some policies were yet to be developed. In the emergency department staff were not aware of the all the policies related to the care of patients with mental health needs.
• Tools to identify patients who may be deteriorating were not used consistently across the services inspected.
• Not all medical staff were up to date with their mandatory training.
• Patient records were not always fully complete. We found some incomplete care plans and nutritional assessments.
• In end of life care, we found patients had not always received their pain relieving medicine on time.
• The uptake of appraisals and completion of mandatory training was variable and did not always meet the trust target.
• In day care morale was low and staff did not always feel supported by their immediate line managers.

However:

• Some action had been taken following previous inspections with improvements maintained.
• The profile and leadership of end of life care had improved and we found some action had been taken to improve patient care along with the systems for reviewing and improving the quality and safety of the service.
• Maternity services had made improvements and was rated as good.
• Staff were aware of the incident reporting system and there was a good culture of incident reporting.
• We saw improvements in staff hand hygiene.
• In most services we inspected there was good multidisciplinary working and we found good cross site working in maternity services.
• In all services we inspected we found staff were caring and patients were treated with dignity and respect.
• Services had systems to record and manage risk but, some risks were long standing and had yet to be resolved.
• The majority of staff were positive about their immediate line managers and felt they were kept informed, listened to and their contribution was valued.
• The divisions were undergoing a restructure at the time of the inspection with the aim of strengthening leadership and devolving decision making.