Following a focused inspection that took place in August 2023, the Care Quality Commission (CQC) has today published its latest reports into maternity services and care we provide at University Hospital Lewisham (UHL) and Queen Elizabeth Hospital, Woolwich.
Both sites have maintained good ratings overall with UHL improving to an outstanding rating in the well-led domain.
Key metrics such as leadership, health inequalities, and listening to women and birthing people garnered special praise and recognition in the reports, which highlight the successful improvement journey that the Trust’s Maternity teams are on.
Ben Travis, LGT’s Chief Executive, said: “Over the last five years, we have been on an active journey of service user-led improvement within our maternity teams, so I am very pleased that we have maintained our overall good rating with well-led improving to outstanding. This is a huge testament to the hard work and dedication of our teams, who are committed to listening to and learning from our women and birthing people – a big congratulations and thank you to you all.
“It is also thanks to the support of our partners, such as our Maternity Voices Partners, FiveXMore, our local Healthwatch partners, and our NHS maternity partners across the South East London system. This is a success that should be shared by everyone who has played their part and worked alongside the LGT Maternity teams. This collaborative and inclusive approach is one that we are very proud of, and we are delighted that it is recognised by the CQC.”
Shirley Peterson, the Trust’s Director of Midwifery, said: “Caring for women and birthing people during their maternity experience is a very special privilege and we work hard to try and get this right for those using our maternity services at LGT. It matters to us that our women and birthing people feel respected and listened to and we are thrilled that this has been noticed by the CQC, especially in such a challenging year for maternity services.
“I am very proud of the team today – as always – and I know that we are committed to work together to continue to drive and improve our services for our women and birthing people. While we will take a moment to reflect on this achievement, we won’t stop looking forward as we know that there is always more to do.”
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: “When we inspected the maternity services at Lewisham and Greenwich NHS Trust, we saw a service that provided good care to women, people using the service, and their babies. Leaders had created an open culture where people could raise concerns without fear and be listened to. People told us they were happy with the care and support they had received while using these services.
“Staff worked well together to help everyone using the service. They knew how to keep people safe from harm. Staff kept detailed records of the care they gave and learned from any safety problems that happened.
“Staff told us they felt respected, supported and valued by managers. They were focused on the needs of people receiving care, and we observed them treating people with dignity and respect. The service promoted equality and diversity and provided opportunities for career development.
“We were pleased to recognise the trust's dedication to ensuring equal care for everyone. The leaders and staff are aware that health differences can affect the treatment and care provided, especially those from ethnic minority and less privileged groups.
“We will continue to monitor the trust, including through future inspections, to ensure people and their babies can continue to receive a good standard of care.”
The full CQC reports for both QEH and UHL’s maternity services can be found here:
Key findings of the reports are summarised below:
In a statement covering both hospitals’ maternity leadership, the CQC said that “Leaders at every level showed they had the experience and ability to provide top-quality, lasting care.” They found that leaders were “visible and approachable”, with several leaders’ offices being located within the maternity units themselves. Furthermore, the Trust’s executive leadership “visited wards on a regular basis… staff told us they saw the executive team regularly and spoke of how accessible and encouraging they were.”
In awarding the ‘Outstanding’ rating to UHL’s maternity leadership, the CQC called the sense of a shared purpose “inspiring”, backed by “a clear understanding of the challenges to quality and sustainability within the service and plans to manage them which were shared with staff.”
The CQC also stated that “the leadership drove continuous improvement” while still making time to “actively and openly [engage] with women and birthing people, staff, equality groups, the public and local organisations to plan and manage services”. Leaders were also found to have “encouraged staff to take part in leadership and development programmes to help all staff progress.”
Health inequalities and the ethnic minority birthing experience
There has rightly been a focus in recent years on the disparate outcomes in maternity groups for different protected characteristics, particularly in terms of race and ethnicity. For example, Black women were found to be 3.7 times more likely to die during or in the first year after pregnancy than White women, with Asian women are twice as likely to die in pregnancy or childbirth.
As LGT serves very diverse communities across Bexley, Greenwich and Lewisham, this has been a huge focus at the Trust. The CQC found that LGT “demonstrated their understanding” of these issues “particularly around deprivation, language barriers and cultural awareness”.
They hailed the Trust’s partnership with local non-profit Five X More to provide Black and Brown pregnant people with personalised information wallets that “empower them to advocate for themselves, promote positive health and wellbeing and tackle negative culture”, and added that at UHL, early adoption of a new clinical decision tool that takes inequalities into account “had reduced the chance of perinatal death for Black, Asian and ethnic minority women and birthing people.”
Beyond ethnicity, the fact that LGT employs smoke-free midwives at both hospitals was welcomed as part of tackling this issue that disproportionately impacts the economically disadvantaged. The CQC report also made space to mention that LGT “provide support for women and birthing people with travel costs to attend appointments, partner with foodbanks to offer foodbank vouchers with local refugee and migrant networks and charities.”
Listening and learning
Maternity colleagues at both QEH and UHL were said to be “open and transparent”, with a culture of learning from incidents and “[involving] women, birthing people, and their families in these investigations.”
Moreover, the CQC found that “managers shared learning with their staff about never events and serious incidents that happened elsewhere” – showing a commitment to improvement no matter the source.