Royal Free didn't learn enough from racism claims, says regulator

The Royal Free Hospital.

Maternity at the Royal Free has improved, said the CQC. But more needs to be done - Credit: PA

Progress has been made at the Royal Free Hospital's maternity services but there is still work to be done, according to the Care Quality Commission (CQC).

After an unannounced inspection, the CQC rates maternity services as "requires improvement" – an upgrade on the "inadequate" rating, from November.

Among issues raised by inspectors was that some women had complained to the hospital that they felt they were treated differently because of their ethnicity, and that "little had been done to learn from this feedback". The hospital trust highlighted that the report did note work had been done at the hospital to improve knowledge of the diverse nearby population.

The previous CQC rating came after the hospital received a warning from the regulator when a patient, Malyun Karama, died after being given an excessive amount of the drug misoprostol, which was used to induce labour while she was suffering a miscarriage in February 2020.

The hospital received a Prevention of Future Deaths Report from the senior coroner for Inner North London, Mary Hassell, after the inquest into Ms Karama's death. This highlighted actions the trust should take to avoid repeat incidents.

The hospital apologised to Ms Karama's family.


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After the most recent inspection, the CQC's Nicola Wise, said: “I am pleased to report that trust leaders have made progress in addressing the concerns we identified in our previous inspection of maternity services at the Royal Free Hospital, and this learning has been shared across the trust, so we also saw improvements at Barnet General Hospital.

"This is good news for women and their families who are using these services."

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Ms Wise said her team had found an "open culture of learning and improvement" and that staff were encouraged to report incidents as part of a "no blame culture".

She praised an initiative which saw knitted orange hats given to vulnerable babies to help staff identify who needed extra support. She said this was "really commendable".

But Ms Wise added: "However, there is still more work to be done, especially around tackling health inequalities experienced by disadvantaged groups."

She said there was not enough of a focus on "understanding and addressing" this issue, adding: "Staff at the Royal Free Hospital told us that women complained about not being treated the same as other women because of their ethnicity, yet little had been done to learn from this feedback, which told us people’s cultural and social needs weren’t being met.

"This is not acceptable, and leaders need to act quickly to ensure that it is addressed."

The CQC said its "requires improvement" rating is down to several issues: 

  • The trust "did not always ensure staff were competent for their roles". The regulator said it found: "Although most staff were experienced, qualified and had the right skills, some midwives did not have the skills required to work in the labour ward, or were not confident with carrying out certain procedures."
  • Staff still had "limited knowledge of the local population". The regulator said: "Further work was needed to connect with women from diverse backgrounds and to address health inequalities."
  • Staff and patient engagement, and limited support for breastfeeding at weekends and out-of-hours were flagged.

But the regulator did comment on improvements around governance, the sharing of learning, and "Duty of Candour". The latter highlights how healthcare workers must be "open and honest" with patients.

Improvements to IT systems in the maternity unit were  welcomed.

Ahead of the report's publication, Ms Wise wrote to the trust saying it had "comprehensively responded" to concerns.

Barnet Hospital – part of the Royal Free NHS trust – also received an unannounced inspection in June after concerns about treatment were raised. Barnet Hospital's maternity services remain rated "good". 

The CQC praised improved management processes and audits, and said safety incidents were "managed well" at the Barnet unit. It highlighted that staff had "the time and opportunity to develop their skills and knowledge" and were clear about their roles. 

The regulator said improvements could be made at Barnet Hospital when it came to waiting times and electronic record-keeping, and also said "birthing pool cleaning was not routinely audited".

A Royal Free spokesperson said: "We are pleased that the CQC has recognised the progress we have made to improve our maternity services.

"We are committed to improving further in the areas identified by the CQC to ensure that every woman who chooses to have her baby with us has the best possible outcome and a positive experience."

The full CQC reports are available on its website cqc.org.uk.

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