We visited the neonatal intensive care unit, special care baby unit, a post natal ward, the Early Pregnancy Assessment Unit and a general gynaecological ward at this inspection.

There were clear systems for assessing people’s needs and delivering care. Patients were very satisfied with their care and treatment and said care was “brilliant” and that staff were “wonderful”, “very approachable and helpful” and “amazing”. Several people said they felt the hospital was “very family orientated”. One family said that they could not imagine getting this quality of care anywhere else in the world.

All the wards we visited were appropriately equipped and staff were resourced and trained to deal with foreseeable emergencies . We observed procedures in place for the prevention and control of infection.

There were sufficient skilled and experienced staff to meet people’s needs. We followed up on our December 2011 inspection. At that inspection we had found the hospital compliant in relation to staffing numbers but with suggested improvements. The trust acted quickly with a comprehensive action plan and on this inspection we found that staff were very pleased with the changes made. Staffing levels were assessed daily in each ward to meet patients' changing needs.

The trust had sound processes for managing risks and reviewing the quality of care and making improvements. They responded appropriately to incidents and complaints and sought and acted on patients' feedback.

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 visited four wards and departments and spoke to patients who were using the service. The majority of patients we spoke with were happy with the care they were receiving. They found staff to be generally polite and helpful and felt they were treated with respect.

Patients told us that they were given information regarding their care and that staff were quick to respond to their calls for assistance. They found the environment to be comfortable. A minority of patients told us that at times communication could have been better, but that overall they found the service and their experience to be very good.

Queen Charlotte's& Chelsea Hospitalprovides maternity and women's and children's services. The hospital is a tertiary referral maternity unit with a nationally renowned centre for foetal care and the largest neonatal intensive care unit in the country. It has a labour ward with two fully equipped operating theatres adjacent to high-dependency care facilities. These are two of the eight core services that are always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection. The other six core services that are not provided by this hospital are: accident and emergency; medical services; surgery; critical care; end of life; and outpatients. These services are covered in the separate reports for Charing Cross, Hammersmith and St Mary’s hospitals.

The team included CQC inspectors and analysts, doctors, nurses, experts by experience and senior NHS managers. The inspection took place between 03 and 05 September 2014.

Overall, we rated this hospital as ‘good’. We rated the hospital ‘good’ for effective, caring and responsive services and ‘requires improvement’ for being safety and well-led.

We rated maternity as ‘good ‘and neonatal services as ‘requires improvement’.

Our key findings were as follows:

Safe:

• Incidents were reported and learning took place from major and moderate incidents. However, learning from near misses and minor incidents did not always take place.
• Nurse staffing levels were not in line with national guidance which impacted on care delivery.
• Safeguarding policies and procedures were in place and appropriate action was taken to safeguard babies.
• The neonatal mortality and morbidity meetings took place regularly but did not have representation from obstetrics or midwifery.

Effective:

• Policies and procedures were based on national guidance. Care was delivered in line with best practice guidance.
• Staff participated in a range of local and national audits. Action was taken on audit findings to improve patient outcomes.
• New staff attended local induction programmes and there was an emphasis on staff development and continuing professional development.

Caring:

• Staff were caring and treated mothers, babies and families with respect and dignity.
• The bereavement midwife was available to provide emotional support to mothers, their partners and staff.
• The neonatal unit had a consultant on duty for the week. Families expressed a view that this arrangement did not promote continuity. They felt that, for those babies who were in the unit for significant periods of time, a named consultant would be beneficial.

Responsive:

• Capacity did not meet the demands for the service; this was due to high staffing vacancies in the neonatal unit resulting in cots being closed. In the maternity unit, midwife shortages meant that the service not always responsive to individual mother’s needs, and this resulted in a task-based approach to providing care that was not focused on the woman and baby.
• Facilities were available for partners and parents to be resident.
• Concerns and informal complaints were addressed proactively, reducing the number of formal complaints received about the services. Action was taken in response to complaints and information was disseminated to staff.

Well-led:

• There were governance structures in place, including local risk registers. However, action to address identified risks was not always taken in a timely manner.

• The units had a vision to improve their services. The new chief executive of the trust was visible and had already made a positive impact on staff morale by listening to their concerns and making them feel supported.

• Neonatal staff were engaged in leading and participating in national research programmes.

We saw areas of outstanding practice including:

The focus on participating in and leading national research projects, including the evaluation of magnetic resonance imaging to predict neurodevelopmental impairment in preterm infants.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Review the staffing levels and take action to ensure they are in line with national guidance.
• Review the capacity of the maternity and neonatal units to ensure the services meet demands.
• Review the divisional risk register to ensure that historical risks are addressed and resolved in a timely manner.

In addition, the trust should:

• Review the current training matrix for statutory and mandatory training and improve the recording system so that there is a comprehensive record of compliance which is consistent with local and trust-wide records.
• Ensure that the risk management process within the neonatal division is suitably robust and fit for purpose to ensure risks are assessed, investigated and resolved in a timely manner.
• Explore how staff can learn from minor incidents and near misses to avoid similar incidents occurring.
• Considerthe neonatal service havingrepresentation at board level.

Professor Sir Mike Richards

Chief Inspector of Hospitals