Inspectors have said there are not always enough staff to keep women and babies safe at Addenbrooke’s and The Rosie Hospitals in Cambridge. 

The Care Quality Commission (CQC) has rated the maternity services at the hospitals as ‘requires improvement’. The hospitals remain rated as good overall. 

Cambridge University Hospitals NHS Foundation Trust (CUH), which runs the two hospitals, said every staff member is “dedicated to providing the best possible care” and that many of the improvements needed are already being addressed. 

A report published by the CQC said there was not always enough medical staff with the right training and qualifications needed to keep women and babies safe from avoidable harm, and to provide the right care and treatment. 

The report said: “The service did not have enough medical staff to keep women and babies safe. Women attending triage often did not have timely medical review because medical staff also provided cover for other units including the delivery suite maternity assessment unit. 

“Lack of medical staffing impacted on the support maternity triage received to maintain safe care for women and birthing people.” 

Inspectors said the trust had improved its midwifery staffing levels and said the total vacancy rate in March 2023 was 1.74, equating to 3.7 full time equivalent roles. 

The report recognised the impact the high cost of living in Cambridge had on recruitment at the hospital, which is not able to offer a higher cost of living allowance as is available in London. 

It said managers had accurately calculated and reviewed the number of midwives and midwifery support staff needed for each shift, but said appropriate numbers of staff with the right skill mix were not always available. 

The report said: “The service confirmed 30 per cent of midwifery workforce were junior staff and junior medical staff told us this impacted on their workload as they were expected to do more on their shifts. 

“Junior medical staff said they did not feel supported in their role. They had raised concerns relating to workload, training, and stress. 

“Leaders told us they would be meeting with doctors to have one to one conversation and to discuss the support they could provide including their postgraduate medical training. They said rota for junior medical staff would also be reviewed to support them.” 

The report said leadership acknowledged gaps in the medical staff rota and said they planned to increase the number of senior level locums. 

Inspectors also found that staff knew how to protect people from abuse, but did not always have up to date training on safeguarding. 

However, the report said staff had training in key skills and “worked well together for the benefit of women”. 

The CQC also rated how well the service was led as ‘good’, stating that leaders had the skills and abilities to run the service, and also understood and managed the priorities and issues the service faced. 

The report said all staff were “committed to improving services continually”. 

Carolyn Jenkinson, the deputy director of secondary specialist healthcare at the CQC, said: “When we inspected the Rosie Maternity Unit we were concerned to find there weren’t always enough staff to ensure people were cared for safely, despite the hard work of existing staff who were skilled, supportive, and dedicated to continuous improvement. 

“For example, we found understaffing meant women and people using the service sometimes had to wait a long time to be seen by medical staff during triage, which could delay care. While staffing challenges are affecting much of the NHS, leaders must ensure this doesn’t undermine people’s safety. 

“However, we also saw some examples of great practice, including a strong relationship with the local maternity and neonatal voices partnership, working together on a programme to provide better care to hard-to-reach communities. 

“We reported our findings to the trust so it knows where there’s good practice to build on and where it must make improvements. We’ll continue to monitor the service to ensure people’s safety and will return to assess whether improvements have been made.” 

Chief Nurse at CUH, Lorraine Szeremeta, said: “Every member of staff in The Rosie Maternity Unit is dedicated to providing the best possible care for our patients. 

“We are pleased that the CQC’s report reflects areas of good practice as well as those areas where we know we need to improve. 

“Many of the improvements identified by the CQC are already being addressed through our comprehensive maternity improvement plan, and this work continues to ensure we deliver the high-level of care our patients rightly expect.” 

Caroline Zwierzchowska-Dod, Co-Lead, at Rosie MNVP, said: “We are very proud of the recognition given to the work of Rosie Maternity and Neonatal Voices within the CQC report, as the inclusion of service user voice is key in improving maternity safety. We look forward to continuing to influence, challenge and support The Rosie Hospital on its improvement journey.” 

The Trust highlighted a number of ongoing improvements including: 

Improving the existing triage process to ensure 24/7 arrangements are in place to treat people requiring urgent support. 

Reviewing the delivery of mandatory training for staff and introducing a training week using the single core competency framework. 

Implementing a new induction process for service users who have undergone previous caesarean section. 

Reviewing medical staffing requirements across the whole service, considering alternative models to care. 

Reducing vacancy levels in midwifery to less than two-per cent, which it said was the lowest in two years.