Dear colleague, 

I’m sure you will have seen in the news that we are one of 14 trusts that will be part of an investigation, led by Baroness Amos, into maternity services in England. 

Her investigation wants to capture experience and learning from a wide range of trusts. We were selected based on several factors, including reviewing data about our maternity outcomes and the experiences of our mothers. 

 

Baroness Amos also wants to look at trusts with a different case mix; at the provision of care to people from diverse backgrounds; and at trusts where previous investigations have taken place. 

We look forward to sharing with Baroness Amos and her team the improvements we’ve made in maternity services at Queen’s Hospital.

When the Care Quality Commission visited our maternity department last month, their inspectors told us about the positive changes they’d seen in the past year.

These changes have led to more people saying they’ve had a good experience at Queen’s and to a fall in complaints.

We have more to do, and I know these improvements have come too late for those who have lost a child and those who have experienced poor care.

I thought it might be helpful to set out some of the key facts about our maternity services at Queen’s, where 7,200 babies are born every year.  We have the third largest single site maternity unit in England (largest in north east London), including:

o    86 inpatient beds

o    Maternity triage - seven beds

o    Birth centre with eight rooms

o    Obstetric assessment unit – five beds

o    Level 2 neonatal intensive care unit (NICU) with four ITU, six HDU and 16 special care baby unit cots

o    A range of specialist clinics including cardiac, haematology, perinatal mental health, birth options, diabetic, pre-term and fetal medicine.

How we’re improving our services

• We’ve recruited 164 more midwives since 2021, with seven more joining us soon
• Our vacancy rate will then be 3.64%. It was at 16% in January 2023
• We’ve invested in additional clinical posts, recruiting 12 additional Obstetrics and Gynaecology consultants since 2022 (with two more joining us soon) and increased our resident doctor numbers
• We’ve introduced bilingual volunteers to support women throughout pregnancy (including attending appointments with them) and during labour
• We’ve implemented pre-term screening for pre-eclampsia
• We are offering enhanced ‘continuity of carer’ (where women are supported by the same team throughout their pregnancy) in areas where health inequalities have been identified
• We have increased triage space and staffing to speed up initial assessment and created a new discharge lounge to improve flow through the unit
• We have increased obstetric theatre capacity and staffing
• Our stillbirth rates are in line with the national average and with other maternity units with a similar demographic
• Around 4% of full-term babies are unexpectedly admitted to NICU. The national target is 6%

• Our Maternity and Neonatal Voices Partners work with our patient experience team to ensure we continue to improve our services through listening to those who use them
• This year we will be launching a new diabetes pre-conception clinic for women who are trying to conceive and a new hybrid closed loop insulin pump service for Type 1 diabetics who are pregnant or trying to conceive
• It’s likely we will soon leave the Maternity Safety Support Programme that we joined in October 2021

The challenges we face

• Population growth across north east London outweighs a declining birth rate nationally, so we’ll be supporting more births over the next decade
• Pregnancies and births are increasingly complex due to health conditions - including increasing rates of obesity, diabetes and hypertension - and social factors
• This means more interventions - such as induction, c-section, and assisted deliveries - and more complications that require more resource and capacity
• Communication and cultural barriers – 50% of our mothers do not speak English as a first language

• 1 in 7 of our expectant mothers either present with diabetes or develop it during their pregnancy. We have reviewed and improved the support and information we offer them

• Lack of designated level 3 NICU 
• Pressure on theatre availability due to a rise in the number of caesarean sections, up from 2,270 in 2020 to 3,005 in 2024 (see below).

Despite the improvements I’ve detailed above, we know that we don’t always get everything right for every family. We’re committed to learning from our mistakes and being open and transparent when we get things wrong. 

I’m confident Baroness Amos and her team will see all of this when they carry out their investigation and I hope her final report will reassure our residents about the safety of our maternity services.

Best wishes.

Matthew Trainer

Chief Executive