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Inspection Summary


Overall summary & rating

Good

Updated 7 October 2014

We inspected the birthing centre at Penrith Hospital on 2 May 2014 as part of our comprehensive inspection of the acute core services of North Cumbria University Hospitals NHS Trust. Although our Intelligent Monitoring data identified the trust as being high risk, the trust’s the birthing centre had not been identified as a risk.

We rated the maternity services at the birthing centre as good.

Our key findings were as follows:

  • The birthing centre at Penrith was well run overall. However, we found it lacked an articulated strategic vision.
  • The centre was not being used to its full capacity. The data we saw showed that out of 60 women booked to deliver at the centre, following a risk assessment at 36 weeks only 23 women actually delivered their babies there. Seven women required a transfer during labour and seven were unable to deliver at the centre because of a shortage of staff.
  • The service had identified its own risks and was monitoring its own performance against national and local maternity indicators. Managers were reviewing all transfers from the centre to the Cumberland Infirmary at Carlisle to identify indicators and trends for the reasons why women could not deliver at the centre. This demonstrates that they were working to understand and predict safe deliveries at the centre.
  • Arrangements were in place to ensure a sufficient number of staff to provide safe care. The service had the standard ratio of one midwife to 28 hospital births, which is in line with national standards. If staffing levels were compromised then arrangements were made to transfer women to other centres so that safe staffing ratios were maintained; 100% of women had one-to-one care in established labour and there were sufficient numbers of supervisors of midwives within the birthing centre.
  • The unit was clean and tidy and each room was stocked with appropriate personal protective equipment for staff.
  • After a recent internal review of the midwifery service, the trust introduced a midwifery governance lead, which had improved the approach to governance and monitoring clinical practice. Although the specialist midwife roles had been welcomed, the clinical lead roles and business unit manager roles were not yet fully embedded. This meant that staff were not clear about roles and responsibilities.
  • We found that maternity services were delivered by committed and compassionate staff who treated patients with dignity and respect. All the people we spoke with were very positive and passionate about the service and about the care they had received.

The trust needs to make improvements in areas of poor practice.

Importantly, the trust should:

  • Ensure the quality of information to improve the support for women who wish to complain. We found that although some complaint leaflets were available, information on both the role and contact details of the Care Quality Commission was out of date and inaccurate, and the leaflets did not clearly direct people to the Public Health Service Ombudsman.
  • Ensure there is a service level agreement with the host trust to identify expectations about servicing and access to emergency continuity plans.

  • Develop a local risk register for the centre to underpin the service risk register and ensure local risks are recorded, mitigated and escalated appropriately. Although we did note that the service was reviewing all transfers to the Cumberland Infirmary to gain assurance that women give birth in an appropriate setting.
  • Clarify the governance structure, as the Maternity Services Liaison Committee had not met for two years.
  • Clarify a leadership role with a clear remit to promote ‘normality’ in child birth as supported by the Royal College of Midwives Campaign for Normal Birth and the National Childbirth Trust Birth Policy.
  • Consider using information technology to improve the effectiveness of data flows. We were informed that the centre had recently received approval to introduce the IT data systems needed to help develop innovation and improvements.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 7 October 2014

Effective

Good

Updated 7 October 2014

Caring

Good

Updated 7 October 2014

Responsive

Good

Updated 7 October 2014

Well-led

Good

Updated 7 October 2014

Checks on specific services

Maternity and gynaecology

Good

Updated 7 October 2014

The Birthing Centre at Penrith was well run overall. The service had identified its own risks and was monitoring its own performance against national and local maternity indicators. The trust provided information that outlined how it calculated staffing levels, and arrangements were in place to ensure a sufficient number of staff to provide safe care. The service had the standard ratio of one midwife to 28 hospital births. This is in line with national guidance.

We found that maternity services were delivered by committed and compassionate staff who treated patients with dignity and respect. All the people we spoke with were very positive and passionate about the service and about the care they had received.