You are here

Inspection Summary


Overall summary & rating

Good

Updated 5 May 2016

Berwick Infirmary is one of the hospitals providing care as part of Northumbria Healthcare NHS Foundation Trust. This hospital provides community inpatient beds; an urgent care centre and midwifery led maternity service. We inspected community in patient and urgent care services as part of our comprehensive inspection of community services as this trust; these services are reported within separate inspection reports. This report specifically relates to maternity services at this hospital.

Northumbria Healthcare NHS Foundation Trust provides services for around 500,000 people across Northumberland and North Tyneside with 999 beds. The trust has operated as a foundation trust since 1 August 2006.

We inspected Berwick Infirmary as part of the comprehensive inspection of Northumbria Healthcare NHS Foundation Trust, which included this hospital, Northumbria Specialist Emergency Care Hospital, North Tyneside General Hospital, Wansbeck General Hospital, Hexham General Hospital, and community services. We inspected maternity services at Berwick Infirmary on 11 November 2015.

Overall, we rated maternity and gynaecology services as good, with well-led rated as requires improvement.

Our key findings were as follows:

  • There were no cases of hospital-acquired Methicillin-Resistant Staphylococcus Aureus (MRSA) or Clostridium difficile (C. difficile) in 2014/15 at this hospital.
  • The hospital had infection prevention and control policies in place, which were accessible, understood and used by staff.
  • Patients received care in a clean, hygienic and suitably maintained environment.
  • There were cleaning schedules in place across all wards and departments which were fully completed in line with cleaning requirements and the trust’s policy.
  • There was adequate personal protective equipment (PPE) such as aprons and masks available to staff. We routinely saw staff using this equipment during our inspection.
  • There were sufficient staffing levels to meet the needs of women. There was a ratio of midwives to births of 1:24, which was better than the ROCG guideline of 1:28.
  • There was no medical staff based at this maternity unit, however a consultant led clinic was held fortnightly for women with a high risk pregnancy.
  • There was a robust midwifery led care policy, which identified the criteria for women being able to deliver within the unit and at home.
  • Women were provided with tea and toast following delivery. There was no formal food service due to the nature of the unit and small number of births.
  • Staff interacted with women in a respectful way. Women were involved in their birth plans and had a named midwife.
  • Women received an assessment of their needs at their first appointment with a midwife. The midwifery package included all antenatal appointments with midwives, ultrasound scans and all routine blood tests as necessary. The midwives were available, on call, 24 hours a day for births as needed.

There were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Complete a comprehensive gap analysis against the recommendation made for the University Hospitals of Morecambe Bay NHS Foundation Trust.
  • Ensure that the maternity and gynaecology dashboard is fit for purpose, robust and open to scrutiny.

In addition the trust should:

  • Ensure that the clinical strategy for maternity and gynaecology services which is embedded within the Emergency Surgery and Elective Care Annual Plan, sets out the priorities for the service with full details about how the service is to achieve its priorities, so that staff understand their role in achieving those priorities.

  • Consider reviewing the provision of hearing screening services in the remote parts of the trust, to meet the needs of the local community.
  • Consider a formal programme of staff rotation to provide assurance of clinical competence.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 5 May 2016

Effective

Good

Updated 5 May 2016

Caring

Good

Updated 5 May 2016

Responsive

Good

Updated 5 May 2016

Well-led

Requires improvement

Updated 5 May 2016

Checks on specific services

Maternity and gynaecology

Good

Updated 5 May 2016

Overall we rated maternity services as good, with well led as requires improvement because:

Staff were aware and were confident in the reporting of incidents, data supplied by the trust showed no reported incidents between June 2014 and July 2015. There were sufficient staffing levels to meet the needs of women. The unit was clean and staff complied with infection control guidelines. Staff used the maternity early warning scores to assess risk and women were transferred to the consultant led centres, if their scores became elevated or concerns were identified in labour. There were guidelines in place for managing normal labour which had clearly defined criteria for transfer. Care and treatment was planned and delivered in a way to ensure women’s safety and welfare.

The service used national evidence-based guidelines to determine the care and treatment they provided and participated in national and local clinical audits. Patient outcomes were monitored and action taken to make improvements.

Staff interacted with women in a respectful way. Women were involved in their birth plans and had a named midwife. There were processes in place to ensure women received emotional support where required.

We found there were procedures in place to ensure that patients were seen at the right place at the right time. Women using the service could raise a concern and be confident that concerns and complaints would be investigated and responded to.

Although the senior management team were aware of the challenges to the service and had a vision for the future, the formal clinical strategy for maternity or gynaecology services which was contained within the surgical business unit annual plan was very generic in terms of outcomes and references to maternity and gynaecological services were minimal. This did not support identification of how the service was to achieve its priorities or support staff in understanding their role in achieving the services priorities. The risk register did not reflect the current concerns of the senior management team.   We found there were risk and governance processes in place; however, we were concerned with the levels of scrutiny provided by the directorate with regard to the clinical dashboard.  Risks were reported and monitored and action taken to improve quality.   The views of the public and stakeholders through participative engagement were actively sought, recognising the value and contributions they brought to the service. There was some evidence of innovative practice

Other CQC inspections of services

Community & mental health inspection reports for Berwick Infirmary can be found at Northumbria Healthcare NHS Foundation Trust.