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Inspection Summary


Overall summary & rating

Good

Updated 5 May 2016

Alnwick 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 at 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 across Northumberland and North Tyneside with 999 beds. The trust has operated as a foundation trust since 1 August 2006.

We inspected Alnwick 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 Alnwick 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 1:3, this 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:

  • 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.

  • Ensure that delivery rooms are fully inspected following delivery and ensure that homeopathic remedies are removed and destroyed or returned to the patient.

  • Ensure that record keeping is consistent across and within maternity services at this hospital.
  • Consider a formal programme of staff rotation to provide assurance of clinical competence.
  • Ensure that the storage and collection of placentas at this hospital is consistent with other hospitals within the trust.

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

We rated maternity services at the Hillcrest maternity unit as good with the well-led domain rated as requires improvement because:

We found there were clear 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. Staff were aware and were confident in the reporting of incidents, however, 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. We found clear safeguarding processes in place; staff knew their responsibilities in reporting and monitoring safeguarding concerns. There were plans in place to ensure staff attended mandatory training.

We found the service used evidence-based guidelines to determine the care and treatment they provided. We reviewed the annual audit plan staff were involved in regular local audit. We found staff had the correct skills, knowledge and experience to do their, however, we found that training had not been provided to support staff on ward 7 when gynaecology was relocated. Training ensured midwifery staff could carry out their roles effectively. Competencies and professional development were maintained through supervision.

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 robust policies 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. 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 Alnwick Infirmary can be found at Northumbria Healthcare NHS Foundation Trust.