Updated 23 June 2023
Liverpool Women’s NHS Foundation Trust is a specialist trust that specialises in the health of women, babies, and their families. It is one of only two specialist trusts in the UK and the largest women’s hospital in Europe. As a tertiary centre the hospital provides care for a significant proportion of patients with high levels of complexity and clinical risk, as well as serving a local population with significant deprivation. The hospital teams deliver around 8,000 babies and perform some 10,000 gynaecological procedures each year.
The trust is situated in an area where 44% of the population live in the lowest quintile for deprivation in England. 26% children (0-15 years) live in poverty. The region performs significantly worse for premature cancer, cardiovascular disease (CVD) and respiratory deaths. 46% of women booking with Liverpool Womens Hospital are from the 1st decile on the deprivation index, compared to a national average of 13%
The maternity team cares for women and their babies from conception to birth supported by the neonatal team who provide around the clock care for premature and new-born babies needing specialist care.
The trust’s fertility team helps families to improve the chance of conceiving babies. Community midwifery teams were based in areas of deprivation.
In gynaecology, the trust undertakes care of women with the many varied conditions associated with the female reproductive system and is a centre for gynaecology oncology. The genetics team supports families with the diagnosis and counselling of genetic conditions. The trust also carries out gynaecology operations including surgical termination of pregnancy.
The new Community Diagnostic Centre (CDC) at the hospital includes a mobile CT scanner. At the Crown Street site, the CDC has a new colposcopy suite, CT, and MRI imaging facilities.
We carried out an unannounced inspection of the gynaecology services provided by this trust.
A focused inspection of maternity services was also carried out as part of the CQC national maternity inspection programme which looked only at the safe and well led questions. We also inspected the well-led key question for the trust overall.
We did not inspect neonatal services, end of life care or outpatients, using our ratings principles the ratings for these services have been aggregated from the inspection in 2019.
Our rating of services went down. We rated them as requires improvement because:
We rated safe and well led as requires improvement. We rated caring, effective and responsive as good. We rated one of the trust’s services as requires improvement and one as good.
Overall, the trust leadership team had knowledge of the main priorities and challenges faced by the service for the future but did not always understand and manage the immediate priorities and issues the service faced.
Although there were governance processes, throughout the service and with partner organisations, these processes were not always managed effectively.
Not all staff felt respected, supported, and valued. However, they remained focused on the needs of patients receiving care. Some staff had raised concerns several times regarding safety and staffing directly to senior leaders however they saw no quick action or improvement.
Leaders and teams did not always use systems to manage performance effectively. They did not always identify and escalate relevant risks and issues with effective actions to reduce their impact.
The trust collected and analysed data however it did not always act on it in a timely way. Not all staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. Data or notifications were not always consistently submitted to external organisations as required.
However:
The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
The service had an open culture where patients, their families and staff could raise concerns without fear. Although in maternity services some women and birthing people gave negative feedback about their experience of care.
Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
The trust promoted equality and diversity in daily work and provided opportunities for career development. The equality, diversity, and inclusion networks had been refreshed. The PRIDE (LBGTQ+) Network was more recently established and was developing.
The trust had plans to cope with unexpected events.
The information systems were integrated and secure.
Staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research.
How we carried out the inspection
During our inspection of maternity services, we spoke with staff including midwives, student midwives and doctors, maternity support workers, midwifery matrons, junior doctors, middle grade obstetricians, consultant obstetricians, as well as administration and clerical staff and senior managers. We spoke to 9 women. In gynaecology we spoke with 4 women and 41 members of staff we also looked at 15 patient records.
We conducted focus group meetings with staff prior to the inspection and during the core service inspection.
The inspection was overseen by Karen Knapton the interim deputy director and included an inspection manager, inspectors, and specialist advisers. An executive reviewer supported our inspection of well-led for the trust overall. Executive reviewers are senior healthcare managers who support our inspections of the leadership of trusts. Specialist advisers are experts in their field who we do not directly employ.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.