Window To The Womb

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we did not rate this key question. At this assessment it has been rated as Good. This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The service carried out risk assessments through the initial online pre-booking questionnaire to determine the women’ eligibility; however, the services processes did not always consistently identify or consider additional needs of women using the service. These included language, cultural, religious and accessibility requirements for women and their relatives. As a result, the service did not always make reasonable adjustments in advance, in line with Equality Act 2010, to promote dignity, equality and inclusion.

Managers and staff told us they did not routinely contact women before appointments to gather further information about individual needs such as mental health status or communication requirements. Staff gave examples of women whose needs were only identified on arrival or at time of the scan. This included a patient who was blind and attended with an assistance dog and a patient who did not speak English as a first language, attended with a family member. In both cases, staff were unaware of these needs until the patients arrived at the clinic limiting the opportunity to plan appropriate support in advance.

While staff responded appropriately once these needs became known, the lack of a proactive process increased the risk that people’s individual needs were not fully address prior to attendance. This meant it may limit location's ability to ensure arrangements consistently support dignity and patient centred care. Leaders told us that the provider was implementing changes in response to our feedback which would address these concerns across other locations also.

However, we did see that staff had completed mandatory training in health and safety, emergency first aid, and fire safety.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff used up to date policies to plan and deliver care. All policies we reviewed were clearly dated, referenced relevant national guidance, and included defined review timelines. Staff demonstrated confidence in accessing policies and procedures. The managers actively monitored policies to ensure alignment with national best practice and regulatory requirements. When updates were made, leaders implemented them across all clinic locations at the same time, ensuring consistent practice. The service had a foetal ultrasound policy which confirmed compliance with the National Institute for Health and Care (NICE), Society of Radiographers (SoR) and British Medical Ultrasound Society (BMUS) guidance. This included ‘Pause and Check’ posters to verify patient identity before performing scanning. We observed patient scanning and saw the sonographers always complied with this guidance.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked collaboratively as a team to provide safe and effective care for women. They supported each other to deliver a high-quality service and carefully planned patient care. We observed staff supporting each other and building a good rapport with the women and their relatives.

Staff described having positive and healthy working relationships with external organisations they engaged with regularly. The service maintained a positive working relationship with local NHS maternity services, referring women when abnormalities were suspected during ultrasound scans.

We scored the service a 3. The service generally supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff provided a range of health promotion advice, guidance, and signposting. Staff also signposted women to services that provided extended, personalised support when required. The service signposted women to a range of specialist support services to help with decision making and managing complex or difficult situations, including referral information for the British Pregnancy Advisory Service (BPAS).

The service made information about pregnancy related conditions available support readily available. Leaflets and posters were available for women and their families, although it was not always clear whether these were provided in multiple languages. However, the services website offered the same information and allowed users to select from a wide range of languages. The franchise also promoted the use of a pregnancy application designed to support mood management during pregnancy.

We observed that the service actively promoted health awareness through clear, visible and accessible information. Posters offering domestic abuse support were discreetly displayed on toilet doors.

We scored the service a 3. The service monitored people’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

The service conducted a monthly audit of clinical images from a sample of sonographers, and the results were fed back to each sonographer. The service used findings from feedback to make improvements and consistently achieved good outcomes, particularly in ensuring women arrived at their treatments on time.

Managers had clear systems to monitor and improve performance. They reviewed key performance indicators (KPIs) regularly and ensured that targets were consistently met. Wherever possible, managers also used commissioner performance data to track progress and drive improvements.

KPI achievement remained consistently high. There was communication from the franchise monthly meetings (held by the franchise regional director and managers) that confirmed that the met expected standards and highlighted the service’s commitment to learning from their audits and feedback.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent.

Staff were not always confident in supporting women with communication barriers and we observed difficulties in applying this in practice. For example, staff relied on a relative to interpret when confirming woman’s date of birth. We raised this with leaders during inspection. Although the franchise has a Patient Support Policy, which outlined the use of professional translation services for consent, staff we spoke with were unaware of how to access these services and relied instead on informal methods such as personal mobile phone translation applications and family members. Following the assessment, the leaders told us that retraining and learning had commenced across the franchise to address these gaps. However, at the time of this assessment, we had not seen evidence to demonstrate this.

Despite this, we observed women who appeared calm, relaxed and comfortable whilst waiting for their appointment. Staff interacted with women respectfully and demonstrated awareness of their responsibility to obtain consent. The consent process required women to confirm they understood the service was elective, non-diagnostic, and not a replacement for NHS care.

Staff told us they discussed and accommodated individual requests whenever possible such as being cared for by a health professional of the same sex. Chaperones were available when requested. These practices supported the woman’s dignity, comfort and choice.

The service had a pre-booking short eligibility questionnaire and only after arrival to the clinic, a full pre-scan questionnaire was given to the women to ensure consent is current and signed on the day face to face.

Staff had completed mandatory training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).