The Fetal Medicine Centre

On this page

• 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

We looked for evidence that people’s care, treatment and support assessed their needs and promoted good outcomes, based on the best available evidence. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment, this key question was not rated. At this assessment this key question has been rated good. This meant care and treatment were planned and delivered in line with people’s assessed needs, current guidance and evidence-based practice.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service offered specialist fetal medicine consultations and diagnostic scanning services to people referred by healthcare professionals or through self-referral pathways. Staff gathered detailed information about people's medical history, pregnancy details and current circumstances before consultations and scans. This was recorded in the patient records we reviewed.

The service carried out non-invasive and invasive prenatal testing, which could detect chromosomal and genetic conditions such as Down syndrome, Edwards syndrome, and Patau syndrome. In the event of an abnormal result, a doctor would contact the patients directly to provide counselling and guidance on the next steps.

Observations of clinical appointments showed staff undertook detailed examinations, clinical fellows explained the purpose of examinations, discussed relevant screening options and took time to ensure people understood the information being provided. Staff adjusted assessments according to individual clinical circumstances and concerns.

Feedback from people highlighted that they received thorough assessments and detailed explanations. Staff demonstrated an understanding of the emotional impact of pregnancy complications and tailored consultations accordingly. Staff told us when they needed to discuss abnormal findings people were supported in private consultation rooms where sensitive discussions could take place.

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.

Scans were performed by specialised fetal medicine clinicians working within a centre that had a strong focus on education and research. Leaders described how the organisation supported education and research in fetal medicine, with consultants and clinical fellows participating in research activity and specialist training programmes. Clinical fellows received structured supervision from experienced fetal medicine consultants, helping to ensure care reflected current best practice and advances in the specialty. Staff told us they benefited from direct access to expert advice and ongoing learning opportunities, which supported the consistent delivery of high-quality care.

The service provided care and treatment based on national guidance and evidence. Staff demonstrated a comprehensive understanding of specialist fetal medicine pathways and applied evidence-based approaches throughout people's care and treatment. Observations of consultations showed clinicians completed detailed examinations, explained findings clearly and discussed screening, diagnostic and treatment options in a balanced and informed way. People were supported to understand the benefits, limitations and implications of different tests before making decisions about their care. Staff followed established protocols for diagnostic testing and had clear pathways for the management of high-risk findings, including prompt referral and escalation when specialist intervention was required.

The service had effective systems to monitor and assure clinical quality. Consultants reviewed scans and provided feedback to support learning and maintain high standards. Staff described a culture of continuous learning, peer support and professional development, which enabled them to maintain specialist skills and deliver care in line with recognised standards. Leaders told us scan quality was reviewed through regular audit arrangements, including external oversight from specialists associated with a leading NHS fetal medicine service. Over the previous 12 months, the service completed 7,662 scans. A sample of 35 scans on average were audited for quality each quarter, all of which were found to be good or acceptable quality. However, as only a small proportion of scans were reviewed, this limited the level of assurance that audit findings were representative of overall scan quality across the service.

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 with external healthcare providers to ensure people experienced joined-up care. Leaders told us clinical information, scan reports and test results were shared electronically with referring obstetricians, maternity services and other relevant healthcare professionals. During our assessment we saw evidence that urgent findings were escalated promptly and direct communication took place with partner organisations when immediate action was needed. Staff understood the importance of timely information sharing to support continuity of care.

The service maintained strong links with specialist NHS providers and fetal medicine services. Leaders described regular engagement with specialist clinicians and quality review arrangements involving external medical professionals. Clinical fellows worked across partner organisations and benefited from consultant supervision and specialist training. Staff described a culture where advice and support were readily available and consultants could be contacted when required.

Multidisciplinary working was embedded across the service. administrative staff, clinicians and managers understood their roles and communicated effectively. Staff worked alongside contracted organisations to support patient care.

The service 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, reduced their future needs for care and support.

The service provided people with information and advice to help them understand their pregnancy, screening options and potential health risks. Observations showed clinicians spent considerable time explaining scan findings, screening tests and treatment choices. Staff tailored information to each person's circumstances, checked their understanding during consultations and provided holistic advice, including dietary guidance where needed and clear information about symptoms to be aware of. People received written reports and information to help them participate in decisions about their ongoing care.

Staff promoted informed choice by discussing available diagnostic and screening options and ensuring people understood the possible outcomes. We observed staff explaining how and when results would be communicated and discussed options for additional testing when appropriate. People receiving higher-risk results were offered additional support and follow-up arrangements. Staff recognised the emotional impact of specialist fetal medicine services and provided reassurance and information throughout people's care journey.

Feedback from people indicated staff supported them to understand their health and make decisions confidently. Staff also maintained contact with people following appointments when further support or clarification was needed.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

As scans were performed by fetal medicine clinical fellows and consultants, complex abnormalities and emerging concerns could be identified promptly, often at the point of care. This meant people received timely advice, onward referral and access to specialist treatment where needed. Staff used highly specialist equipment to perform scans that supported effective care. Staff described consultant expertise as readily available, and observations showed specialist knowledge was used to support swift clinical decision-making. Staff told us this supported timely clinical decision-making and onward referral where further assessment or treatment was required.

The service had effective systems to monitor the quality and performance of the service. The provider undertook quarterly audits of scan quality, service performance and operational processes. Leaders described reviews involving an external specialist clinician from a leading NHS fetal medicine service, which provided additional scrutiny of the quality of scans and clinical practice. Scans performed by clinical fellows were also regularly reviewed as part of their ongoing development, creating opportunities for shared learning and maintaining high clinical standards. These arrangements provided opportunities for review, feedback and shared learning about scan quality and clinical practice. The service demonstrated a proactive approach to identifying opportunities for improvement and implementing changes. Leaders monitored waiting times, delays and service capacity and used audit findings to improve people's experiences. For example, following a review of appointment delays, the provider introduced changes to clinic scheduling to minimise waiting times and reduce the risk of clinics running behind schedule.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had an appropriate a consent policy and information on staff responsibilities in relation to the Mental Capacity Act 2005 (MCA).

Staff understood the importance of obtaining consent before carrying out examinations, investigations and treatment. During clinical observations, we saw staff explained the purpose of scans, discussed screening options and provided opportunities for people to ask questions before proceeding. Clinicians ensured people understood what examinations involved and what information the tests could provide. Consent processes reflected the nature of the procedures being undertaken. Patient consent was documented in patient records, and records showed women had been provided with relevant information about their scans. The service also audited whether consent was obtained and clearly documented in patient records. The most recent audit showed 100% compliance in gaining and recording patient consent in the 50 records reviewed.

However, staff did not always have a clear understanding of how to respond to language barriers. The service could access telephone interpreters when needed, but most staff we spoke with were not aware of this provision. Staff told us they rarely saw patients who did not speak fluent English and said interpreters were usually arranged through the person’s embassy where required in many instances. This reduced assurance that staff could consistently support people with limited English to understand information and make informed decisions.