The Fetal Medicine Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff described a supportive learning environment where they could develop their skills and seek advice from senior clinicians. Staff told us experienced consultants provided oversight, supervision and opportunities for professional development. Clinical fellows told us they learned both clinical and communication skills through regular exposure to specialist fetal medicine practice and the direct support from senior clinicians.

Staff spoke positively about the support they received and described a culture where they could seek advice when needed. Clinical fellows reported receiving specialist fetal medicine training and valued the opportunity to learn from highly experienced consultants. They told us they learned how to communicate effectively with people receiving care, particularly when discussing complex findings or delivering unexpected results. Administrative staff told us they also felt supported in their learning and development.

The service had systems to identify, record and respond to incidents. Staff understood how to escalate concerns, were aware of emergency procedures and could access relevant protocols when required. The service kept an incident log, incidents were reviewed by the management team, and appropriate action was taken to ensure learning. In the last 12 months, the service recorded 10 incidents, with no recurring themes identified. This supported a culture where learning from events and maintaining patient safety was understood as shared responsibilities.

The service provided examples of changes made following incidents and patient feedback. For example, following an incident where a patient receiving non-invasive prenatal testing was inadvertently informed of the sex of their baby when they did not wish to receive this information, leaders reviewed the process and amended consent documentation. The consent form was updated to include a specific question about whether patients wished to know the sex of their baby, and this was subsequently checked before results were shared. This showed leaders reviewed the process and made changes to reduce the risk of recurrence.

The service had an up-to-date duty of candour policy in place. The duty of candour is a regulatory duty that requires providers to be open and transparent with patients when safety incidents occur, including notifying them and offering reasonable support. Administrative staff we spoke with had not received training in duty of candour so were unable to demonstrate that they understood the requirements related this. However there had been no incidents in the 12 months before our inspection that met the threshold for applying the formal duty of candour.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had systems and processes to support safe pathways, referrals and transitions between services. People could access the service through self-referral or referral from external clinicians; and staff worked flexibly to accommodate urgent appointments, including offering same-day assessments where possible. This helped ensure timely access to care.

Staff demonstrated a clear understanding of referral pathways and onward management arrangements. Following assessments, reports were shared digitally with obstetricians and referring clinicians, with paper copies also available if required. Staff routinely asked patients about their booking hospital and ensured findings were communicated to appropriate healthcare providers to support continuity of care.

The service had a referral and escalation pathway for abnormal ultrasound findings. Where concerns were identified, staff described established arrangements for onward referral and follow-up, if required patients could be seen within 24 hours at the fetal medicine unit at an NHS Trust. Patients requiring additional monitoring or support could be directed to early pregnancy units or back to their referring hospital. Staff explained that people receiving unexpected or serious news were not returned to the waiting area and were given time, privacy and support while plans for ongoing care were discussed.

The service maintained ongoing contact with patients after appointments when required. Staff told us patients could contact the centre following their scan and would receive advice and support, particularly when abnormalities had been identified or further information was needed. This supported safe transitions between services and reduced the risk of people feeling unsupported following consultation.

The service had an appropriate acceptance criteria policy. Where an invasive procedure was anticipated, the service required confirmation of the patient’s blood group before the appointment. This helped ensure staff could make the necessary preparations in advance and reduce the risk of delays or complications if additional clinical intervention was required.

The service worked with people and partners to help keep people safe from abuse, avoidable harm and neglect, and shared safeguarding concerns quickly and appropriately.

The provider had systems and processes to safeguard people from abuse and avoidable harm. We found that there was a safeguarding policy in place which reflected national guidance. The practice manager was the safeguarding lead and had oversight of safeguarding arrangements across the service. Staff demonstrated an understanding of safeguarding responsibilities and knew who to contact if they had concerns about a person's safety or welfare. At the time of our inspection, leaders reported that there had not been any recent safeguarding incidents or referrals.

Training arrangements ensured staff were equipped to recognise and respond to potential safeguarding concerns. Staff received safeguarding training appropriate to their roles. Data we reviewed showed the safeguarding lead had completed level 3 safeguarding training for both adults and children, while staff completed level 2 safeguarding training. The data demonstrated 100% compliance with safeguarding training.

During our assessment, we observed staff treated people with dignity and respect. Staff provided privacy and allowed time for people to ask questions when sensitive findings were discussed. Staff told us clinicians remained available to provide further explanation and support during consultations where this was needed.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff involved people in decisions about their care and provided information that supported informed choices. A thorough pregnancy and obstetric history were obtained before undertaking scans and diagnostic testing. This included discussing previous pregnancies, relevant medical conditions, medications and the circumstances surrounding the current pregnancy. Taking a thorough history enabled clinicians to identify individual risk factors, tailor investigations appropriately and ensure people received advice and care that reflected their specific needs. We observed consultations where clinicians explained scans in detail, discussed findings throughout the examination and checked patients' understanding. Staff encouraged people to ask questions and ensured information was communicated in a way they could understand.

During consultations, staff explained screening options, test procedures and possible outcomes. Patients were provided with scan images, reports and information regarding when and how results would be available. Staff discussed risks and benefits to help people participate in decisions affecting their care.

People receiving care gave positive feedback about the way information was shared. One patient described communication as excellent and said the service had been recommended by their antenatal team. Another patient told us staff were kind, friendly and thorough, explaining each stage of the scan and checking throughout that they were comfortable.

The service also demonstrated sensitivity when discussing difficult findings. Staff told us people receiving unexpected news were supported in private consultation rooms where clinicians remained available to answer questions. This allowed people to understand risks and make informed decisions about next steps in their care.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service provided an environment that was clean, well maintained and suitable for delivering safe care. We observed that the reception and waiting areas appeared comfortable and visibly clean. The environment was maintained to a high standard and facilities promoted a welcoming atmosphere for people attending appointments.

There was appropriate equipment available to support clinical activity. Staff used specialist ultrasound equipment and described processes for maintaining equipment. There were regular servicing and maintenance arrangements with manufacturers to support safe clinical practice and reduce risks associated with faulty equipment. Clinical rooms were suitably equipped for procedures, and staff had access to emergency equipment and emergency response protocols if required. The service managed clinical equipment and consumables appropriately. Sharps bins were available in clinical areas. All areas within the service were regularly audited to monitor health and safety standards.

Staff and patients had access to facilities that supported comfort, dignity and wellbeing. Waiting areas contained information resources, a coffee machine and hand sanitising facilities. The environment promoted privacy and helped create a calm setting for people attending appointments.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had staffing arrangements in place to support safe service delivery, including suitably qualified and experienced clinical and administrative staff. The multidisciplinary team included consultants, fetal medicine clinical fellows, reception staff and phlebotomy support. Staff told us consultant cover was available at least 5 days per week and specialist expertise could be accessed when required.

Staff had access to training relevant to their roles, such as training in chaperoning and records management for the administrative and management team, and blood transfusion and antenatal screening training for clinical fellows and consultants. Reception staff had completed training such as fire marshal training and understood arrangements for obtaining assistance during emergencies. Mandatory training records showed 100% compliance for management and administrative staff.

Scans were performed by clinical fellows and consultants. The fellows were internationally recruited doctors who received training both at a London NHS trust and within the service. As NHS employees, clinical fellows completed mandatory training through the NHS; the service confirmed compliance with the NHS trust, and the records we reviewed showed 100% completion. Consultant mandatory training and professional development were monitored through annual appraisals, with records also demonstrating 100% compliance.

Clinical fellows described receiving regular supervision and support from experienced consultants. Staff spoke positively about the knowledge and expertise available within the service and told us they were able to discuss complex cases with senior clinicians. This provided clinical staff with access to specialist advice when managing complex cases.

Management described flexible staffing arrangements to ensure continuity in care. Staff described cover arrangements when colleagues were absent and explained how the team worked together to ensure appointments were arranged and completed safely. For example, the service could draw on additional clinical fellows to cover clinical absences, and managers were able to provide administrative cover where required.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had arrangements to reduce the risk of infection and maintain a clean environment and equipment. Infection prevention and control responsibilities formed part of the service's governance and operational arrangements, with external cleaning contracts supporting environmental cleanliness.

Staff had access to equipment and facilities needed to maintain safe standards of hygiene. Regular infection control and hand hygiene audits showed good compliance of between 98% and 100% in the audits completed in the last 12 months. This helped provide assurance that staff followed practices that reduced the risk of infection for people using the service.

Systems and processes were in place to support a clean and safe environment for people using the service and staff delivering care. The provider also had contracts in place for the management of clinical waste and sharps disposal. These arrangements helped ensure waste was managed safely and in accordance with expected standards.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The service did not routinely prescribe or administer any medicines. The service had emergency medicines available to support people receiving care in the event of a medical emergency. We saw that the service kept a list of emergency medications and checks were completed of the stocked medicines monthly.

Policies were in place to guide staff in the event of an emergency and arrangements existed to contact emergency services where required. Leaders reported that no medical emergencies had occurred within the previous 5 years.

During the inspection, we identified that an adrenaline auto-injector was being stored in a refrigerator when it should have been stored at room temperature in accordance with the manufacturer's recommendations. Incorrect storage could affect the medicine's effectiveness if required during an emergency. Following feedback provided during the inspection, leaders responded promptly and took immediate action to address the concern. The service purchased a replacement adrenaline auto-injector, moved the medicine to appropriate storage conditions and provided evidence that it was being stored securely in a lockable cupboard. Leaders also reviewed and updated their medicines management and storage arrangements. The provider introduced a revised medicines management and storage policy, clarified responsibility for carrying out regular medicines checks and communicated the new process to staff.