Midland Metropolitan University Hospital

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 rated safe as requires improvement. The service could not always manage patient risks safely. This was mostly due to insufficient staffing and delays for patients in receiving care and treatment. Patients were not always cared for in the appropriate areas and the flow was poor. The service was not always proactive in sharing learning from safety events. At our last assessment, we rated this key question inadequate. At this assessment, the rating improved to requires improvement. This meant people were not always safe and were at risk of avoidable harm.

The service was previously in breach of legal regulations in relation to premises and equipment. Improvements were found at this assessment and the service was no longer in breach of this regulation.

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 evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Feedback was not always shared in a format which was appropriate for the staff. Incidents were discussed in clinical governance meetings and weekly incident meetings. Although learning was shared through various channels staff did not feel fully informed about feedback from incidents. These channels relied mostly on staff reading their emails and staff informed us they did not always have time to do this. The managers had recognised this and the week prior to our inspection had sent out a short video which updated the staff on risk, incidents and governance. The community teams did a safety brief daily at 9am and did the same update for a week to ensure all staff received the same update messages.

Not all incidents were acted upon promptly. In July 2025 there were 141 overdue incidents, 58 of them were for labour ward. Managers met weekly to review incidents and to identify immediate actions.

Incidents were not always reported at the time of them occurring. Staff reported knowing how to raise incidents and told us they felt supported to do so but did not always report them promptly. For example, during the inspection there were 2 women who were undergoing a category 3 caesarean section delayed over 12 hours due to shortage of midwives. This was against their standard operating procedure which stated they should be performed within 6 to 8 hours. There were no incidents reported for these delays at the time of the inspection.

Staff reflected and acted upon data and incidents to improve care. For example, they had noted an increase in third- and fourth-degree tears for women during birth. There was a workstream which was looking into improvements required such as training sessions, implementation of a pelvic floor app and education. At the time of the inspection most staff had received up-to-date training on protecting the pelvic floor in labour.

Managers provided debriefs and support following serious incidents, which were reported in line with trust policy. There were professional midwifery advocates who supported staff after serious incidents.

The trust reported 1 never event in July 2025. This was investigated using the Patient Safety Incident Response Framework and identified several areas for immediate action which had been completed.

Safety champions completed monthly walkarounds of the departments to talk to staff and escalate any concerns. They were members of the executive board. They had open conversations with staff and acted upon any concerns raised.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care.

Communication of information about women between health professionals was inconsistent. The SBAR (Situation, Background, Assessment, Recommendation) communication tool was not used during verbal handovers in some of the areas of maternity. We observed 4 handovers and found information was not always conveyed concisely or in line with SBAR. Lack of a good SBAR handover was also found in an after-action review of an incident. A recommendation from the incident was to improve SBAR handover between midwifery and neonatal team. Notes reviews were conducted monthly on 10 sets of notes from each area. Results showed SBAR completion was poor for both the midwifery led unit and postnatal ward. Out of 60 notes combined for both wards over 3 months we found 20% of the SBAR handovers were completed but they lacked detail. There was no associated action plan with the audit to drive improvements.

Women were mostly reviewed by midwives in triage with the recommended timeframe based on their level of risk. Midwives were expected to provide triage coverage 24 hours a day, 7 days a week. The trust had set a target compliance rate of 70% of women to be seen within 15 minutes of their arrival into triage. Data from between 1 and 15 September 2025 showed they were over 70% compliance for 11 out of the 15 days. Compliance with this standard ranged from 21% to 95.2%. Low compliance was mainly due to staffing levels.

Women were not always reviewed promptly by the doctors upon arrival to triage in accordance with the Birmingham Symptom Specific Observation Triage System (BSOTS). The service recognised the impact this had on women’s care and had employed 2 doctors to work from 8:30am until 8:30pm 7 days a week on a trial basis for 2 months from September 2025. Initial data showed improvements in the time taken to be seen.

There was a risk that women were not triaged by the telephone triage team in line with their policy. The midwives recorded calls on paper forms rather than their online recording system. There was a potential to miss if a woman had called 3 times in 24 hours, whereas, in line with their policy, this would automatically trigger a warning on the trusts online record system. We fed this back to the trust who have since commenced conversations with the maternity team to digitalise the triage phone documentation.

Women scheduled for induction of labour (IOL) did not always have their IOL completed in a timely way. In July 2025, there were a total of 177 IOL and 9.6% of women had a delay of more than 6 hours. No harm was reported relating to these delays.

Women and babies transferred from the maternity led unit did not always have an up-to-date management plan. Care plan reviews between June and August 2025 showed 18 out of 30 notes did not contain a management plan for the mother or baby. There was no action plan with the audits to improve compliance, and this theme continued each month within the audits.

Women were put at risk of harm as they did not all have a named midwife in the community. The community midwives had high caseloads of up to 130 to 140 women. This was due to high vacancy rates in the community.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff demonstrated a clear understanding of how to protect women from abuse and worked effectively with external agencies to do so.

Staff were knowledgeable about how to make safeguarding referrals and knew who to contact when concerns arose. There was a dedicated safeguarding team for maternity, and most staff told us they were supportive. They visited the community hub weekly to ensure they were accessible to the community midwives. The safeguarding lead gave examples of how staff had managed complex cases.

Staff reported vulnerable women had birth plans developed with input from the safeguarding team, and safe discharge plans were arranged during antenatal appointments. The safeguarding team supported the wards to manage complex safeguarding cases. The community midwives attended supervision for safeguarding every 3 months and felt they had great support from the team.

There was a vulnerable women’s team which included staff trained in mental health, domestic violence, female genital mutilation, young patients and substance abuse. They worked closely with the safeguarding team to support vulnerable women.

There was a Sandwell Unborn Baby Network which worked with partner agencies to support the oversight of safeguarding concerns and ensure early detection.

A safeguarding policy and pathway were accessible to staff, alongside a baby abduction policy. Practice drills for baby abduction were conducted, with a recent drill having taken place in June 2025. Staff were familiar with the policy, and ward areas were secure with monitored doors. Wristbands were given to birthing partners and partners staying overnight allowing easy identification for staff.

Not all staff were up to date with their safeguarding training. Data showed staff compliance to safeguarding adults’ level 3 training was below the trust target at 79.4%. However, 90.2% of staff were trained in level 3 in safeguarding children.

At our previous inspection we issued a Warning Notice as the staff were not recording routine enquiries around domestic abuse regularly. Since our previous inspection, the service had made the routine enquiry regarding domestic abuse a mandatory field to be completed at each antenatal appointment. We found in all the notes we looked at every woman was asked the routine enquiry question a minimum of 10 times.

Staff could provide examples of how they protected women from harassment and discrimination, including those with protected characteristics under the Equality Act. They demonstrated an understanding of equality and diversity and ensured care and treatment aligned with the Act.

Staff were also aware of the Mental Capacity Act 2005 and its relevance to the women in their care. Safeguarding and mental health needs were discussed during handovers.

The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Women did not always receive treatment within agreed timeframes and national standards, but this was improving. The triage process followed evidence-based practice and patients were graded in accordance with the seriousness of their presenting complaint. There was a colour-coded scale to give a visual appearance of those patients needing more urgent review. There were 2 triage midwives, but the service still found there were delays despite introducing a third midwife dedicated to telephone triage. The service wanted to bring in another midwife to assist in triage during busier times of the day and had submitted funding for this to be approved; this would bring down waiting times for women.

Women and babies were put at risk of potential harm due to continued delays in medical reviews. Women attending triage were not always seen in line with national recommendations and local compliance timescales. The service had recently introduced a dedicated senior doctor in triage 12 hours a day to reduce waiting times for women. This improved direct patient care, but more work was needed. Even with the doctors there 12 hours a day, only 47% of women were seen within the recommended time frame between 1 and 15 September 2025; the trust had a target of 85%.

Staff used nationally recognised tools to identify risks of deterioration in women and babies. Staff used national tools such as the Modified Early Obstetric Warning Score (MEOWS) for each woman and Newborn Early Warning Scores (NEWS) for each baby. These were consistently recorded in records we reviewed. We reviewed notes audits, and we saw MEOWS completion and escalation was 100% each month between June and August 2025.

The staff did not always manage sepsis in line with policy. The service completed a sepsis audit looking at 30 women with sepsis between 15 September 2024 and 16 October 2024. Results showed only 22 women followed the sepsis 6 bundle pathway, 26% did not have blood cultures done, and 10% did not have a lactate or glucose blood test. We did not see an action plan with the audit to improve compliance. It was recommended for re-audit within 6 months; this was not completed. However, we found sepsis documentation was completed in notes we reviewed. Staff were able to describe how they cared for women who had sepsis. There was a pathway for women who had sepsis. Observations were recorded electronically, and they automatically triggered a warning if sepsis was indicated. All midwives and doctors attended annual sepsis training.

There were 4 enhanced maternal care beds on the labour ward. Women in these beds were always cared for by midwives who had completed their enhanced maternal care training. We were told that although there were always midwives on shift who had completed this training it was a challenge, due to the junior workforce, to ensure there were enough senior midwives on labour ward for all women to be safely cared for.

The trust had a fetal monitoring surveillance day. This was run annually, and midwives could not work on the labour ward until this had been completed; 95% of midwives had completed this training.

The service had centralised monitoring. This allowed doctors or senior midwives to review a woman’s cardiotocography trace immediately from any computer. This reduced the risks for women and their babies by waiting for the doctor to attend the ward.

Newborn risk assessments were completed using recognised tools and reviewed regularly. Transitional care was provided; however, it was on the antenatal ward which staff told us did not make sense; there were plans to move this to the postnatal ward.

There were no ligature risk assessments completed in any area, no ligature cutters and a lack of awareness from staff around it’s importance.

There was a designated midwife on each shift allocated to respond to and manage the triage telephone line. However, calls were documented on paper rather than on the online record system. This meant if a woman called 3 times in 24 hours, this would not be automatically flagged and there was a risk the woman would not be seen in line with guidance.

The service had recently brought in a new triage telephone system which recorded all calls and had a call-waiting function. This meant women were able to stay on the line if it was not answered and the staff could see how many women were waiting. Calls were recorded and managers listened to these to ensure consistency with triaging. An audit of the calls in August 2025 showed 88% of calls were answered promptly and 64.8% were answered within 2 minutes.

Risk assessments were not always consistently completed for women attending triage and in the antenatal period. Notes reviews undertaken on the antenatal ward showed that 20% of notes were either missing a risk assessment or the assessment lacked significant detail. However, all notes we reviewed showed risk assessments were well completed.

Staff mostly reduced the risks to women and their babies by consistently using the hourly ‘fresh eyes’ approach to carry out fetal monitoring safely and effectively. We reviewed 5 sets of notes of women having continuous cardiotocography and they all had completed hourly ‘fresh eye’ assessments. Managers audited fresh eye’s compliance monthly. Results for March to August 2025 ranged between 79% to 87%. There was no associated action plan with how to improve the compliance.

The service did not complete the World Health Organisation (WHO) surgical checklist paperwork at the time of verbally completing the checklist. We watched the WHO checklist being completed during a caesarean section and found whilst the staff verbally talked through elements of the checklist, it was not documented until after the procedure had finished. We also found not all elements of the checklist were discussed. We fed this back to the managers who immediately briefed the team and changed the way the checklist was completed to ensure it was completed in real time. They told us compliance would be monitored through monthly audits and spot checks.

Staff liaised with mental health colleagues as required. They were available 24 hours a day, 7 days a week. Staff explained when and how they could seek assistance to support women with mental health needs.

Staff handovers were completed but we found they did not always include all necessary key information to keep women and babies safe and at times were very long. During the assessment, we attended 4 handovers and found not all the key information was shared. For example, on the postnatal ward, a staff member handed over a baby had been transferred to another hospital and when questioned, they were not sure why. There were huddles at the beginning of the shift to ensure all staff were up to date with key information although these were brief and there was a missed opportunity to share learning and key information for staff.

Women who required induction of labour (IOL) were mostly brought in for induction in line with guidance. However, they often experienced delays once they were admitted to the hospital for their induction. The service captured delays to IOL above 6 hours. These delays were reviewed by the labour ward coordinator and consultant and prioritised based on risk. These delays were discussed at the midday huddle, and all delays were reviewed weekly, and harm reviews were completed. This was reported to governance committee monthly. In August 2025, 3.6% of IOL were delayed between 6 and 24 hours.

Women were not cared for in appropriate areas due lack of availability of beds. This impacted on the flow through the departments and caused delays for women who were waiting for IOL and caesarean sections. During our inspection, we saw 5 women experienced a delay in either an IOL or caesarean section. In August 2025, there were 13 delays in the transfer of women for induction of labour from the inpatient wards to the labour ward due to the acuity on labour ward. Where there were delays the consultant obstetrician reviewed the list of women and prioritised their care based on risk. They induced up to 8 women per day. The list was reviewed twice daily, and all women were brought in for a cardiotocograph, and assessment and had their plan of care reviewed if their IOL was delayed.

The managers completed operational pressure escalation levels (OPEL) status but there was limited action based on the score. This was a red, amber, and green (RAG) rating assessment of the pressures the departments were under. On 10 September at 8.30am the OPEL status was amber as they had 10 midwives out of the required 12 on labour ward due to sickness. Staff told us the OPEL status was mostly amber due to staffing pressures and high acuity of patients. It was not clear how the service used the OPEL scores as staff told us there was little action or change based on these. This was discussed twice a day at staffing meetings with managers present. Staff told us they were often short-staffed with no solutions from managers.

The service ran regular specialised clinics to support women, but they did not always have the staff to sustain the services. For example, they ran diabetic clinics but had found a large increase in women who had diabetes in pregnancy. As a result, there were an insufficient number of diabetic specialist midwives to support this high-risk group. Women requiring specialist diabetic care did not receive adequate blood glucose monitoring, and some missed essential scans, placing them at risk of harm. These issues were on the service’s risk register. The service had worked to mitigate this risk by putting extra clinics on at the weekend but said this was not sustainable as this was covered by the current diabetic midwives working bank shifts.

The community team had found they had an increased number of babies who had lost weight by day 5 post birth. They had therefore committed to weighing each baby at day 3 as well as day 5 to try and support women with feeding and reduce large weight losses in babies. A midwife support worker fed back they had seen a reduction in babies losing more than 8% of their birth weight since introducing the day 3 weights.

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

The design of the maternity environment followed national guidance. The premises was purpose-built and met the needs of the women and their families who used the service. The unit was fully secure, with monitored entry and exit points in each area. There was a specific lift from the car park for women who were in labour with direct access to the labour ward.

There was a midwifery-led unit “serenity” which had 6 large en-suite rooms all containing a birthing pool. This was not utilised daily due to the high acuity of women giving birth and needing to be on the labour ward. This unit was staffed if a woman requested to give birth here.

Women were at risk of giving birth in the wrong place due to inductions commencing on the wards rather than in the induction of labour suite. There was a purpose-built induction of labour suite adjacent to the labour ward which was not in use due to lack of staffing. Women who were admitted for induction of labour were put in various areas including the antenatal wards depending on their level of risk. This posed a risk to them as they were not close to the labour ward and there was a risk of them giving birth in the wrong place. In August 2025, 5 women gave birth outside of the labour ward or serenity: 1 in antenatal and 4in triage.

At our last inspection the triage area was not fit for purpose. The service had since moved to a new building which had 7 triage bays and 2 soundproofed triage rooms.

Women had access to call bells, and staff responded promptly.

The service had sufficient suitable equipment and observation monitoring tools, to support safe care for women and babies. Daily safety checks of specialist equipment were being carried out, addressing a previous assessment finding where such checks were not consistently performed. There was an online application where all checks were recorded which detailed expiry dates and ensured records were consistently checked. Managers were alerted when checks were not completed.

Facilities were adequate for partners staying overnight. Visiting hours for birthing partners had been extended to 24 hours a day.

A soundproofed bereavement suite was available on the labour ward with 2 rooms, designed in line with national guidance. It was sensitively decorated and allowed families private space to grieve.

Two well-equipped theatres were located adjacent to the labour ward, with a recovery area. The service undertook an elective list for 3 caesarean sections a day on Monday to Friday mornings. The service was increasing this to include afternoon lists later in the year.

There were 4 enhanced maternal care beds equipped for level 1 high dependency care in the labour ward.

Clinical waste was managed safely. Sharps bins were correctly labelled and not overfilled, and staff used appropriate bins for waste segregation.

The Maternity and Neonatal Voices Partnership (MNVP) were due to do the 15 steps for maternity which looks at the environment from the perspective of those who use them. This had been cancelled by the MNVP twice and was still outstanding at the time of the inspection.

The service did not have sufficient staffing to meet the needs of women due to high vacancy rates. Managers moved staff according to the number of women in clinical areas and patient acuity.

At our previous assessment, we issued a Warning Notice as the service did not have enough midwifery staff to provide safe care and treatment, and skill mix did not always follow national guidance. We found on this inspection there were still daily concerns with the staffing levels, and this caused delays to care daily for women. During the inspection, the number of midwives and maternity support workers did not meet planned staffing levels. Daily shortages of midwives were reported, with the labour ward typically staffed with 10 to 11 midwives each shift against an establishment of 12. For instance, on 9 September 2025, 10 midwives were present on the labour ward, compared to the planned 12 and there were no maternity support workers. Staff were moved between areas to maintain safety.

There was a lack of resolution for the daily staffing shortages. There was a daily manager who was assigned to coordinate staffing adjustments. There were regular meetings throughout the day regarding staffing levels and ward acuity. Staff told us there was not always much assistance from the managers and often no resolution to the shortages of staff. One patient told us staff shortages caused delays in answering call bells and made them feel uncomfortable asking for their bed to be changed as they knew staff were busy.

The labour ward had a junior workforce which posed a risk of potential harm and delays of care due to high levels of support needed. This also increased the pressure on senior staff to provide support.

Clinical practice support midwives were assigned to shifts to support less experienced staff. A recruitment drive had led to hiring 27 new Band 5 midwives, reducing the vacancy rate. However, senior midwives were anxious about the level of support required during already busy shifts and the expectation on them when new Band 5 midwives started. Managers had recognised this and had put extra support plans in place.

Delays in the induction of labour were attributed to midwife staffing issues. This was on the risk register. Mitigations included active recruitment, daily staffing safety huddles, active roster management, and escalation protocols. Despite these efforts, many inductions were still delayed.

Managers reviewed staffing levels and skill mix in accordance with national guidance and were in the process of completing a maternity staffing workforce review. The service had noted an increase in births per annum by 9.7% and therefore expected the review to identify a continued shortfall in midwifery staffing to meet patient acuity.

There were not enough midwives in the community to delivery continuity of care for women and their families. Not all women had a named community midwife and there was no enhanced continuity of care team. The Director of Midwifery discussed the need to reconfigure the community teams to ensure continuity of care. There were 14 midwifery vacancies in the community at the time of the inspection. There were initiatives to support the recruitment programme and decrease vacancy rates. Vacancies were mitigated by using bank midwives.

A review of the Maternity and Neonatal Safety Investigations found women in the community came to harm due to short staffing. Midwives were not always following national guidance due to time restraints. For example, a woman had not had urine testing at every antenatal appointment, as recommended in local and national guidance.

The staff sickness and turnover rates were within the expected range between June 2024 and May 2025. Data showed anxiety, stress or depression accounted for the highest number of sickness days in May 2025.

The labour ward had 2 Band 7 midwifery shift coordinators scheduled on each shift. However, due to staffing constraints, there were occasions when only 1 was present. These coordinators were supernumerary, overseeing staffing, acuity, and capacity.

The service utilised an acuity tool to ensure safe staffing levels across all shifts and departments. Acuity data was submitted 4 times within 24 hours, generating a red-amber-green rating called BIRTHRATE PLUS status. This information was shared across the Local Maternity and Neonatal System (LMNS) and discussed in staffing meetings. The LMNS is a partnership of people involved in maternity and neonatal services, working together to improve services. On 9 September 2025, the BIRTHRATE PLUS status was red as they were -4.4 midwives due to their elective caesarean sections. This caused a delay in treatment and poor patient flow. There was no evidence of any harm reviews being completed during the inspection for the delays of treatment. Staff told us they only got extra midwives in emergencies, otherwise it was rare they got help.

Vacancies were filled with bank staff and fill rates for shifts had improved and were above 90% in August 2025 for shifts.

There was evidence of good collaboration within the LMNS to improve services. Managers held a daily meeting to review acuity, staffing, and associated risks, in line with the OPEL process.

There were not enough midwives to staff the induction of labour suite safely. This meant women were induced on the antenatal and some women gave birth in these areas. Women who had more than 2 risks factors or had a pre-labour rupture of membranes were induced on the labour ward.

Women could not choose to give birth at home. There were not enough midwives to staff a home birth team. Managers told us it was a priority to open the induction of labour suite by 1 December 2025 and introduce a home birth team once their new starters had embedded in the service.

Staff did not always get the support they needed from the on-call managers. Staff told us managers did not always try and offer resolutions or assistance, and this left them feeling frustrated and lacked the support they needed out of hours. We raised this with the managers who said an urgent review of the on-call maternity manager role was being undertaken, and a standard operating procedure was to be produced.

There was evidence of harm and delays to care due to the lack of staff available for the second maternity theatre. This was on the service risk register. Maternity theatres were appropriately staffed, and there were contingency plans for the use of a second theatre, but these often resulted in relays. They relied on support from the main theatres when required. Incidents occurred where women waited to go to theatre. The Perinatal Patient Safety Report for May 2025 highlighted that 7 incidents were reported in April 2025 relating to theatre capacity and access to a second theatre team; there were no incidents reported in June or July 2025 relating to theatre capacity. One case a woman experienced a prolonged second stage of labour lasting over 5 hours due to a delay in transfer to theatre because of lack of availability of a second theatre team.

The service reported ‘red flag’ staffing incidents in accordance with National Institute for Health and Care Excellence guideline [NG4]. Midwifery red flags were a warning sign something may be wrong with midwifery staffing. There were 33 red flags were reported between March and August 2025, primarily due to delays in care and induction of labour.

The service was not aligned to the Royal college of Gynaecologists Maternity Triage Good Practice Paper 17 with their maternity staffing for triage. At our previous assessment we issued a Warning Notice due to the lack of appropriately skilled midwives in triage. At this assessment, whilst this had improved as there were 2 suitably qualified midwives allocated to triage this was still not in line with guidance. The Birth Rate Plus acuity tool completed in August showed that staffing levels met acuity 66% of the time. Additionally, 25% of the time it was rated amber and 9% was rated red. The matron discussed they wanted to be in line with guidance to improve outcomes for women. They wanted a third midwife during peak hours, which they found was 10am to 10pm, to ensure women were seen within 15 minutes as per guidance.

At our previous assessment, we issued a Warning Notice as we found there was not adequate medical cover in triage. Two weeks prior to our assessment, the service employed a locum senior doctor to be ringfenced to triage from 8.30am to 8.30pm 7 days a week for 2 months. They were going to review the data during this time and put in a business case to make this role permanent if they saw an increase in productivity and women being seen quicker. Out of hours cover relied on on-call doctors.

The service maintained a good skill mix of medical staff per shift despite the concerns in permanent obstetric cover. There were consultant vacancies at the time of the inspection. Locum doctors were used to fill staffing gaps and received full inductions. Consultants were on-site from 8am to 8pm and on-call outside these hours. Consultant ward rounds occurred at twice a day. Staff reported consultants were accessible and approachable.

An anaesthetist was available 24 hours a day, 7 days a week although there was no specific obstetric anaesthetist cover at the weekend.

There was a limited fetal medicine rota. This was run by 2 consultants which limited the availability of fetal medicine input. They relied on support of the neighbouring trust. There was no out of hours or weekend cover for women who needed fetal medicine input. This was on the risk register.

Not all staff had the appropriate training to provide safe care to women. Mandatory training percentage was 67% in August 2025 in intrapartum care; this had improved from 44% in March 2025. Managers told us it was hard to keep track of training due to the midwives rotating around the departments and were therefore only responsible for them for a short time. There was no centralised point for training to be chased and there was a lack of oversight on this. Training was integrated into staff rotas to encourage attendance, although staffing gaps sometimes made this challenging.

All staff were required to complete Practical Obstetric Multi-Professional Training. Most staff were over 90% complaint apart from the anaesthetic consultants, trainees and GP trainees. An additional training had been added to improve compliance. Effective fetal monitoring compliance was over 95% complaint for all midwives, consultants and trainee doctors.

A preceptorship program was available for Band 5 midwives, supported by clinical preceptorship midwives who worked alongside them to aid development and sign-off competencies.

There was a clinical education team who all worked clinically to support staff where required. They completed ‘skills and drills’ sessions ad hoc based on local learning but found these were often cancelled due to staff availability.

Women were put at risk of potential harm due to the lack of enhanced maternity care (EMC) trained midwives. There was always an enhanced maternal care trained midwife available on each shift but they at times had to look after 4 patients due to the junior workforce. There was no lead for EMC. The enhanced maternity care area was supported by the anaesthetists, labour ward co-ordinator and the trust outreach team when required. There was an EMC passport for Band 6 midwives to complete. This was signed off by the Band 7 midwives as there was no formal training.

The service ensured staff were competent in their roles. Managers conducted appraisals and provided support and development opportunities.

The service assessed and managed the risk of infection. Staff used equipment and control measures to protect women, themselves and others from infection. They kept equipment and premises visibly clean.

Infection risk was mostly managed in line with current national guidance. There were effective systems to ensure there was thorough cleaning and decontamination of rooms following patient discharge or transfer. Cleaning records were consistently updated and showed all areas were cleaned regularly. However, there was not a clear procedure used in every area to see what equipment was clean.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. Managers audited compliance with infection control practices including hand hygiene, care quality assurance and cleaning. Audit results we saw were positive and mostly above 98%. The cleaning audit for the antenatal ward for August was 93% and there was completed no action plan attached to the audit to improve compliance.

Audit results were not always shared with staff. They were not all aware of compliance in their areas. They told us communications were sent through emails, but they did not always have time to read these and therefore were not always up to date with audit results. Up-to-date audit data was not displayed in the ward areas.

We observed staff following infection prevention and control principles. We saw staff washed or gelled their hands in line with the 5 moments for hand hygiene and hand gel was available at the entrance to each ward area.

Each room and patient area had cloth curtains; these were not disposable. Housekeepers told us they were on a 6-month rotation, and they used their initiative to check curtains themselves. There was a risk soiled curtains were not changed between patients.

The Trust had safe systems for appropriate and safe handling of medicines to ensure people were given their medicines as prescribed. Medicines storage was locked and secure with access only to authorised staff.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff knew how to contact pharmacy for advice and processes were in place for the supply of medicines. Staff had access to medicines out of hours, and an on-call pharmacy service supported staff. Pre-packs of medicines ready for patient discharge. These were prepared and supplied by pharmacy to enable patients to be discharged with reduced waiting times.

There was a lack of communication regarding medicine shortages and when medicines had been replaced with safe alternatives. There was a good medicine supply service with clear pathways from pharmacy direct to wards. However, due to ongoing national medicine shortages some medicines were unavailable and needed to be replaced with safe agreed alternatives. Midwives shared examples where there had been a lack of guidance and communication on the administration of some medicines which then required midwives to contact pharmacy for guidance and assurance for safe administration.

We observed that medicines, including controlled drugs, were locked and secure and stored safely. The pharmacy team checked the safe and secure handling of medicines for safe medicine storage and provided reports to the wards with any actions to be taken for improvement. Trust wide controlled drug audits were undertaken by pharmacy. We saw compliance was above 91% in all areas and where actions were needed, these were taken. All the wards we visited were able to share their audit results and explain the action they had taken to make the required improvements.

Resuscitation medicines were stored in tamper evident emergency trolleys to ensure they were safe and ready in an emergency. Daily safety checks on emergency medicines and equipment were undertaken using an electronic checking system to ensure expiry dates of medicines and equipment were safe to use.

Processes were in place to ensure people received their medicines as prescribed.

The service had systems and processes to safely support people with their medicines. We reviewed 4 medicine administration records, and it showed people were receiving their medicines as prescribed.

Weights of patients were recorded, which helps support calculating weight-based medicines prescribing. However, there were two digital online systems used to record patients’ weights. BadgerNet, which is used to manage maternity and neonatal patient records and the trust EPMA system where medicines administration is recorded. We found that the recording of patient weights in the two systems did not always match but midwives said they would use Badgernet for checking patients’ actual weight, however it is important that any patient information is correct on all digital platforms to reduce the potential risk of an error.

Midwives were able to supply and administer certain medicines without a prescription according to specific legal permissions in medicines legislation. This enabled midwives to manage certain conditions commonly used in midwifery for example pain relief for induction.

There was a process for managing and reporting any errors or incidents involving medicines. Reported incidents and trends were reviewed and staff were able to talk through the process that would be followed if this occurred.

National Patient Safety Alerts were communicated to staff and appropriate action was taken for safety. For example, all staff spoken with were aware of the ‘National Patient Safety Alert – risk of oxytocin overdose during labour and childbirth’ that was issued by NHS England in September 2024 with action to be completed by 31 March 2025. Local guidelines had been developed and staff spoken with explained that they were following the guidance and not preparing oxytocin infusions at ward level in advance.