Harrogate District Hospital

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

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.

At the 2016 assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were good, and people’s feedback confirmed this.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. 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. However, we observed some shortfalls in the systems for example, record keeping, records and quality audits and the completion of personalised risk assessments.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, well being and communication needs with them.

We scored the service as 2. The evidence showed shortfalls in record keeping and the completion of risk assessments. 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, well being, and communication needs with them.

We reviewed 17 women’s records during the assessment and found some shortfalls in the completion of these records. We noted that staff had completed women’s health assessments on registration with the service. Risk assessments included carbon monoxide (CO) monitoring and venous thromboembolism (VTE) assessments. The review of 10 women’s records confirmed one CO assessment was not captured at consultation.

We reviewed 17 records for evidence of risk review whilst women were in the maternity assessment centre; 13 records did not identify risk ratings, and 7 women’s records did not have a triage flow identified. Records identified gaps, for example, no record of the attending midwife, no evidence of categorization, prioritization or risk level, no evidence of escalation or review and no documentation to explain delays when they happened. Since the assessment the trust has confirmed that this was due to being unable to access the relevant module on Badgernet. It was not due to a risk review not occurring. The trust said this was escalated and will be resolved now that access is allowed.

Ten records did not document fresh eyes if a cardiotocography reading was performed and the swab counts post vaginal birth.

The 2022 CQC assessment identified records audits were not completed. We requested details of women’s records audits for the last 6 months. The trust did not provide any records audits or confirm any had taken place.

Staff could access numerous evidenced based guidelines which assisted them with the provision of care for women, for example, water birth and the use of the birthing pool, nutrition policy, epidural analgesia care plan, labour analgesia, obstetric analgesia guideline, post anaesthetic care in the operating department.

Staff said since the introduction of the electronic prescribing and medicines administrations (EPMA) system the timeliness of pain relief had improved. The EPMA system had prompts in place for midwives to follow when reviewing a woman’s pain.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard, although work on updating policies, procedures and guidelines was ongoing. 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 participated in clinical audit, bench marking and quality improvement initiatives. The service has reviewed the progress made against the national maternity and perinatal audit (NMPA) AND ‘Saving Babies Lives’. Saving babies lives was designed to tackle still birth and neonatal death.

The June 2025 strengthening maternity and neonatal safety report updated the progress made to date and the outcome of the June 2025 Yorkshire and Harrogate Local Maternity Network System’s (LMNS) review of saving babies lives’ quarter 4 compliance (January to March 2025) against version 3 of the Saving Babies Lives Care Bundle. The trust confirmed the review found high levels of compliance and evidence that improvements continued to be made. Overall compliance against version 3 decreased from 86% in quarter 3 (Q3) to 81% In Q4. The next compliance meeting with the LMNS was planned for July 2025.

The team included or could access a full range of specialists required to meet women’s needs. The team comprised of doctors, midwives and nurses, safeguarding and mental health professionals, social workers, pharmacists, speech and dietitians.

At this and the last two previous assessments we observed policies; NICE guidance and leaflets were out of date. We reviewed 5 guidelines at this inspection; two guidelines sepsis and venous thromboembolism guidelines were past their review dates; however, we were told both were under ongoing reviews. Post assessment the document list provided by the trust confirmed the maternal sepsis guideline had been reviewed.

The June 2025 strengthening maternity and neonatal safety report confirmed 28 or 18.1% of local guidelines of a total of 155 guidelines were overdue for review. Leaders told us the remaining guidelines were currently being reviewed and would be presented at the maternity quality assurance meetings for ratification. Since the assessment an updated list of guidelines, clinical procedures and standard operating procedures were received. The list comprised of 135 documents/guidelines all were within date.

The trust confirmed clinical teams had a 6-month period to review NICE guidance. During this period, the trust recorded the status as “Working Towards”. Two guidelines were in development (Intrapartum Care and Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years). One guideline had been updated and was now compliant (Caesarean birth) and one guideline was non-compliant (Abortion care).

The baseline assessment tool for maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years (NG247) was used to identify NICE compliance within practice, for example, gestational diabetes (1.2:18, 1.2:19). The service confirmed recommendations were met.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Women confirmed their nutritional needs were met. We saw a daily patient menu which identified healthier and vegetarian choices. Women said they completed the menu daily which included portion size options. Bread was available on the ward areas and women could access hot and cold drinks. A separate toaster was available for use with Gluten free bread.

Families were encouraged to have skin to skin contact with their baby as this practice offered benefits for baby and parent such as regulation of the baby’s temperature, breathing and heart rate, promotion of breast feeding and strengthened the bond between parent and child.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

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.

The maternity service worked closely with local stakeholders, system partners and the local maternity and neonatal systems. Attendance at monthly to quarterly external meetings took place, for example, the bi-monthly perinatal safety learning forum and delivery board. Daily sitrep meetings included discussions of delayed inductions of labour so that escalation and support was identified.

Two local maternity and neonatal system network meetings took place daily. West Yorkshire and Harrogate, and Humber and North Yorkshire LMNS calls took place Monday to Friday. Discussions included the trusts operational pressures escalation levels (OPEL) status, performance, ongoing inductions, and delayed inductions of labour. Leaders described good relationships between the neonatal and maternity teams. At weekends the midwife coordinator rang hospitals to ascertain which hospitals could accept patients.

We attended the Pannal ward morning handover meeting; staff had time to ask questions; safety information and learning was also shared.

Consultant led multi-disciplinary team (MDT) ward rounds took place twice daily. We attended one MDT medical handover. This handover did not follow the situation, background, assessment and recommendation (SBAR) approach and was a paper-based exercise. Discussions included staffing, bed status, admissions, theatre cases and the prioritization of women for induction of labour.

SBAR handovers took place when maternity assessment centre staff handed over women to the Delivery suite prior to closure of this service each evening.

Consultant staff attended at weekends or out-of-hours if there was a clinical need.

There was good senior obstetric anaesthetist support and cover 24/7. Resident anaesthetists joined morning MDT safety huddle meetings and twice daily ward rounds.

Good relationships existed between the service and intensivists. The 24-hour critical care outreach team and designated anaesthetist worked closely. All Delivery suite coordinators were Maternal Enhanced and Critical Care (MEaCC) trained.

The service worked closely with an ambulance transfer service.

Imaging provision for the early pregnancy assessment unit was 6 days a week. Acute cover was provided by a sonographer / radiologist at weekends.

The tissue viability service was available Monday – Friday 9-5pm (excluding national bank holidays). All referrals were triaged within 1 working day. The tissue viability service provided face to face, virtual and telephone appointments.

Pharmacy service provision was 7 days a week with a reduced service at weekends.

Staff said the mental health team were easy to contact and responded quickly when called. Women’s mental health status was checked at every appointment by the Consultant Obstetric Lead and Perinatal Mental Health midwife.

We asked how the trust assured itself of the completions of MDT assessments for mothers with complex needs and a management plan or treatment put in place within 24 hours and how this was monitored. The trust provided 3 guidelines which identified actions and how risks were identified. Two of these documents identified monitoring, one was to submit an incident form, the other identified deviations from the guideline would be reviewed at the maternity risk management group and safety incident review meeting.

We support people to manage their health and well being so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and well being to maximize their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice and screening for cancer. Guidance displayed was an aid to support people live healthier lives, for example baby feeding and nutrition guidance, safe sleep guidance. In the antenatal clinic the television was used to display health promotion data.

The trust equality action plan focused on the national priorities to improve the populations health. The action plan identified 5 objectives and actions whose status was either complete or on track. The objectives focused on an understanding of the population’s health outcomes, risks, protected characteristics, deprivation, access and culture.

The diabetes specialist midwife was part of the multi-disciplinary diabetes team, led by a consultant obstetrician. The diabetes specialist midwife held a caseload of high-risk women for whom they coordinated their care and supported communication between the community midwives and obstetrician. All eligible women were offered hybrid closed loop pumps to control their diabetes. Community midwives referred women who were newly diagnosed diabetics and these women received additional visits from the specialist midwife during their pregnancy pathway.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard. 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.

In July 2025 the service had undergone re-accreditation for Baby Friendly Status. The service had retained gold accreditation for Baby Friendly Status which was awarded by the United Nations International Children's Emergency Fund (UNICEF). The UNICEF UK Baby Friendly Initiative supports breastfeeding and parent infant relationships by working with public services to improve standards of care. The Harrogate Maternity Services Overview (January 2024 – December 2024) confirmed the breastfeeding initiation rate as 82.9%.

The babies born before arrival (BAA) audits from July 2024 to June 2025 identified the numbers of babies born before arrival to the hospital or before a medical professional arrived. The data confirmed small numbers of BBA; in February 2025 audit data confirmed 4 BBA otherwise lower numbers of BBA’s were identified for 6 months in this period.

Perineal care is provided as per the obstetric anal sphincter injury (OASI) care bundle. Monitoring of perineal care was ongoing through the monthly reporting, review of incidents via Safety Incident Review Meeting (SIRM) and Maternity Risk Management Group (MRMG). Staff said this was to understand whether this would provide better detection and / or what the drivers were. The report from 2016 to January 2025 showed the national average for perineal tears was just above 2% for this period. The service provided monthly audit data on the 13-watch metrics (August 2024 – June 2025). Monitoring of third- and fourth-degree perineal tears for this period whose threshold was >4 (12-month average) confirmed all but two months were at or below this target. The outliers were in December 2024 and January 2025 where thresholds were recorded as 5.97% (8) and 3.6% (5) respectively. The remaining 9-months rates ranged from 1.34% to 2.67%.

Postpartum haemorrhage rates had been monitored since 2017; above 1.5 litres / month equated to 4.5%. The trust target for PPH was less than two a month and the national average was 3.4% for April 2018-March 2019. In 2024 PPH rates were 4.2%; in 2025 PPH rates had decreased to 3.8%. Staff said an audit of caesarean sections and PPH had taken place in June 2025, however, recognised the audit focused more on the caesarean section aspect. The audit recommendation was to provide a prophylactic tranexamic acid. Staff said the frequency of the audit was governed by the previous audit’s outcome; the service monthly watch metrics data identified a threshold of >4.37% readings had increased again in May and June 2025 and leaders could not confirm why PPH rates had started to increase again.

Leaders said spot checks had taken place to monitor compliance in areas such as venous thromboembolism (VTE).

We requested details of recent nutrition and hydration audits, details of improvements and action plans where compliance was below expected standards. The evidence received did not relate to both nutrition and hydration, but to fluid monitoring only. The incidents referred to related to those from December 2022 and December 2024. Learning included what went well and what did not and a standard operating procedure for fluid management in labour and prevention and treatment of dilutional hyponatraemia was in place.

We requested details of recent maternity unit pain management audits with details of improvements and associated action plans if compliance fell below expected standards. The information the trust provided related to anaesthetic timings from the 1 January to 30 June 2025. The audit identified the types of pain relief administered and at what frequencies. The trust did not confirm whether any other planned pain management audits had taken place. From the evidence provided we were unable to determine whether the service had undertaken pain management audits which included feedback from women using the service, the frequency or outcome of these audits.

Documentation confirmed the service had monitored perinatal mortality and had reviewed this in line with the saving babies’ life care bundle which identified 6 elements. The audit sample included 85 women whose care was considered alongside the guidance in place at the time of pregnancy and perinatal loss.

The Perinatal mortality report (PMRT) (2017 – 2022) (ID Ref 2024/25) identified one recommendation which related to embedding learning and improvement. The action plan did not identify a target date, person responsible or progress on actions. Following the assessment the trust provided additional evidence for progress made against the Perinatal mortality report (PMRT) (2017 – 2022) (ID Ref 2024/25) which identified one recommendation to embed learning and improvement. The action plan identified the action plan owner, monitoring group, 28 actions and the last review date of 6 June 2023. Six elements were identified within the saving babies lives care bundle. The action plan identified actions in relation to 3 areas: fetal growth, raising awareness on reduced fetal movement and effective fetal monitoring. We noted additional actions in other areas were also identified as part of this action plan. All 28 actions were identified as complete. However, we observed evidence of progress / completion was identified against 18 of the 28 actions. New target dates if required were not identified against 26 actions. We observed that some actions, for example fetal growth, fundal height measurements and patient feedback were captured in the PMRT summary report action plan (1/1/2024 – 23/7/2025).

The latest PMRT summary report (1/1/2024 – 23/7/2025) identified actions which included shared learning; however, no accountable persons, timescales or progress was identified against the planned actions therefore we were unable to ascertain what progress had been made for each issue. Following the assessment the trust provided additional evidence for the latest PMRT summary report (1/1/2024 – 23/7/2025). The action plan (dated 9 May 2025) confirmed the action plan owner and monitoring group. From the 10 issues identified on the original report, the action plan included actions for 6 issues. The latest action plan dated 9 May 2025 confirmed 11 actions. Evidence of progress was identified against 3 actions, 4 actions were identified as complete, however, evidence of completion was not shared.

The trust should ensure that the progress made against action plans is completed as part of their monitoring process so that they can triangulate previous evidence should it be required identify past and future trends.

Discussions had taken place at trust board with regards to the outcome of the mothers and babies reducing risk through audits and confidential enquiries (MBRRACE-UK) peri-mortality report (2023). The slides presented to the trust board were undated.

We reviewed the information associated with a neonatal death in 2023 during the inspection and the additional information provided following inspection. The actions within the action plan were completed and learning associated with this sad case had taken place. External feedback was received from an Maternity and Newborn Safety Investigations (MNSI) and shared with staff through the risk management newsletter. The action plan confirmed the service had implemented the actions requested by the Maternity and Newborn Safety Investigations (MNSI) branch; these actions meant staff had completed additional escalation and cardiotocography training.

Three neonatal deaths took place in 2025, and the trust had followed the processes for reporting to the maternity and newborn safety investigations (MNSI) and performed PMRT as required. The trust provided the incident information pertaining to each and associated learning from each case. There was good evidence of case discussion at multi-disciplinary mortality/morbidity meetings with presentations from Obstetrics and Neonatal teams, however, we saw no clear process for shared learning. The learning identified areas which required further development, for example, for one case there were issues importing pathology information between two trusts the woman had received care with. The trust recognised this as an issue and tasked the digital midwives to improve and embed these processes; the trust has not confirmed whether this remains an issue.

We requested 2 recent mortality and morbidity meeting minutes, but these were not submitted as evidence. The trust submitted the maternity obstetric meeting minutes for 30 April and 25 June 2025 instead which included discussions on baby incidents, the appropriateness of baby admission to the neonatal unit and baby deaths.

Staff used technology to support patients which allowed prompt access to blood test results and scans. Separate computer systems were in use to capture clinical information. Badgernet was used to record clinical information, and a separate patient administration system (PAS) was used by clerical staff for managing patient appointments. Women’s ultrasound scans were logged on the radiology information system CRIS. The technology systems did not consistently talk to each other which meant staff had to check different technology systems to access all the women’s information.

The screening midwife compiled quarterly key performance indicator reports against screening indicators. Staff said booking by 10 weeks had decreased to 73.1% (quarter 3 report) which resulted from a change in process.

Five antenatal and newborn key performance indicators for 2024 – 2025 mostly confirmed compliance was achieved across the year. Most of the scoring was within 92.1% - 100%.

For the Newborn Infant Physical Examination (NIPE) programme a dip in compliance was noted in the last 2 quarters of the year, 76.2% and 78.3% respectively.

Shortfalls were identified within the sickle cell and thalassaemia KPIs in relation to the timeliness of antenatal screening; the national average was 61.8%. The trust sickle cell and thalassaemia KPIs in relation to the timeliness of antenatal screening was 55.3% - 75.4% across the year.

Completion of laboratory request forms for combined / quad scans were also noted to score between 2.4% - 37.5%.

The Antenatal and Newborn Screening Steering Group minutes (27 February 2025) reported quarterly progress against both the sickle cell and thalassaemia KPIs in relation to the timeliness of antenatal screening and the completion of laboratory request forms for combined / quad scans, however, we observed that for both actions were not identified as to how to improve the KPIs.

The service monitored smoking at time of booking and at birth. The Harrogate Maternity Services Overview (January 2024 – December 2024) confirmed a slight decrease in smoking at birth as the rates fell to 3.6% from 3.8%.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Consent guidance and procedures, teenage pregnancy and young person’s guidelines and child safeguarding policies were used by the maternity service to support and advise on the consent process. Reference to Gillick competencies was identified within the teenage pregnancy and young person’s guidelines as medical professionals would need to consider Gillick competency if a young person under the age of 16 wished to receive treatment without their parents or carers consent or knowledge.

Staff took all practical steps to enable patients to make their own decisions. Women said they were involved in decision making and consent processes. We reviewed 10 women’s notes and confirmed consent had been obtained prior to those procedures which required consent to be obtained. Coordinators were trained in postmortem consent processes.

The Maternity Risk Management Newsletter – June 2025 informed staff of the incidents which related to a lack of informed consent between October 2024 – January 2025. Good practice points, immediate and further actions were identified from this audit. This audit identified a failure to listen to some women during some examinations as was identified by the women’s quotes provided on the newsletter. Although, shared the service did not confirm when this area would be re-audited to ascertain whether practice had improved. Following the inspection the trust confirmed actions and monitoring against the consent audit were ongoing.

One consent audit was shared by the trust. The consent audit took place in June 2025 and included a review of women’s records to confirm consent was obtained at obstetric and anaesthetic interventions. 10 patients per experience were sampled to look for evidence of consent. The audit outcome confirmed compliance from 70% – 100% for the procedures audited. There was opportunity for improving consent documentation for induction of labour, epidural administration and spinal anaesthetics. No formal consent form was used in ventouse birth which relied on free-text documentation or the instrumental birth form being completed. The recommendations was a future audit should consider the quality of information shared, as suggested by the Royal College of Obstetricians and Gynaecologists (RCOG) 2024 to ensure consent was based on an informed decision.

The trust confirmed no women were subject to deprivation of liberty safeguards in the last 12 months.