Milton Keynes 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

Our rating of safe stayed the same. We rated it as good. We assessed 8 quality statements: learning culture, safe systems, pathways, and transitions, involving people to manage risks, safe environments, safe and effective staffing, medicines optimisation.

The service controlled infection risk well. Staff assessed risks to women and birthing people, acted on them and kept good care records.

There was a learning from incidents when they were being reported and investigated however some staff did not always report incidents and near misses. Staff were trained and competent and had the right skills to meet people’s needs.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service learnt from incidents and made improvements based on feedback, however, the service did not always investigate these in a timely manner.

All women and birthing people we spoke with told us they felt supported to raise concerns and felt staff treated them with compassion and understanding. We reviewed 5 complaints and found the service took concerns seriously and used them to make improvements to the service.

People told us they were able to raise concerns and report incidents. The concerns and incident reports were taken seriously, investigated and learning shared with relevant colleagues. People or those who represented them were given an apology and an explanation when things went wrong.

Staff told us they had systems in place to raise concerns and log incidents. Some staff said they did not record a near miss and gave examples when very busy on the ward. There was risk that underreporting of near misses and incidents leading to lost opportunities to improve and reduce the risk of avoidable harm.When incidents had been logged, managers investigated them, and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave women and birthing people honest information and support.

Managers reviewed incidents so they could identify potential immediate actions. Managers investigated incidents thoroughly. They involved women, birthing people, and their families in these investigations and recorded ethnicity as part of the review process.

In order to give staff the opportunity to give feedback, we conducted an electronic staff survey which was sent to all staff in maternity. There were 76 responses in total. Staff had mixed reflections on learning culture. Most staff felt changes were made in response to incidents. All maternity staff who returned a survey knew how to report an incident, and most staff believed their organisation made changes in response to incidents.

Staff had a good knowledge of their responsibilities in relation to duty of candour (DoC). Duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of certain ‘notifiable safety incidents’ and provide reasonable support to that person. Staff monitored duty of candour compliance through a service dashboard that reported through governance.

Maternity specific mandatory training included but was not limited to practical obstetric multidisciplinary training (PROMPT), fetal monitoring, saving babies lives bundle training, infant feeding, maternity skills, neonatal life support and maternal basic life support. Midwifery staff exceeded the trust target of 90% in all maternity mandatory training and was at 93.28%.

Medical staff received and kept up to date with their mandatory training and rates were just above trust target of 90% with medical staff at 93.03%.

We observed clinical governance boards in all the clinical areas which highlighted the top three complaints, risks and incidents for the month. The notice boards also identified learning from incidents, feedback from staff and training compliance.

There were processes to report incidents, investigate what happened and share learning, however, incidents were not always reviewed in a timely manner which meant people could be at risk of avoidable harm.

The governance team was not embedded and that had impacted on the service’s capacity to review incidents in a timely manner. Following the onsite assessment, we reviewed incident data from February 2024 to July 2024. There was a total of 567 incidents, excluding incidents relating to the neonatal unit. A total of 55 incidents had been open for between 3 and 6 months. Some of these incidents are dependant on external factors such asopen inquests or MSNI investigations, or complaint investigations.

At the time of our inspection the service was recruiting into governance roles within the service. The inability to recruit to these roles had meant leaders were supporting to cover this gap and that was impacting their ability to focus on the strategic elements of their role. The trust had seconded two 8a staff while recruitment was underway.

There were 53 incidents that had not been categorised, so we were not assured that there was sufficient overview of these incidents and their themes. We requested evidence that incidents were categorised by level of harm, however this information was not provided by the trust as it was not readily accessible. Following the inspection the trust responded that PSIRF went live on 1 May 2025 and process' were still embedding and that maternity incidents are reviewed by a corporate multi disciplinary team at a daily triage (Monday to Friday) with daily documented escalation to leaders. Incidents are categorised by level of harm on RADAR and in triage.

Staff listened to concerns about safety however not all incidents were investigated in a timely way. The service had a system in place to investigate incidents and identify learning. The service had regular meetings to discuss incidents, identify themes and learning. However, maternity incident data in August 2024 showed that, 272 incidents remained open – this was 47.9% of the total incidents. Of these incidents 8 were from February 2024 (2.9%), 13 from March 2024 (4.7%), 34 from April 2024 (12.5%), 53 from May 2024, 93 from June 2024, 71 from July 2024.

The service worked with the local Maternity and Neonatal Voice Partnerships (MNVP)to ensure the voices of women and birthing people were heard. The MNVP reported that women and birthing people had a broad range of both positive and negative experiences at the service. They consistently received complimentary reflections about the support provided by the perinatal team. There were consistent themes being communicated by women and birthing people regarding delays in induction of labour, wait times and informed consent. There were regular meetings between staff and the MVP to collaborate on a range of activities such as reviewing complaints and guidelines.

Staff were aware of the key areas of patient safety risk and the focus for improvement within the maternity service. Staff told us that the service was often very busy and that capacity issues could result in time sensitive clinical activity such as induction of labour (IOL) being delayed. Data provided by the trust showed that IOL delays for 1 January 2024 to 31 March 2024 showed that 9.8% of women and birthing people were not able to be admitted on their planned date of admission of induction. At times where capacity was stretched the maternity escalation process would result in specialist midwives being used on the ward. Staff voiced concerns that they could be placed on busy wards caring for women and birthing people and this pulled from their specialist role.

Staff and leaders we spoke with had a good understanding of safe systems, pathways, and transitions. During the assessment we observed midwifery and medical handovers as safety huddles. These were well attended and followed a standard format to identify escalation of patient care, including the management of induction of labour, staffing, capacity and use of space.

Staff completed risk assessments for each woman on arrival, using a recognised tool, and reviewed this regularly,

The service had appropriate midwifery staffing in place to manage the maternity telephone triage. There was a designated midwife on each shift allocated to respond to and manage the triage telephone line.

Community midwives we spoke with reported that they were able to escalate women and birthing people they saw in community if they required a review as an inpatient.

Staff used a nationally recognised tool to identify women and birthing people at risk of deterioration and escalated them appropriately. Staff used national tools such as the Modified Early Obstetric Warning Score (MEOWS) for women and Newborn Early Warning Trigger and Track (NEWTT) for each baby.

Staff were aware of where to find guidance documents. These where accessible through the trust intranet.

During the assessment we observed shift changes and handovers using necessary key information to keep women and babies safe. The Situation, Background, Assessment, Recommendation (SBAR) tool was used to monitor and identify risk, however data provided by the trust showed that SBAR was not always completed in April SBAR was used 61%, 79% in May and 78% June against a target of 90%. We saw evidence of a QI project to improve performance.

Staff completed risk assessments prior to discharging women and birthing people and pregnant people back into the community and made sure third-party organisations were informed of the discharge.

Women and birthing people we spoke mostly had positive experiences of using the service. Patient survey results were mixed. Women and birthing people we spoke with reported that they were provided with information prior to their appointment and that they received good care when being seen by staff. Women and birthing people felt confident in engaging with the service to escalate concern if they needed to. All women and birthing people that we spoke with were satisfied their dignity and privacy had been respected.

We spoke with 6 women and birthing people who were postnatal and were from a range of different ethnic backgrounds. They confirmed they had no concerns about the care they received throughout labour and birth. We heard examples of how their pain was managed, and how they were kept informed, and that consent was always sought.

We saw evidence that some women and birthing people did not have positive experiences and were unable to get help when needed – for example during staff handovers. There had been a theme of some women and birthing people were labouring in the labour ward reception, ADAU and on ward 9.

We saw evidence from governance audits that access to translations services was not always provided to people. Data provided by the trust showed in January 2024 only 18% of people that were identified as needing an interpreter at booking had an interpreter. Good communication between healthcare professionals and women and birthing people is essential for safe and effective maternity care.

The majority of women and birthing people we spoke with confirmed they had a named midwife throughout their pregnancy and were able to contact them if required.

We reviewed 9 patient records and saw that risk assessments were completed and there was clear indication where mental health of safeguarding concerns was identifiable to staff to help deliver personalised care.

Most women and birthing people attending the maternity unit were admitted through maternity triage. The maternity triage service used the Birmingham Symptom-Specific Obstetric Triage System (BSOTS) to assess women and birthing people on arrival. BSOTS is a system used to assess women and birthing people presenting with pregnancy related concerns to enable them to be seen or prioritised based on their clinical need. Prioritisation was undertaken using a red, amber, green (RAG) rating system and then recorded on a paper documentation sheet. According to BSOTS women and birthing people should be seen by a midwife within 15 minutes of arrival and prioritised as either red, orange, yellow or green. Each colour identified how soon women and birthing people should be reviewed by a doctor or midwife as required. A red rating required immediate transfer to labour ward, orange required a review within 15 minutes, yellow required a review within 1 hour and green required a review within 4 hours.

Data supplied by the trust showed that compliance with 15-minute initial midwife review was 64% in March 2024, 75% for April, 80% in May and 75% in June 2024; these results were consistently below the trust target of 90%. There was an action plan in place to increase staff compliance on the hourly assessment.

During labour, high-risk women and birthing people were monitored through a Cardiotocograph (CTG). Staff used cardiotocography (CTG) as a method of assessing fetal well-being. In addition, central monitoring was used enabling senior midwifery and obstetric staff to continually assess and monitor the wellbeing of women and identify risks of deterioration. According to National Institute for Health and Care Excellence (NICE)guidelines NG229, women and birthing people being monitored through a CTG during labour should have an hourly fresh eyes review of the reading. Hourly fresh eyes require 2 clinicians to review the CTG trace during the intrapartum period to ensure the baby is safe to continue with labour. The fresh eyes stickers were completed appropriately in all the labour notes we reviewed. Audits of fresh eyes from January 24 to May 24 showed that compliance was at 90% which was in line with the trust target.

The service had community midwives who carried out outpatient appointments for women and birthing people in the community.

The service had 24-hour access to mental health liaison and specialist mental health support.

The trust reported that all 10 safety standards for the Maternity Incentive Scheme (MIS) had been met for year 5. The MIS is a financial incentive programme designed to enhance maternity safety within NHS trusts. It rewards trusts that can demonstrate they have implemented a set of core safety actions.

All women and birthing people we spoke with confirmed they felt safe in hospital.

Staff reported that they knew how to make a safeguarding referral and who to inform if they had concerns. Staff could give examples of how to protect women from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff also knew how to identify adults and children at risk of, or suffering, significant harm and knew where to document and access this information.

Midwifery and medical staff said they received training specific for their role on how to recognise and report abuse. The service provided midwifery and medical staff with level 3 safeguarding training which included but was not limited to training on domestic abuse, mental health, substance misuse and female genital mutilation (FGM).

The safeguarding team was made up of a named safeguarding midwife and a band 7 safeguarding midwife who were both involved in triaging safeguarding referrals, attending ward rounds on the unit, attending case conferences and coordinating training.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Staff explained safeguarding procedures, how to make referrals and how to access advice.

The service had processes in place to safeguard women and babies from abuse. This included a baby abduction policy and regular baby evacuation drills During our onsite assessment some staff were unclear about their role in reporting a missing baby or the escalation process if a baby could not be located on the ward.

Women and birthing people told us they were well informed about potential risks and benefits of medical procedures and healthy life choices throughout their pregnancy journey. They had been given details about appointments, what to expect and were encouraged to ask questions.

The service had access to phone based translation service. We saw evidence that patients that were assessed as requiring access to translation services did not have an interpreter and the reason for this was not documented.

Providing high-quality interpretation and translation services is an important part of ensuring that women receive the right care, with informed consent, and have improved health outcomes. The maternity service was aware of the diverse needs of the community it served. Patient information leaflets were available in a range of languages. The service had electronic tablets to communicate with people who were deaf and unable to verbalise.

We observed staff give women and those close to them help, emotional support and advice when they needed it. We reviewed patient records that demonstrated women living with mental health conditions, were risk assessed and referred to mental health specialists when needed.

Staff completed risk assessments for women using nationally recognised tools.

Staff used national tools such as the Modified Early Obstetric Warning Score (MEOWS) for women and Newborn Early Warning Trigger and Track (NEWTT) for each baby.

Care plans were developed using this information to provide care and treatment and minimise risks as identified. During our assessment we saw staff completed venous thromboembolism (VTE) scoring in the 9 notes of women and birthing people we reviewed onsite. Following the assessment we reviewed VTE audits. The data January to March 2024 showed that 42% of service users had a VTE risk assessment completed with 6 hours of admission and 19% of women did not have the correct dose of low molecular weight heparins (LMWH). Low molecular weight heparins are used to help the prevention of blood clots when birthing.

The service had 24-hour access to mental health liaison and specialist mental health support. The service also had a dedicated mental health team of midwives for women and birthing people with additional mental health needs.

Theatre staff completed the World Health Organisation (WHO) 5 steps to safer surgery checklist prior to starting surgical procedures in all the women and birthing people’s notes we reviewed. The WHO checklist is a set of priority checks to ensure patient safety before, during and after a surgical procedure. We reviewed data provided by the trust that showed WHO checklist compliance was audited and exceeded the 90% target.

People told us that they felt the environment was safe while being treated and cared for at the hospital. Some women fed back that it felt cramped on the wards, particularly when birthing partners were staying overnight.

Staff also described the maternity wards as cramped. The triage area shared a space with the day assessment unit, both of which saw high volumes of women.

Senior leaders and staff confirmed that there was building underway for a new maternity block. Staff reported that they had access to all the equipment they needed and used personal protective equipment in line with regulations.

Staff cleaned equipment after contact with women and birthing people.

Emergency equipment such as resuscitaires and cardiac arrest equipment had been checked regularly, however, the epidural trolley on labour ward was not checked daily in line with trust policy. In June 2024 the trolley was not checked for a total of 15 days. There was therefore a risk that women may not receive timely analgesia pain relief as the equipment was not always checked.

At the time of our inspection, equipment was being stored in a manner that represented a risk to people’s safety. Equipment was kept in inappropriate areas which would impede the ability to evacuate the area in the event of an emergency. This was escalated to senior leaders who stated that this had been assessed. On day two of the inspection the area had been cleared of additional equipment to ensure compliance with fire safety regulations.

Women and birthing people could reach call bells however, staff did not always respond quickly when called. A patient we spoke with informed us that they had to wait 11 minutes for a call bell to be answered. Staff also reflected that care was not always the responsive when the ward was busy.

Following from our last inspection the bereavement room had additional soundproofing installed to the bereavement room. This was an improvement on our last inspection.

The design of the environment followed NHSE national guidance – health building note 09-02 maternity care facilities however the storage of equipment in corridors make the wards cluttered. The maternity unit was fully secure with a monitored entry and exit system. There was a monitored buzzer entry system to the maternity unit and reception areas. We saw visitors being politely challenged on entry by a dedicated member of staff at the entry points to the ward.

Women told us they were happy with the care they received. We saw feedback from the Friends and Family Test (FTT)that were consistently positive- the community midwife team and the labour ward teams received 90% positive feedback between November 2023 and January 2024. We saw feedback from women and birthing people that praised their midwife for their support through their maternity journey, ‘My midwife was an absolute blessing to have throughout. She was extremely caring and compassionate and tried to take away negative feelings I had.’.

Whilst the maternity survey results for 2023 were about the same as other trusts, the service did perform worse than expected for being left alone, the score was 6.2/10 (the higher score the better). This related to not being left alone by midwives or doctors at a time when it worried them.

Staff told us there had been an increase in sickness and we were told this was due to work pressures.

Senior leaders confirmed that registered and non-registered nurse staffing did not always meet the planned versus actual planned staffing levels. This was mostly due to vacancies, maternity leave, and sickness. This meant they did not always have enough staff with the right skill mix and experience to make sure women received consistently safe and good quality care.

Staff reported they received the support they needed to deliver safe care. Senior leaders had good oversight of mandatory and specific core competency training completion.

Staff at all levels reported they had opportunities to learn and develop specific skills. they confirmed they had yearly appraisals by their ward managers. Managers confirmed their appraisal rates for their areas was 90%.

The number of midwives and healthcare assistants did not always match the planned numbers for each shift. There were regularly 1 or 2 midwives less than establishment on every shift. Staffing levels depend on the acuity of individuals and the numbers of women needing care. Birthrate Plus is a midwifery-specific national tool for calculating staffing levels and recommended numbers of midwives. The service RAG rated within the birth rate plus tool as; red if they were understaffed by 2 or more midwives; amber – if they were understaffed by up to 2 midwives; and green – if they were fully staffed. Between April and August 2024, the labour ward was rated green 70% of the time, amber for 27% of the time and red for 2% of the time. This meant they did not always have enough staff with the right skills mix and experience to make sure women and babies received consistently safe and good quality care that met their needs.

Managers moved staff from across the service in line with their maternity escalation policy when needed. We reviewed the escalation policy that set out clear roles and responsibilities for senior leaders and staff. During escalation maternity specialist midwives and the community team were on call for escalation were redeployed to work clinically. There had been an increase in births, which had led to ongoing escalation in maternity. Across May, June and July 2024, the community midwives on call were called into the unit on 5 occasions due to escalation.

The service monitored maternity ‘red flag’ staffing incidents in line with National Institute for Health and Care Excellence (NICE) guideline 4 ‘Safe midwifery staffing for maternity settings. A midwifery ‘red flag’ event is a warning sign that something may be incorrect with midwifery staffing. The service provided data that identified 23 red flags for January 2024 and of these 52% of the red flags were for ‘coordinator unable to maintain supernumerary status – NOT providing 1:1 care’ and 30% were for ‘delay between admission for induction and beginning of process’. We requested data for 6 months but this was not provided. The service was reviewing performance through governance meetings. We also saw induction of labour being reviewed at handovers and safety huddles.

The supernumerary status of the labour ward coordinator was prioritised in escalation and was at 100% between April 2024 and August 2024.

There had been a significant staffing turnover in the past 12 months. Between July 2023 and July 2024 10 maternity staff had left of these 7 were midwife staff, this included 3 midwives retiring and 4 were promoted internally within maternity.

Staff received effective support, supervision and development. The mandatory training rate was 93% across the maternity service. The appraisal rates across the maternity service were 91.3% which exceeded the trust target of 90%.

All staff received an induction specific to their role and the service reviewed induction completion.

The maternity service had a high midwifery vacancy rate. This was at 9.9% (16.10 whole time equivalent) for March 2024 this had reduced to 14.23 whole time equivalent at the time of the inspection. Leaders were reviewing the establishment and rostering of staff within maternity and planning to allocate additional transitional care within ward 10.

At the time of inspection, the service had medical staffing numbers that met their planned numbers.

People said they found the maternity unit to be clean and tidy. They said domestic staff were visible and kept the premises clean. People said that staff were observed to be bare below elbows and used hand sanitiser after each episode of care.

Staff told us they knew who was responsible for cleaning different areas within the wards and units, and which pieces of equipment. All areas of the service we visited were visibly clean, cleaning staff explained their schedules, which included the areas they were allocated to clean daily.

Maternity service areas were visibly clean and had suitable furnishings which were clean and well-maintained. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.

Staff cleaned equipment after contact with women and birthing people.

Staff disposed of clinical waste safely. Sharps bins were labelled correctly and not over-filled. Staff separated clinical waste and used the correct bins. They stored waste in locked bins while waiting for removal.

The service generally performed well for cleanliness. Cleaning audit data provided by the trust showed that the service met the trust target of 98% for labour ward, 95% for the maternity wards and 85% for the day assessment unit between the months of April and July 2024.

Staff followed infection control principles including the use of personal protective equipment (PPE). Leaders completed regular infection prevention and control and hand hygiene audits. Data showed monthly infection prevention and control audits between May 24 and August 24 were in line with trust targets and completed in all maternity areas.

Women who were booked for elective caesarean sections were screened for methicillin- resistant staphylococcus aureus (MRSA) during their pre-operative assessment appointment. MRSA is a type of bacteria that is resistant to many antibiotics and can cause life threatening infections as a result.

Results from the CQC maternity survey 2023 showed that the service performed worse than expected, compared to other trusts, when women were asked about pain management during labour and birth. The service scored 6.2/10 (where a higher score is better).

We reviewed governance minutes that showed access to timely pain relief was a consistent theme from patient feedback.

During the assessment, women and birthing people? we spoke with said they felt well cared for and informed about their medicines. They told us their pain relief was managed well.

Staff told us they received mandatory medicine management training. We did not have any concerns raised by staff in relation to medicines.

Staff told us they could request pharmacy support when needed.

Staff stored and managed all medicines and prescribing documents safely. The clinical room where the medicines were stored was locked and could only be accessed by authorised staff. Medicines were in date and stored at the correct temperature.

We observed midwives using a red apron system during medication rounds to alert staff, women and birthing people to the fact that they were administering medicines. This ensured staff were not interrupted or disturbed during medication rounds and to prevent medicines incident, which was in line with best practice.

Staff monitored and recorded medication fridge temperatures and knew what actions to take if there was variation.

Staff followed systems and processes to prescribe and administer medicines safely. Medicines were prescribed on paper charts. Medicine records we reviewed showed that allergies and weights were always documented to ensure medicines were prescribed safely and, medicine charts were fully completed by staff when administering medicines.

Staff reviewed each woman's medicines regularly and provided advice to women and birthing people and carers about their medicines. The pharmacy team supported the service and reviewed medicines prescribed. These checks were recorded in the prescription charts we checked.

Controlled drugs (medicines requiring additional security measures due to their potential for misuse and diversion) were stored securely and checked daily to ensure their balances were correct.