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Liverpool Women's Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 8 September 2020

Liverpool Women’s NHS Foundation Trust is a specialist trust that specialises in the health of women, babies and their families. As one of only two such specialist trusts in the UK and the largest women’s hospital in Europe the trust holds a unique position.

Liverpool Women’s Hospital is the main hospital and is a modern landmark building near Liverpool city centre. It is here that the team deliver around 8,000 babies and perform some 10,000 Gynaecological procedures each year.

The maternity team cares for women and their babies from conception to birth supported by the neonatal team who provide around the clock care for premature and new born babies needing specialist care. The trust’s fertility team helps families to improve the chance of conceiving babies. In gynaecology, the trust undertakes care of women with the many varied conditions associated with the female reproductive system and is a centre for gynaecology oncology. The genetics team supports families with the diagnosis and counselling of genetic conditions.

On average 20 babies and three premature babies are born and cared for daily, the trust is primarily known for maternity and neonatal services. However, the trust also carries out 30 gynaecology operations and the reproductive medicine unit completes six cycles of IVF treatment every day.

We did an unannounced focused inspection of Liverpool Women’s Hospital; the trust was given 48-hours’ notice of our inspection. This was because at our last inspection we found concerns relating to the safe and proper management of medicines in gynaecology, maternity and neonatal services. We visited maternity and neonatal services and gynaecology services including theatres. We spoke to staff in all three core services and senior managers.

We did not rate the hospital at this inspection as we only inspected one key line of enquiry to ensure the hospital now managed medicines safely. We found the following improvements:

  • The hospital now used systems and processes that ensured the safe prescribing, administering, recording and storage of medicines. This was in all core services inspected, maternity, gynaecology and neonatal services.
Inspection areas

Safe

Good

Updated 8 September 2020

Effective

Good

Updated 8 September 2020

Caring

Good

Updated 8 September 2020

Responsive

Good

Updated 8 September 2020

Well-led

Requires improvement

Updated 8 September 2020

Checks on specific services

End of life care

Good

Updated 22 May 2015

Patients who were considered to be in the last year of life were cared for in one of two specialist end of life suites on wards within the hospital (whenever possible). The Mulberry and Orchid suites were part of gynaecology ward 1 and provided patients with a private and calm environment where they could be cared for in an appropriate and tranquil setting. Patients and those close to them valued the environment and some patients had chosen the suites as their preferred place to die. The specialist palliative care team responded to the needs of patients in a timely way and were accessible to ward staff for support, advice and mentoring. There was good multidisciplinary working for the benefit of patients. Staff participated in regional and national networks to support service development and improvement. Staff were caring and compassionate and there was evidence of individualised, person-centred care. Processes for rapid discharge were in place to allow patients to return quickly to their preferred place of care. However, we did not see robust evidence of advanced care planning and ‘do not attempt cardio-pulmonary resuscitation’ (DNACPR) decisions were not always made in a timely way so that patients could be involved in the decision making.

Maternity (community services)

Requires improvement

Updated 22 May 2015

There were systems in place for reporting actual and ‘near miss’ incidents in the community maternity service. The service monitored all its risks and had local risk registers. However, we did not see evidence that identified risks had been addressed and mitigated. Additional areas of concern included equipment that was not regularly maintained and medicine stocks, carried by community midwives, that were out of date. Midwifery staffing levels were calculated using a recognised dependency tool and were sufficient to meet the needs of patients. Staff had a good knowledge and understanding of the policies and procedures to promote the safeguarding of women and babies at risk of abuse and neglect. Staff observed, understood and followed best practice infection control guidance. Services were delivered by caring and compassionate staff. We observed that staff treated women with dignity and respect, and planned and delivered care in a way that took women’s wishes into account. Emotional support was available for both mothers and those close to them. Most women were offered a choice with regard to their preferred place of birth and the service ran an on-call system for women choosing home birth. The caseload ratio (midwife to woman) was 1:92, which was similar to the national average of 1:96. Integration between the hospital and community teams could be further developed.

Maternity (inpatient services)

Good

Updated 22 May 2015

Overall we found that the inpatient maternity service was providing a good service to women and their babies.There had been a significant improvement in the numbers of midwifery staff across the service, and this was having a positive impact on patient safety as there were more midwives to deliver care to women and their babies. However, there were areas relating to safety that required improvement. The maternity assessment unit did not have any equipment with which to resuscitate a newborn baby. Medicines were not always stored at the correct temperatures and an appropriate tracking system for keys to patient medication lockers was not in place.The storage of formula milk was not well managed. Effective controls were not in place to prevent the abduction of infants from the labour ward and the Catharine Medical Centre. Midwifery staffing levels were satisfactory across the service; however the number of hours of consultant cover (77 hours) were lower than the recommended minimum (98 hours) from the Royal College of Obstetrics and Gynaecology for a unit this size. The ward and clinical areas were visibly clean and well maintained. National guidelines were followed in treating patients and the outcomes for patients were comparable with other trusts nationally, although a small number of women were unable to access their chosen method of pain relief during labour. Patient care and treatment were delivered effectively by a multidisciplinary team 7 days a week both within and outside normal working hours. Midwives required to work in theatre recovery needed additional training. Integration between the hospital and community teams could be further developed. Maternity services were delivered by caring and compassionate staff. Staff treated patients with dignity and respect. Care was planned and delivered in a way that took into account the wishes of the patients. The services were, in the main, responsive to patients’ needs. They were planned and delivered to meet the needs of women; however, there were capacity issues within the induction of labour suite that sometimes meant low-risk patients waiting several hours for induction of labour. Timely advice and support via the telephone triage line was not always available. Leadership within maternity inpatient services was good overall and staff spoke highly of managers with the exception of those in the labour ward. Midwives working in this area found it difficult to raise concerns because doing so was not always met with a positive response. In addition, staff working in this area reported that staff meetings felt punitive in nature and that staff who were involved or witnessed serious incidents were not always well supported. Risks were managed satisfactorily and performance was monitored appropriately, but action was not always taken, or monitored, to address issues highlighted during audits.

Neonatal services

Good

Updated 8 September 2020

We did not rate neonatal services at this inspection. We only looked at those areas where we had found breaches of regulations and wanted to check that the service had improved. We did an unannounced focused inspection of safe, looking at how the service ensured the safe and secure management of medicines.

We found:

  • The service had improved systems and processes to safely prescribe, administer, record and store medicines.

Outpatients and diagnostic imaging

Good

Updated 22 May 2015

There was good practice in the outpatient and diagnostic imaging departments to promote the safety of patients and staff. There was a clear process for reporting and investigating incidents. Learning from incidents was shared and there were examples of changes in practice in response to incidents. Cleanliness and hygiene in the department were of a good standard. Regular hand hygiene audits showed an appropriate level of compliance. Patient records were generally available for clinics although there were occasions when they were not. It was not possible to ascertain how widespread the issue was because incidents that related to the availability of patients’ notes were not reported consistently and the availability of notes was not audited. Staff and managers could not tell us the percentage of notes that were unavailable. The issue was recorded on the risk register a week before the inspection started. Staff were aware of the policies and procedures to protect and safeguard children and adults, and training statistics showed that most staff had completed training in safeguarding for both children and adults. Other mandatory training courses were well attended and staff were positive about the training provided. They had also been trained in managing major incidents. Staffing was generally good; however, there were occasions when the foetal medicine unit was understaffed and managers were looking at ways to resolve this. The diagnostic imaging department used a private provider for sonography to address staff shortages. There was no evidence at the time of our inspection that this was having an impact on patient safety.

Termination of pregnancy

Good

Updated 22 May 2015

There were robust systems for the reporting of incidents and the management of risk within the Bedford Centre. The centre was visibly clean, medicines were safely stored and well managed, and the standard of record keeping was good. There were sufficient well-trained nurses to provide safe and effective care.

The multi-disciplinary team worked well together, using national guidelines to treat patients. Access to information was good and there were robust processes in place to gain consent.

Services were delivered by caring and compassionate staff who treated patients with dignity and respect. Care and treatment was planned and delivered in a way that took into account the wishes of the patient.

Access to treatment, advice and information was good both during procedures and after discharge. Complaints were well managed. The trust’s vision and values for the organisation had been well communicated to staff.

There was a ‘no blame’ culture

that gave staff confidence to report incidents and ‘near misses’.

We saw individual members of medical and nursing staff who displayed good leadership skills and were positive role models for staff generally.

Gynaecology

Requires improvement

Updated 8 September 2020

We did not rate gynaecology services at this inspection. We only looked at those areas where we had found breaches of regulations and wanted to check that the service had improved. We did an unannounced focused inspection of safe, looking at how the service ensured the safe and secure management of medicines.

We found:

  • The service had improved systems and processes to safely prescribe, administer, record and store medicines.

Maternity

Good

Updated 8 September 2020

We did not rate maternity services at this inspection. We only looked at those areas where we had found breaches of regulations and wanted to check that the service had improved. We did an unannounced focused inspection of safe, looking at how the service ensured the safe and secure management of medicines.

We found:

  • The service had improved systems and processes to safely prescribe, administer, record and store medicines.

However:

  • At this inspection we found, while there had been improvements overall, there was still some inconsistent practice in relation to the monitoring of medicines stored in fridges.