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Some of the ratings of services provided at Liverpool Women's Hospital shown on this page are no longer relevant. Our latest ratings of specific services offered at the hospital are:

  • End of life care: Good  
  • Neonatal services: Good  
  • Gynaecology: Requires improvement  
  • Maternity: Good  

The other service ratings are from areas we now inspect as part of these. We will update this page to reflect this soon.

Read the latest inspection report for Liverpool Women’s Hospital.

Inspection Summary


Overall summary & rating

Good

Updated 8 August 2018

Our rating of services stayed the same. We rated it them as good because:

  • There were enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff assessed patient risk well. Staff identified risks to patients and took appropriate measures to mitigate these risks.
  • Medicines were prescribed, administered, recorded and stored well. Patients received the right medication at the right dose at the right time.
  • There was an established Maternity Services Liaison Committee (MSLC), which provided an effective channel for users of maternity service to influence the local provision of maternity services.
  • Community staff made prompt and timely referrals for women and babies that were identified as vulnerable and there was evidence that the trust worked closely with the enhanced midwifery team, safeguarding team and social services.
  • Parents were involved in choices about their baby’s birth both at booking and throughout the antenatal period.

However:

  • We found that some governance structures, processes and initiatives were recently developed and had yet to be fully embedded and audited in practice.
  • Staff did not always have prompt access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Managers across the hospital did not always promote a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • Computer information systems needed to be enhanced, streamlined and developed further to reduce and mitigate risks.
Inspection areas

Safe

Good

Updated 8 August 2018

Effective

Good

Updated 8 August 2018

Caring

Good

Updated 8 August 2018

Responsive

Good

Updated 8 August 2018

Well-led

Good

Updated 8 August 2018

Checks on specific services

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.

Maternity

Good

Updated 8 August 2018

Our rating of this service stayed the same. We rated it as good because:

  • Staff recognised and reported incidents well. However, initiatives for shared learning to reduce recurrence were relatively new and still needed to be embedded into practice.
  • Safety systems, processes and standard operating procedures were reliable or appropriate to keep women and babies safe. Staff followed policies and national guidance.
  • Staff identified potential safeguarding risks, involved relevant professionals and had systems in place to manage it.
  • The service had enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Ward managers matched staffing levels to patient need and could increase staffing when care demands rose by rotation of staff within the unit.
  • Performance and patient outcomes on the maternity dashboard were good.
  • Stillbirth rates were monitored closely and were on a downward trend.
  • There was an established mandatory training programme for midwives and medical staff.
  • The service had specialist clinics and staff with enhanced skills to support women with special needs.
  • Enhanced midwifery team provided individualised needs-based holistic care to women with significant mental health problems, alcohol, substance misuse, social care involvement, learning disabilities. They provided one-to-one care within a setting, which was comfortable for the woman (Better births, 2017).
  • Patients’ needs and preferences were considered and acted on to ensure that services were delivered in a way that met their needs.
  • The maternity service had two height adjustable baby cots with handset-operated controls for women with disabilities.
  • There were eight cots dedicated for transitional care of babies situated on the maternity ward.
  • There was an established bereavement system in place following the loss of a baby.
  • There was an established Maternity Services Liaison Committee (MSLC), which provided an effective channel for users of maternity service to influence the local provision of maternity services.
  • The culture among staff was good.
  • Patients were positive about their care.
  • Staff were aware of the maternity vision and strategy plan or the maternity service development plan.
  • Senior managers had a good oversight and awareness of issues within the services and there was evidence of plans to improve these.
  • Midwives had implemented a new “reconciliation” process, which monitored closely all medicine stocks. This aimed to reduce medication errors, monitor supplies and expiry dates and improve traceability of the drugs. This was an improvement since the last CQC inspection in 2015.

However:

  • Some governance structures, processes and initiatives were recently developed and had yet to be fully embedded and audited in practice.
  • There were access and flow issues within the triage and Maternity Assessment Unit (MAU).
  • We observed issues in antenatal clinic regarding the environment, cleaning schedules, infection control and cleanliness, effectiveness of the self-check in service and fridge temperature recordings.
  • Timely advice and support via the telephone triage line was not always available.
  • Maternity Early Warning score (MEWS) audit results in 2017 were overall good. However, some areas scored low or were scored as “not applicable”. Therefore, this highlighted some inconsistencies with either the staff completing the MEWS incompletely or issues with the audit process.
  • Patient records were not stored confidentially at all times in some clinical areas.
  • Mandatory training rates showed that compliance rates were below the trust target of 95% in three of the four main inpatient clinical areas.
  • Compliance rate for safeguarding training for inpatient midwifery and medical staff was under the trust target of 95%.
  • Not all staff had received annual appraisal reviews.
  • Some ward staff had not completed medical device training since 2014.
  • The homebirth rate was low.
  • Computer information systems needed to be developed further to reduce and mitigate risks.

Gynaecology

Requires improvement

Updated 8 August 2018

Our rating of this service went down. We rated this service as requires improvement because:

  • The service did not have a vision for what it wanted to achieve and had not developed plans with involvement from staff, patients, and key groups representing the local community.
  • Managers across the service did not always promote a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service did not use a systematic approach to continually improving the quality of its services.
  • The service did not always plan and provide services in a way that met the needs of local people.
  • The emotional needs of patients were not always taken into account when planning services.
  • Staff did not always take time to interact with patients outside of essential conversations during observations or examinations.

  • Staff did not consistently provide emotional support to patients to minimise their distress.
  • Patients’ privacy was not maintained at all times. Consultations of patients attending the colposcopy clinic could be overheard by patients in the waiting area.
  • Staff did not always have prompt access to up-to-date, accurate and comprehensive information on patients’ care and treatment.

However:

  • The service managed patient safety incidents well.
  • The service assessed patient risk well. Staff identified risks to patients and took appropriate measures to mitigate these risks.
  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.

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.

Surgery (gynaecology)

Good

Updated 22 May 2015

Surgical services at Liverpool Women’s Hospital were caring, effective, responsive and well-led. There were some concerns about the comprehensiveness of patient records, medical handovers, medicines management and storage, safeguarding practices and levels of staff training, which meant that safety required improvement. There were processes and procedures used in practice both pre and postoperatively to ensure that people received good care and treatment that resulted in a short hospital stay. Systems were in place to monitor the quality and performance of the various wards and areas, and these resulted in actions to improve care when necessary. Staff had access to the information they needed to deliver care to their patients. Patients reported that staff were kind and patient, protecting their privacy and dignity while providing a high level of care and support. The gynaecology service responded to the needs of the local population by providing services where gaps had been identified. Joint working with other organisations had also resulted in improved access to services for patients. Staff were proud of working at the trust and described a culture of openness in which they could discuss concerns or ideas with the managers.

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.

Neonatal services

Good

Updated 22 May 2015

We found that, overall; the neonatal services provided were good. There was a sense of pride in the service and staff were committed to providing high-quality services. Neonatal nurses and doctors worked well together to achieve the best outcomes for the babies in their care. Babies received high quality care from dedicated and caring staff who were highly skilled in working with newborn babies and their families. There was a robust system in place for reporting and learning from incidents. The unit was visibly clean with a well-managed, clearly understood approach for maintaining a suitable environment. The standard of record keeping was good and both the nursing and medical staffing levels were appropriate to meet the needs of the babies in the unit. The multidisciplinary team worked well together. There were clear evidence-based guidelines to support practice. The service had achieved level 3 baby friendly status and there was focused work by staff to improve breastfeeding rates. Parents were active partners in the care of their babies, and communication with parents and families was good. Services were delivered by staff who were caring and considerate. Parents were universally positive about the care their babies had received and provided us with examples of when staff had ‘gone the extra mile’ to care for their babies and support them at the same time. Staff were proud to work in the unit and passionate about the service they provided. They were keen to receive feedback from families and the results were clearly displayed on a noticeboard. Feedback was used to support service developments. The service received very few complaints but had dealt with the ones they had received in an appropriate manner. There was access to a translation service for parents and families, and information available in different languages. There was a transitional team and an outreach team that helped babies to be discharged home at the earliest opportunity. The services provided by the unit were well-led. There was strong medical and nurse leadership. Senior staff were positive role models for staff, and were visible and accessible. Staff were supported and encouraged to be innovative in their practice. There were robust governance systems in place. We saw good examples of a positive ‘no-blame’ culture and a well-developed approach to learning.

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.