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Liverpool Women's Hospital Good

We are carrying out a review of quality at Liverpool Women's Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 29 Jan to 28 Feb 2018

During a routine inspection

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.


  • 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 carried out on 18 - 19 February and 4 March 2015

During a routine inspection

Liverpool Women’s Hospital is one of two locations providing care as part of Liverpool Women’s NHS Foundation Trust. This hospital provides a range of specialist services for women including inpatient and community maternity services, which deliver approximately 8,000 babies a year, a neonatal service to support newborn babies needing specialist care, obstetrics, gynaecology, gynaecology oncology, termination of pregnancy and a unique emergency room for patients who have urgent gynaecological problems or women with problems in early pregnancy (at fewer than 16 weeks). The trust is also a major obstetrics, gynaecology and neonatology research hospital, one of only two specialist trusts in the UK, and the largest women’s hospital of its kind in Europe.

Liverpool Women’s NHS Foundation Trust serves more than 30,000 patients from Liverpool, the surrounding areas and across the UK.

We carried out this inspection as part of our comprehensive inspection programme.

We carried out an announced inspection of Liverpool Women’s Hospital on 18 and 19 February 2015. In addition, we undertook an unannounced inspection between 4pm and 7pm on 4 March 2015. As part of the unannounced visit, we looked at maternity and surgical services.

Overall we rated Liverpool Women’s Hospital as good although we found that the Community Maternity Service required improvement. There were plans in place to reconfigure and integrate the community service. The plans had not yet been implemented at the time of our inspection.

Our key findings were as follows:

Overall we found that the hospital provided effective care with outcomes comparable with or above expected standards. Patients were very positive about the care and treatment they received at the hospital.

Staff were positive about the additional investment in midwifery and nursing staff and morale within the hospital had improved as a result.

The senior team was visible and accessible to staff and managers were seen as supportive and approachable. Managers were keen to engage and include staff in service development. There were some concerns raised in relation to the leadership style in the Labour Ward that managers have committed to exploring and addressing.

There was a positive and enthusiastic culture throughout the hospital. Staff were committed and passionate about their work and proud of the services they offered to patients. Staff were keen to learn and continuously improve the services they offered to patients.

Nurse and Midwifery staffing

Nurses and Midwives were caring and compassionate and treated patients and those close to them with dignity and respect. They were committed to giving patients a high standard of care and treatment. Staffing levels were calculated using a recognised tool and regularly reviewed.

Since our last inspection there had been a significant increase in the numbers of nurses and midwives employed and there were sufficient numbers to meet the needs of patients. There were plans in place to increase the number of neonatal nurses to meet the British Association of Perinatal Medicine (BAPM) standards. At the time of the inspection, staffing was sufficient to meet the needs of babies being cared for as current neonatal staff were working extra hours to fill in gaps on the staffing rota.

The neonatal service had introduced the Advanced Neonatal Nurse Practitioner (ANNP) role. The ANNPs were having a positive effect in supporting high quality care for babies requiring specialist neonatal support, however, it was acknowledged that more work was required to fully embed and integrate this key role within the service.

Medical staffing

Medical treatment was delivered by skilled and committed medical staff. There were excellent examples of medical staff providing strong leadership and active engagement in the design and development of services.

There were sufficient numbers of consultants and middle grade doctors to provide good quality care and treatment for patients; however, in maternity – inpatient services, the consultant cover was only 77 hours, which was lower than the 98 hours minimum recommended by the Royal College of Obstetrics and Gynaecology for a unit this size. Junior medical staff were well supported and provided with excellent teaching and learning opportunities.

The tier 1/middle-grade staffing levels were acceptable in terms of establishment but frequently the neonatal unit operated below the establishment. In response to this, the service had introduced an Advanced Neonatal Nurse Practitioner role to help and support junior doctors working in the unit.


There were robust policies and procedures in place for raising child safeguarding concerns. These processes were supported by staff training. All relevant staff had received appropriate levels of training for safeguarding children.

Staff were aware of the process and demonstrated a good understanding of their role in safeguarding vulnerable children. Interagency working was well developed and there was good communication with relevant professionals in this regard.

Staff training for the safeguarding of vulnerable adults had recently been introduced. Staff were developing their understanding, competency and knowledge in this area at the time of our inspection. Staff training figures indicated that by March 2015 95% of relevant staff would have received Adult safeguarding training.

Safeguarding practice was supported by a trust wide safeguarding team that staff could access for advice and support. However, we did find some examples in the surgical service where the approach to the safeguarding of adults required further development.

There were specialist clinics in place, supported by a Somali health link worker, to identify and address the needs of women who had experienced female genital mutilation (FGM) and designated midwives within the community service to support women whose circumstances had been identified as making them vulnerable.

Incident reporting

There were established systems for reporting incidents and ‘near misses’. Staff had received training and were confident in the use of the incident reporting system. The latest national reporting and learning system (NRLS) data (September 2014) stated that the organisation had a reporting rate of 68.48 per 1000 bed days, which was higher than the median of 35.92 for the cluster of acute specialist trusts. The trust were in the highest 25% of reporters. The trust was however slow to upload incidents to the NRLS system with 50% of incidents submitted more than 41 days after the incident had occurred.

The reporting rates had improved significantly from the previous reporting period. Managers had identified that it was ‘no harm’ and ‘near miss’ incidents that were not being reported appropriately. This was supported by the NRLS report, which highlighted that the percentage of incidents reported by the trust in which no harm had been caused was 51%, compared with 76% across all acute specialist organisations.

There was low incident reporting for all types of incidents in the community maternity service. The trust was working with its staff teams to address this issue and to encourage and support staff to report all incidents appropriately. Managers realised that the poor patient safety incident reporting culture could hinder staff in identifying risks and the trust in taking action to prevent avoidable harm to patients.

There were good examples of learning from incidents. Staff in all clinical areas were able to describe changes in practice following incident investigations. To support learning from Serious Incidents, staff were provided with a one-page summary of the key findings and recommendations to disseminate the learning across their service.

Cleanliness and infection control

There was a visibly high standard of cleanliness throughout the hospital. Staff were aware of current infection prevention and control guidelines and observed good practice. Hygiene audits demonstrated a high level of compliance. There were suitable arrangements for the handling, storage and disposal of clinical waste, including sharps.

Cleaning schedules were in place and displayed throughout the ward areas and departments. There were clearly defined roles and responsibilities for cleaning the environment and cleaning and decontaminating equipment.

Staff were vigilant in managing and preventing infection risks. There were services in the hospital whose practice in infection control was exemplary.

Nutrition and hydration

People were given a choice of suitable and nutritious food and drink, and we observed hot and cold drinks available throughout the day.

Patient’s religious and cultural needs were considered and food was provided in accordance with their requirements. Staff provided appropriate and discreet support for those patients who needed help with eating and drinking.

Specialist dietary support was available to patients whose condition indicated or required a specialist diet.

The hospital had a team of midwives, support workers and infant feeding advisers who helped support women to feed their babies. The hospital team was supported by Liverpool BAMBIS (Babies & Mums Breastfeeding Information and Support), a team of peer supporters who offer breastfeeding support and information to pregnant women, breastfeeding mothers and their families.

Access to services

Services were planned to meet the diverse needs of patients using the hospital and community based service. There were access points designed so that pregnant women without a GP could self-refer. There was a unique gynaecological emergency service that provided immediate support to women who again could self-refer.

A link booking clinic was held at Liverpool Women’s Hospital for women whose first language was not English. The Birth Choices Clinic provided support throughout pregnancy to women with tokophobia (fear of childbirth) and a vaginal birth after caesarean section (VBAC) clinic was also available.

There was a specialist clinic, supported by a Somali health link worker, to identify and address the needs of women who had experienced female genital mutilation (FGM) and designated midwives within the community service to support women whose circumstances had been identified as making them vulnerable.

We saw several areas of outstanding practice including:

  • The implementation of the HeRo system. The neonatal unit was the first in the country to put this system into practice.
  • The neonatal unit’s benchmarking of its practice and outcomes against other units in the UK and the USA.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the hospital must:

  • Improve the way in which medicines are managed and stored.
  • Check the folder of medication data sheets in each room within the neonatal unit at more regular intervals; and confirm with a signature that they have been checked and are valid.
  • Store the portable box containing emergency medicines in the high dependency unit securely.
  • Provide appropriate neonatal resuscitation equipment in the maternity assessment unit.
  • Provide effective controls to prevent the abduction of infants from the labour ward and the Catharine Medical Centre.
  • Ensure that risks regarding the storage of formula milk are appropriately assessed, and effective controls implemented to manage those risks.
  • Provide operating department practitioners or suitably qualified midwives in theatre recovery outside of normal working hours.
  • Ensure that the telephone triage line is staffed at all times.
  • Ensure that, when restraint is necessary, it is undertaken in accordance with the relevant regulations and legislation.
  • Ensure that paper medical records are of an adequate standard and provide an accurate, up-to-date record of the consent, care and treatment provided.
  • Ensure that all staff are able to safeguard adults appropriately.

In addition the hospital should:

  • Review the number of hours of consultant cover in maternity, which were lower than the recommended minimum from the Royal College of Obstetrics and Gynaecology for a unit this size.
  • Ensure that issues identified during audits are addressed.
  • Review the numbers of incidents reported in all services.
  • Ensure that domestic violence referrals from the police are reviewed within agreed timescales.
  • Review practice with regard to the artificial rupture of membranes during induction of labour.
  • Improve the response rates for the NHS Friends and Family Test.
  • Consider including emergency appointments in the induction suite diary.
  • Ensure that there is an effective system in place for testing portable electrical appliances.
  • Allocate a non-executive director with responsibility for termination of pregnancy services.
  • Review the timing of resuscitation decisions so that discussions are initiated with patients at a time when they are well enough to fully consider their wishes.
  • Initiate work on advanced care planning with patients at a time when they are well enough to fully consider their wishes.
  • Monitor the quality of care planning on the wards against patients’ assessed needs.
  • Provide dementia training for ward staff.
  • Address the leadership issues and staff morale within the intrapartum areas.
  • Address the role of the advanced neo-natal practitioners (ANNPs) so they are clear where their role sits and take steps to involve them in developments in the neonatal service.
  • Consider the provision of newborn life support training for community Midwives.

  • Consider auditing the availability of patient records.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 30 September 2014

During an inspection to make sure that the improvements required had been made

We had previously inspected this service on 9 April 2014. During this inspection we found there had been significant improvements in the areas of non-compliance at Liverpool Women�s Hospital since our last visit. The inspection focused on the maternity unit as this was where the previous areas of non-compliance had been identified.

We spoke with 11 women about their experience of receiving care and support at Liverpool Women�s Hospital. Everyone spoke very positively about their experiences at the hospital. Comments included:

�They really look after you well here�,

�The Women�s is the best place to have a baby�.

During this inspection we spoke individually with 14 midwives. We also spoke with the members of the executive team with responsibility for implementing the trust action plan formulated to address the areas of non-compliance identified at our last inspection.

Staffing levels had improved significantly within areas of the hospital providing intrapartum care (care during childbirth), which had led to improvements in the experience for patients. However midwives had been regularly moved from the principal post natal ward to areas providing intrapartum care during busy periods, leaving the post natal ward short of midwives.

Complaints were well managed within Liverpool Women�s Hospital. Considerable improvements had been made to the way risks and quality were managed within the trust but there was still further development needed to the way in which the organisation investigated serious incidents and learned from incidents and complaints.

Inspection carried out on 9 April 2014

During an inspection to make sure that the improvements required had been made

We had previously inspected this service on 7 and 8 July 2013. During this inspection we found there had been some improvements in how women and their babies were cared for and in how staff were supported. However, there were other areas where the trust failed to meet essential standards of quality and safety. Part of this inspection was undertaken outside of normal working hours. We started the inspection at 6am to see how women and their babies were cared for during the night shift.

We spoke with ten women and four relatives during our inspection who all spoke positively about their experiences at the hospital. Their comments included:

�It has been brilliant; they told you what was happening,"

�There are no words to describe how grateful we are,�

�They made my stay a happy one,�

�They explained everything to me.�

Staff at all levels were better supported to undertake their roles through training and appraisal, and staff morale throughout much of the maternity directorate had improved. However, maternity staffing levels were still sometimes inadequate, which meant that the trust was not always able to provide safe and effective intrapartum (care during childbirth) and post natal care to women and their babies.

There were systems in place to assess risk and quality within the trust, but the quality of these systems was not adequately managing risks to staff and patients. Improvements were also needed in the way in which the trust handled complaints.

Inspection carried out on 7, 8 July 2013

During an inspection in response to concerns

We carried out a responsive inspection of Liverpool Women�s Hospital as a result of us receiving a number of concerns about the service including a concern about staffing levels on the maternity unit and the impact of this on women�s and their babies experiences of the service.

We arrived at the service unannounced at 6pm on Sunday 7 July 2013 and we returned the following day to continue the inspection.

During the visit we spoke with women across the maternity service and with their partners and relatives. This included the postnatal ward, labour ward, the midwifery led unit and the triage and assessment unit. The feedback we received from the majority of women and relatives was very positive and people in the main described good experiences and good outcomes from their stay or visit.

People described the care and treatment they had received as �excellent�, �brilliant� and they described staff as �amazing� and �approachable�. People felt safe and confident in the ability and experience of the staff supporting them.

However, people did also tell us that they felt the staff were �too busy� and �very busy� and they felt that this prevented them from asking for too much support.

We found concerns about staffing levels throughout the maternity unit. This was evident through our discussions with women who were using the service, from discussions with staff at all levels and from other information which suggested the staffing levels had been a cause of concern for some time. We found the staffing levels had a direct impact on some aspects of women�s care and welfare and on how staff were being supported.

Senior managers were aware of the concerns about staffing levels and had been actively trying to address the problems we found prior to our visit. They shared information with us about the actions they had taken to date to reduce the risks associated with reduced staffing levels and to prevent future recurrence of staff shortages.

Inspection carried out on 19 February 2013

During a routine inspection

Patients told us they felt fully involved in making decisions about their care and treatment throughout their stay.

Patients gave us good feedback about their experiences at the hospital. Their comments included;

�We can�t fault them, they have looked after us from start to finish�.

�I had a very nice midwife who took care of me�.

�It has been brilliant, we have had a good experience here�.

�I was close to giving up the breast feeding but they got me through it�.

�I would give the service ten out of ten�.

��Midwives have been amazing, I couldn�t have coped without them��

We found patients were protected against the risks associated with medicines because arrangements were in place to manage medication safely.

Patients were cared for and treated by staff who had undergone appropriate pre employment checks, in line with NHS employment requirements, before they started working at the hospital.

Overall patients gave us good feedback about the support they had received from staff and staff told us they felt sufficiently trained to meet their roles and responsibilities.

A complaints procedure was in place which enabled patients, carers and visitors to complain if they were dissatisfied with the care or treatment they had received. Systems were in place to monitor all concerns and complaints and to ensure learning took place from these.