Liverpool Women's 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

Our rating of effective stayed the same. We rated effective as good.

Staff worked together for the benefit of people who used the service. They assessed their needs and supported them to make decisions about their care. Staff followed national guidance to gain consent. Most people experienced positive outcomes following their care and treatment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Admission policies were in place to provide guidance for staff around the assessments required on admission to the maternity services.

Women presenting in the maternity services were assessed and triaged by trained staff and placed on care pathways depending on clinical risk and needs.

Staff completed risk assessments for each person on admission and care plans were put in place where risks were identified. Staff carried out routine monitoring and observations at regular intervals during their hospital stay.

The service had 24-hour access to mental health liaison and specialist mental health support teams. Staff understood how to seek guidance and advice to support women with mental health concerns. Staff completed, or arranged, psychosocial assessments and risk assessments for women thought to be at risk of self-harm or suicide. We saw mental health assessments were completed in the care records we reviewed.

People who used the service received timely assessment by medical staff and advanced clinical practitioners and daily consultant led ward rounds took place to assess people’s needs.

People who used the service told us staff carried out assessments on admission to the service to identify key risks and took into account their needs and preferences. The care records we looked at were complete and up to date and showed people’s needs were assessed and risk assessments and care plans were routinely reviewed and updated with involvement from people who used the service.

Clinical guidelines and pathways were based on national guidance, such as from The National Institute for Health and Care Excellence (NICE) and the Royal College of Paediatrics and Child Health. We reviewed a number of care pathways, including for postpartum haemorrhage (PPH), induction of labour, assisted birth, obstetric pathways, pathways of care for under 18's accessing maternity care and care of women with pre-existing diabetes in pregnancy and found these were based on best practice guidance.

Staff used nationally recognised maternity triage assessment tools and used the national maternity early warning system (MEWS) and newborn early warning system to assess and respond to any change in people's condition, in line with national guidance.

Changes to clinical practice, national guidance and policies were reviewed and developed through routine monthly maternity guidelines, policy, audit and research meetings and clinical governance meetings and shared with staff.

The service had undertaken compliance reviews to assess compliance against NICE guidelines, such as asthma diagnosis, monitoring and chronic asthma management (NG245), maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years (NG247) and tobacco: preventing uptake, promoting quitting and treating dependence (NG209). Action plans were developed where full compliance against standards had not been achieved and these were reviewed at routine clinical audit and governance meetings.

Staff told us policies and procedures reflected current guidelines and were easily accessible in electronic and paper format. We looked at a selection of the policies, procedures and care pathways and these were up to date and based on current national guidelines.

Staff made sure people who used the service had enough to eat and drink including those with specialist nutrition and hydration needs. Staff used nationally recognised screening tools to monitor people at risk of malnutrition. People were given a choice of food and drink, and their nutritional needs were monitored and assessed by staff. Specialist support from staff such as dietitians was available for people who needed it. Mothers were supported with breastfeeding.

We saw there was effective daily communication between multidisciplinary teams across the service. Daily staff safety huddles and handover meetings took place to ensure all staff had up-to-date information about risks and concerns. Staff at all levels took part in routine multidisciplinary team meetings to plan and deliver safe care and treatment.

People who used the service spoke positively about the way their care and treatment was coordinated. They told us all staff worked well together as a team.

Mental health liaison services were available 24 hours per day. Diagnostic imaging services were available 7 days per week through weekend scanning lists and night on-call service. MRI and CT scan services were also available from 8am to 8pm, 7 days per week as part of community diagnostics centre.. Social worker, district nursing and community midwifery teams were available to support people being discharged from the service. Staff told us they received good support from specialist midwives and pharmacists, dietitians and tissue viability nurses and diagnostic imaging services. Most specialist support services were available during weekdays with on-call arrangements during out of hours and on weekends.

Care records showed there was routine input from midwifery and medical staff and allied health professionals in the delivery of people’s care and treatment.

Service partners and stakeholders told us staff across the maternity services had developed close working relationships with colleagues within the hospital, and across the wider health system.

People who used the service told us they received good support from staff and were provided with information around healthier living. Staff told us they routinely discussed health promotion and lifestyle choices with people who used the services.

Health promotion information was displayed on notice boards and in information leaflets that were readily available across the areas we inspected. People could be referred to specialist support with smoking cessation or alcohol or drug abuse.

People identified with weight concerns were given advice on healthy eating and were referred to dietitians or signposted to specialist support services.

People who used the service spoke positively about the quality of the care and treatment they received.

The maternity services participated in 3 national clinical audits and 5 local clinical audits during 2024/25. The clinical audit forward plan 2025/26 included plans to undertake 13 clinical audits relating to the maternity services. Findings from clinical audits were reviewed during routine audit and maternity risk meetings and any changes to guidance and the impact that it would have on their practice was discussed.

Outcomes for people who used the service were mostly positive but mixed outcomes had been achieved in some indicators when compared with other similar services or to national standards.

In the MBRRACE perinatal mortality surveillance report published in February 2025 (based on births in 2023), the stabilised and adjusted perinatal mortality rate was 5 % worse than the comparator group average for all births. However, the mortality rate was within 5% of the comparator group average for births excluding congenital anomalies (birth defects). Managers told us they worked with the local specialist children's hospital to identify improvements to mortality rates involving congenital anomalies.

The maternity services implemented the saving babies lives care bundle and carried out routine audits to monitor outcomes against indicators such as fetal growth assessment and management, reduced fetal movement awareness, reducing preterm birth, reducing smoking in pregnancy and management of pre-existing diabetes in pregnancy. We looked at a selection of audits undertaken during the past 12 months and these showed high levels of staff compliance against most of the care bundle quality indicators.

The national pregnancy in diabetes audit (NPID) 2023 was completed with no improvement actions identified for the maternity services. The most recent national maternity and perinatal audit report had not been published at the time of our inspection.

The clinical quality improvement metrics (CQIMS) data for January 2025 showed the maternity services were worse than the national average for babies who were born preterm and for women who had a postpartum haemorrhage (PPH) of 1500ml or more. The service reported that preterm birth indicators were likely to be higher due to the service being a tertiary level unit.

We also looked at a selection of internal clinical audits, such as the information provision on safer sleeping audit (2023-24), the reduced growth velocity: quality control of fetal growth ultrasound audit and the placenta accreta spectrum diagnostic performance audit (October 2022 to September 2024 data). These audits showed good staff compliance with audit standards and action plans were put in place to address areas for improvement identified during the audit.

Staff had the appropriate skills and knowledge to seek informed verbal consent and written consent before providing care and treatment. Staff gained consent from people for care and treatment in line with legislation and the hospital's consent policy.

Staff were clear about how they sought informed verbal consent and written consent before providing care and treatment. Care records we looked at showed verbal and written consent was recorded prior to undertaking care and treatment. People who used the service told us staff clearly explained what they were doing and asked for consent when delivering care and treatment.

Written consent was sought for certain procedures, such as elective caesarean sections. Staff told us the risks and benefits of procedures were discussed with people who used the service prior to treatment.

Managers monitored staff compliance against consent processes. The maternity services reported 11 incidents relating to consent breaches between April 2024 and March 2025. The most frequent incidents related to consent not being recorded prior to treatment. Each incident had remedial actions to aid staff learning and improvement.

The policy for children treated in an adult healthcare setting provided guidance for staff on how to obtain consent for care and treatment from young people. Staff we spoke with understood how to seek consent from young people using the Gillick competence / Fraser guidelines or consent of a person with parental responsibility if under 18 years of age.

Staff had policies in place and understood the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff received training in the Mental Capacity Act and Deprivation of Liberty Safeguards as part of the mandatory safeguarding training. Most staff (87.2%) in the maternity services had completed this training.

If a person lacked the capacity to make their own decisions, staff told us they sought consent from an appropriate person (advocate, carer or relative) that could legally make decisions on the patient's behalf. When this was not possible, staff made decisions about care and treatment in the best interests of the person and involved their representatives and other healthcare professionals.

Staff told us they could seek support and guidance around consent, mental capacity and best interest decision making processes from the hospital-wide safeguarding team.

A trust-wide audit was undertaken to check compliance with NICE guideline NG108; decision-making and mental capacity. The audit sampled 90 admissions between January 2024 and December 2024 where the person was identified with dementia, autism and or a learning disability. The audit also reviewed all DoLS authorisations undertaken during this period.

The audit concluded there was good compliance with DoLS processes and partial assurance was achieved in relation to compliance with NICE NG108 guidelines. The audit identified some learning and improvement in relation to completion of mental capacity assessments, recording best interest-decision making and for patients with additional needs to have a flag on their record.