Liverpool Women's Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Our rating of responsive went down from outstanding to good.

The service planned care to meet the needs of local people, took account of people's individual needs and future care plans, and made it easy for people to give feedback about their experiences. Care and treatment was centred around people and their needs. Most people could access the service when they needed it, in a way that promoted equality and protected their rights.

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.

People who used the service told us their needs and preferences were taken into account. They told us their care and treatment was person-centred and focused on their needs. Staff told us they assessed people’s clinical and personal needs with their involvement to develop person-centred care plans.

We observed positive interactions between staff and people who used the service. We saw staff understood their needs and provided appropriate care and treatment.

Care records showed staff regularly discussed people’s care and treatment with them and provided care in accordance with their needs and preferences. There was routine involvement from medical, midwifery and specialist staff to meet people’s needs. We saw person-centred care plans were in place for women that took into account their clinical needs and preferences before, during and after giving birth.

Most staff had completed mandatory training on learning disability and autism. Care records included hospital passports for people with a learning disability, autism or mental health disorders and these included people’s preferences and choices. Reasonable adjustment care plans were put in place to support them. Care records we saw included reasonable adjustment care plans for people with autism, dyslexia and neurodiversity and records demonstrated staff had delivered care and treatment in accordance with the care plans.

We looked at the care records for a pregnant person under 18 years of age, a person who did not speak English as a first language and a person with a safeguarding flag. We found person-centred care plans and reasonable adjustments had been put in place and care was appropriately delivered to meet their needs and preferences.

Services were planned and delivered to meet the needs of pregnant women. There were daily meetings so access and flow could be monitored and maintained and to identify and resolve any issues relating to admission or discharge from the services.

Staff were aware of how to escalate key risks that could affect people's safety, such as staffing and bed capacity issues and there was daily involvement by shift coordinators, managers, clinical leads and matrons to address these risks.

People who used the service told us their care was coordinated well, and staff planned and delivered their care and treatment in a way that met their needs.

Facilities and premises were appropriate for the services being delivered. The maternity services operated 24 hours a day, 7 days per week. The midwifery led unit (MLU) had had capacity for up to 9 people. The induction of labour (IOL) suite consisted of 5 single ensuite rooms. An additional 5 bedded bay area had also been created to expand capacity for induction of labour. The mat base was a 52 bedded combined antenatal and postnatal ward with segregated areas for women pre and post-labour. The maternity assessment unit (MAU) had sufficient waiting area with 3 triage rooms. The delivery suite had 3 theatres, with two theatre teams available at all times for emergency treatment, when required.

The service had escalation and divert policies in place, which provided guidance for staff on how to escalate and manage risks in the event of staffing challenges or capacity issues.

There had been only one instance where the midwifery led unit had been closed (for one day due to staffing shortages) between April 2024 and March 2025. Staff told us they used the delivery suite if the MLU could not be fully utilised. The service reported that in the circumstances when the MLU was closed and delivery suite space was utilised for low risk women, an ethos of low risk care was still delivered to those women who chose midwife led care.

Service partners told us the maternity services had a strong focus on meeting the needs of the diverse population, particularly for non-English speaking people and those from deprived areas. They told us staff from the maternity services played an active role in the `best for baby too' improvement collaborative (2022-2025), which was focused on enhancing care for vulnerable mothers and their babies.

Service partners told us the staff in the maternity services worked collaboratively with local and regional partners and other service providers to support and improve people's access to the maternity services. Examples included working with the local NHS ambulance trust to provide safe and effective handovers and contributing to their `case for change' report.

Staff told us they regularly discussed and provided people with relevant information, so they were well informed about their care and treatment. People who used the service told us staff provided them with necessary information about their care and treatment.

Information leaflets were readily available. Information leaflets could be provided in different languages or other formats, such as braille or easy read format, if required.

People who used the service were offered support as part of the trust-led digital inclusion programme, including free preloaded SIM cards and tablet devices and support with accessing the NHS app, virtual appointments and accessing services such as benefits and housing.

Staff told us they received all the information they required to plan people’s care and treatment. They told us they could access information such as care records, policies and guidance relevant to their role. Electronic status boards had been installed across the maternity services, enabling staff to view information about people who used the service in real-time.

Staff across the maternity services used a number of different electronic record systems to record people’s care and treatment. Staff told us this sometimes led to additional workload as they needed to access multiple IT systems to obtain information about people who used the service.

Whilst most staff understood how to access the relevant care records information, we found examples where staff were not always able to access information in a timely manner. For example,some paper surgical consent records not been scanned to the electronic health records at the time of our visit. Some staff were not able to access this information when asked as they were not sure where it was stored. We raised this with managers during the inspection and they told us they would raise awareness and provide further guidance and training for staff. There was a longer-term plan to implement a single electronic patient record system across the hospital to address this issue.

The clinical areas had notice boards providing information for staff and people who used the service. Whilst the maternity services were co-located in the same part of the hospital, we noted there was limited corridor signage and directions available to direct people to the different wards and departments across the maternity services. We raised this with managers during the inspection and they told us they would review this and undertake improvements where necessary.

Managers produced an integrated performance dashboard which included information around performance, staffing, safety incidents, audit results and outcomes. The dashboard information was shared with staff during routine engagement and staff meetings.

Most staff had completed mandatory training, information governance and data security. There had been no information commissioner’s office (ICO) reportable data breaches relating to the maternity services in the past 12 months.

People who used the service told us they knew how to raise a complaint or concern. Staff understood the policy on complaints and knew how to handle them. They told us information about complaints was discussed and learning shared through learning bulletins, newsletter, daily huddles, handovers and routine staff meetings.

The hospital’s management of complaints and concerns policy stated that complaints would be acknowledged within 3 working days and responded to within 6 months. People who used the service were given information on how to escalate their concerns internally in the trust or to external organisations such as the Parliamentary and Health Service Ombudsman.

The maternity services received 104 complaints during the past 12 months. The most frequent reasons for complaints related to communication with people who used the service, delay or failure in observations and inadequate support provided. Most complaint responses were completed within the timeframe agreed with the complainant.

Staff across the maternity services told us they routinely engaged with people who used the service and families to gain their feedback. This was done informally through daily engagement and formally through participation in surveys, such as the NHS friends and family test.

Friends and family test survey data between April 2024 and April 2025 showed an average satisfaction score of 87% was achieved, indicating most people were positive about their experience of the maternity services.

Managers told us they reviewed complaints, compliments and feedback from surveys to aid learning and improvement. Staff were able to give examples of improvements made following people’s feedback, including improvements to information, posters and signage and improvements around facilities, waiting areas, provision of refreshments and vending machines for people who visited the services and changes to partners staying overnight due to feedback about noise at night.

People who used the service told us they received care and treatment in a prompt and timely manner and did not experience long waiting times. We saw there was sufficient capacity across the areas we inspected and observed people receiving timely care and treatment in a relaxed and calm environment.

During January 2024 and April 2025, most women admitted to the maternity service resided in Liverpool, followed by the Sefton and Knowsley areas. The service also had low numbers of admissions from women across the North West region. There had been 9,376 births during this period (average 586 births per month), of which 19% were by elective caesarean section and 26% by emergency caesarean section.

Most people could access the service when they needed it and received the right care promptly. Most women attending the MAU department were triaged within 15 minutes, in line with national guidance.

Staff monitored delays of ongoing induction of labour (IOL) over 12 hours. A quality improvement project had been commenced to improve IOL delays through improvements to staffing levels and bed capacity and flow.

During the period between April 2024 and September 2024, there had been 1,239 IOL procedures performed with 324 delays reported. During October 2024 to March 2025, there had been 1,313 IOL procedures performed with only 126 delays reported, indicating that improvement initiatives had led to an approximate 50% reduction in IOL delays over 12 hours.

The maternity services had undertaken a number of measures to improve capacity and flow. The obstetric day unit (ODU) was previously located within the MAU department. This was not deemed appropriate and had since been relocated to a separate area. The relocation of the ODU led to improved capacity in the MAU and was received positively by staff.

People who used the service did not stay in hospital longer than they needed to. The average length of stay was 0.93 days between January 2024 and March 2025.

There had been 7 elective caesarean section procedure cancellations due to capacity issues between April 2024 and March 2025. This included 6 due to list overruns and 1 cancellation due to no beds available. The service reported they had carried out time trials and process map exercises to identify improvements to elective caesarean processes and additional theatre lists were undertaken on weekends to address increased demand for elective caesarean sections.

The services reported there were no delayed discharges or people with no criteria to reside as women were either directly discharged home after giving birth or had an existing plan of care in place.

The services reported there had been 243 readmissions following discharge between May 2024 and April 2025. Reasons for readmissions included reduced fetal movement, abdominal pain and raised blood pressure.

Staff followed the equality and human rights policy, which outlined a commitment to recognise diversity, promote equal opportunities and support human rights in the provision of health services. New and existing policies and procedures included equality impact assessments.

Staff were able to describe the processes for embedding equity including how they ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions.

Most staff across the maternity services had completed mandatory training in equality, diversity and human rights.

People who used the service told us their needs and preferences were assessed and understood by staff.

Protected characteristics were taken into account when planning for people’s care and treatment. Care records showed care plans were in place for people with specific needs and preferences and staff provided care and treatment in line with their wishes where possible.

We looked at data around incidents and complaints and this did not identify any disparity in care experiences or inequalities for people with protected characteristics.

Staff told us clinical outcomes for pregnant women and newborns were impacted by factors such as people’s ethnicity or levels of socio-economic factors. The maternity services had undertaken an analysis of the local population demographic and had a good understanding of the challenges faced by the services due to an increased level of deprivation and health inequalities among the local population. The service estimated 50-75% of maternity and gynaecology admissions had at least one risk factor for worse outcomes due to health inequalities.

People who used the service underwent risk assessments on admission to identify and manage risks around ethnicity, lifestyle choices (such as smoking and drinking), social and economic factors and pre-existing health conditions. Reasonable adjustment care plans were put in place to meet people’s needs and preferences.

The average length of stay for women from a black, Asian and minority ethnic (BAME) background was longer (1.05 days) than white women (0.79 days) between January 2024 and March 2025.

We found information such as a person’s ethnicity, lifestyle and social factors were assessed when undertaking reviews following serious incidents or mortality reviews.

People who used the service told us the staff discussed their care and treatment plans, expectations and outcomes with them and their preferences were taken into account. Staff told us they planned and discussed care and treatment plans, including discharge arrangements, on admission to the service.

Discharge planning took place at an early stage. Discharge records included records of discharge medicines, emergency contact numbers and communication with the person, their families and other healthcare professionals (such as GP's) to ensure people were discharged in a planned and organised manner. Complex discharges included involvements from community teams and social workers to ensure continuity of care. Discharge letters written by the doctors included all the relevant clinical information relating to the person's stay at the hospital.

Staff told us they could seek advice and guidance from the hospital's palliative care team, including for bereavement and counselling support. A multi-faith chaplaincy service was available for spiritual or religious support to people of all faiths and beliefs.

Staff were able to describe how they could utilise advanced care plans for palliative and end of life care, and these were based on national guidelines (such as ‘ReSPECT').