Liverpool Women's Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Our rating of safe improved. We rated safe as good.

The service had enough staff to care for people and keep them safe. Staff had training in key skills, understood how to protect people from abuse, and managed safety well. The service managed infection prevention and control risks well.

Staff assessed risks to people, acted on them and kept good care records. Premises and equipment were clean and well-maintained. The service had oversight of safety incidents and learned lessons from them.

Staff used separate systems to prescribe and administer medicines and for recording of people's care records. Information such as people's weights and medicines discharge summaries were recorded on one system, meaning that staff would need to check both systems and there was a risk a person's general practitioner (GP) would not receive up to date information about their medicines whilst in hospital. There was a longer-term plan to implement a single electronic patient record system across the hospital to address this issue.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses on an electronic incident reporting system, in line with the hospital's managing incidents and patient safety incident investigations policy. Staff used the Patient Safety Incident Response Framework (PSIRF) to aid learning and improvement. Incidents were reviewed and investigated by staff with the appropriate level of seniority, such as clinical leads, ward managers and matrons.

Staff received feedback following the investigation of incidents. Staff met to discuss the feedback and look at improvements to people's care during daily safety huddles, handover meetings and during routine departmental and divisional staff meetings so shared learning could take place. Learning from incidents was also shared through hospital-wide alerts and bulletins, clinical governance gazette briefings and safety-first newsletters to aid learning and improvement.

Staff understood duty of candour. They were open and transparent, and gave people who used the service and families a full explanation if and when things went wrong. People who used the service told us they felt safe and did not have any concerns around safety incidents.

Weekly trust safety review meetings took place where incidents that met statutory duty of candour were reviewed. This was to ensure staff took the appropriate actions to comply with duty of candour and also learn from experiences reported.

There had been 3,212 incidents relating to maternity services reported by the hospital between April 2024 and March 2025. Most reported incidents resulted in no or low harm. There had been 4 severe harm incidents reported during this period. We looked at the investigation report for a serious harm incident and this showed the incident had been appropriately investigated and improvement actions were identified to aid learning and minimise reoccurrence.

There had been 3 never events reported by the maternity services between January 2024 and April 2025. Never events are serious patient safety incidents that should not happen if healthcare providers follow national guidance on how to prevent them. Each never event type has the potential to cause serious patient harm or death but neither need have happened for an incident to be a never event.

The never events had not led to any patient harm and each incident occurred in isolation with no related trends. Our observations and discussions with staff during the inspection showed learning from the never events had been shared with staff and remedial actions had been undertaken to minimise reoccurrence.

There had been no maternal deaths reported by the maternity services during the 12 months prior to our on-site inspection.

The maternity services reported 20 stillbirths (after 24 weeks of pregnancy) excluding termination of pregnancies between April 2024 and March 2025. Stillbirth incidents were reviewed to identify learning and improvement using a perinatal mortality review tool, with a multidisciplinary approach involving internal and external medical and midwifery staff. Duty of candour principles had been applied in each case and families were invited to be involved in the review process. Deaths were also reviewed and shared with staff as part of routine mortality and morbidity reviews during medical staff meetings and training days to aid learning and improvement.

Two stillbirth incidents had been referred for investigation under the Maternity and Newborn Safety Investigations (MNSI) programme and we saw learning following the incidents had been identified and shared with staff to improve the services.

The maternity services had operational policies that provided guidance for staff around admission, transfer and discharge in the maternity assessment unit (MAU), the maternity inpatient ward (mat base), the midwifery led unit and delivery suite. People who used the service told us they were kept informed about their care and treatment at all stages from admission to discharge from hospital.

Pregnant women could be admitted through a number of routes, such as self-referral or referral through a GP, community midwife or through other healthcare professionals and local service providers.

The MAU mainly admitted pregnant women with 18 or above weeks gestation or postnatally within 6 weeks of birth presenting with conditions related to pregnancy. Women less than 18 weeks pregnant or after 6 weeks of birth were excluded and referred to the gynaecology emergency department.

Staff followed the maternal high dependency (level 2) care (including admission and discharge) guideline when providing care for women and babies whose health deteriorated and required high dependency care such as enhanced observation or respiratory support.

Most staff across the maternity services had completed basic life support, immediate life support and newborn life support training. There was at least one person present on site with advanced life support training at all times. There was a hospital-wide resuscitation team and an escalation process was in place to contact emergency bleep holders during an emergency.

The hospital had a neonatal intensive care unit (NICU) but did not have a dedicated intensive care unit for women. Those requiring level 3 (intensive care) support were stabilised and transferred to local acute hospitals and specialist children’s hospitals, in line with the hospital’s ‘Acutely unwell / critically ill, pregnant or recently pregnant woman’ policy and established critical care or trauma pathways.

There had been 49 transfers from the maternity services to other regional NHS acute hospitals or children’s specialist hospitals between April 2024 and March 2025. Maternity incident records showed there had been no or low harm incidents identified in relation to transfers to other services during this period.

Staff liaised with other services for women and newborn babies transferred into the maternity division. Detailed care records were kept which included their condition prior to transfer and any treatment given.

Midwifery nursing and medical staff handovers took place during daily shift changes and these included discussions about people’s needs and any staffing or capacity issues. Shift changes and handovers included all necessary information to keep people safe. Staff utilised the situation, background, assessment, recommendation (SBAR) tools during handovers. Staff also took part in a daily ‘safety huddles’ where discussions took place around safety, capacity and risks.

The digital lead midwives carried out routine monthly care record audits to check for accuracy and completeness. Audit results between January 2024 and December 2024 showed they did not find any serious omissions or errors. Staff received feedback and additional training where individual documentation errors were identified. Most of the care records we looked at were complete, up to date and had few errors or omissions.

Service partners and stakeholders spoke positively about the systems and pathways in place for the admission, transfer and discharge of people who used the maternity services.

The safeguarding adults policy and safeguarding children and young people policy provided guidance for staff on how to identify and report any safeguarding concerns, including making referrals internally and to external agencies, such as the local authority safeguarding team.

People who used the service told us they felt safe and would raise any safeguarding concerns they had with the staff.

The hospital’s electronic system flagged if an adult or child was thought to be at risk or had a known safeguarding history.

Staff told us they had received safeguarding training and understood how to identify abuse and report safeguarding concerns. They told us learning from any reported safeguarding incidents was shared as part of daily huddles, handovers and during routine staff meetings.

There had been 24 safeguarding incidents reported by the hospital relating to maternity services between May 2024 and April 2025. Records showed appropriate actions had been taken to safeguard vulnerable people.

The safeguarding training strategy (2024-2026) outlined the requirements for staff training, in line with national guidance.

Staff completed training specific for their role on how to recognise and report abuse, in line with current intercollegiate guidance for adults and children. Most staff across the maternity services had completed adult and children’s safeguarding training.

Records showed training compliance above the hospital’s target of 90% had been achieved for adults safeguarding training (level 1,2 and 4) and children’s safeguarding training (level 1, 3 and 4).

The proportion of staff that had completed adults safeguarding level 3 training (86.6%), children’s safeguarding level 2 training (89.7%) and Mental Capacity Act training (87.2%) was slightly below the hospital’s 90% compliance target. Additional training sessions had been arranged to improve staff compliance and achieve the 90% compliance target.

Training in the Mental Capacity Act, deprivation of liberty safeguards (DoLS), prevent (counter-terrorism strategy) basic awareness, modern slavery and female genital mutilation training was incorporated into the adult and children’s safeguarding training. 95.2% of staff had also completed prevent WRAP e-learning training.

Staff in the maternity services received support and guidance from the hospital’s safeguarding team, which included the head of safeguarding and medical and midwifery safeguarding leads for adults and children. The safeguarding leads had completed the higher level of safeguarding training (level 4).

The safeguarding leads attended routine meetings and were involved in serious incident and patient death reviews. The safeguarding leads produced 3-monthly and annual safeguarding reports and information around safeguarding was reviewed as part of routine safeguarding sub-committee meetings held every 3 months. Safeguarding staff had recently started to attend ward handover and safety meetings to offer advice and support at the point of case discussion. Staff told us they found this beneficial to support patients and meet their needs.

Pregnant women attending the maternity assessment unit (MAU) underwent triage using BSOTS (Birmingham Symptom Specific Obstetric Triage System). The national best practice guidelines state that women should be triaged within 15 minutes of arrival at the unit. During the period between January 2024 and April 2025, the average 15-minute triage compliance rate was 93.9% and the average compliance within 30 minutes was 99.5%, demonstrating high levels of compliance with national triage time guidelines.

Pregnant women could access the telephone triage service 24 hours per day. The telephone triage service was undertaken by senior midwifery staff. There was a system in place to contact any woman who did not attend for assessment or who needed a follow up call.

We observed that women accessing the telephone triage service were given appropriate and timely advise and those attending the MAU were prioritised appropriately and received timely care and treatment, including medical reviews based on risk.

Women could choose to give birth at home, at the midwife led unit or on the delivery suite. Staff completed a risk assessment on admission for labour / induction of labour to assess for appropriate place of birth. Women identified at low risk were deemed suitable for admission to the midwifery led unit (MLU) and those identified as medium or high risk were admitted to the delivery suite with either midwife or consultant-level assessment dependant on the required level and frequency of fetal monitoring and auscultation (listening to a baby's heartbeat during labour).

Staff undertook computerised cardiotocography (continuous electronic recording of a baby's heart rate and the mother's contractions during labour) and utilised the `Fresh eyes' system where the CTG was regularly reviewed by a senior midwife or obstetrician, in line with National Institute for Health and Care Excellence (NICE) guidance NG229; Fetal monitoring in labour.

Care records we looked at showed CTG and fresh eyes records were complete and up to date. Staff also used the Dawes-Redman CTG Analysis System to assess fetal well-being during pregnancy by analysing fetal heart rate patterns on a CTG.

A monthly fresh review hourly assessment compliance audit in the delivery suite showed there had been significant improvement in staff compliance month on month between February 2024 and January 2025 through additional staff training and monitoring and oversight of staff non-compliance. The audit showed average compliance ranged between 30% and 51% during February 2024 to April 2024. Average monthly compliance ranged between 83% and 88% during the 4 months from October 2024 to January 2025 and the compliance target of 85% had been achieved during 3 of these months.

In addition, a monthly `fresh ears' assessment audit in the MLU showed the compliance target of 85% had been exceeded in 9 of the 12 months between February 2024 and January 2025.

Staff completed risk assessments for each person on admission, using a locally designed tool, and reviewed this regularly, including after any incident. Care records included up to date risk assessments for venous thromboembolism (blood clots), pressure care, post-partum haemorrhage and an overall risk assessment taking into account key risks, needs and preferences. Risk assessments were routinely reviewed and updated at specified intervals.

Women at high risk were placed on care pathways so they received the right level of care. People who used the service told us staff routinely discussed and updated risk assessments and care plans. They told us staff carried out regular observations and kept them informed about any changes to their care or treatment.

Staff had policies in place and received training around the use of maternity and newborn early warning score processes. Staff used the national maternity early warning score system (MEWS) and newborn early warning score system (NEWS) and carried out routine monitoring and vital observations based on peoples' individual risks and needs so that any changes to their medical condition could be promptly identified.

If a person's health deteriorated, staff were supported with medical input and specialist midwifery support when needed. Care records we looked at showed people who used the service had regular timely observations and monitoring, and were escalated appropriately when required.

We identified regulatory breaches around the monitoring of observations and management of people whose health deteriorated during our previous inspection in January 2024.

During this inspection, we found improvements had been made, including additional staff to support monitoring and compliance, updates to IT systems such as the implementation of digital whiteboards across the maternity services to provide real time MEWS status and staff alerts and strengthening of communication processes, such as twice daily safety huddles and weekly quality and safety meetings.

The quality improvement programme, as part of the deteriorating patient collaborative, was launched in 2024 to improve MEWS observation compliance. The maternity services had seen an 18% improvement in daily observation compliance from 59% average compliance during 2024 to 77% average compliance in April 2025.

MEWS audit records undertaken every three months during 2024 showed good staff compliance in completion MEWS scoring and recording vital observations, but compliance around timely escalation varied between 33% and 100% across the maternity services. The next phase of the deteriorating patient collaborative quality improvement programme was focused on making further improvement to escalation and medical review times.

The optimising on-site safety improvement programme was planned for launch during 2025 and aimed to make further improvements around managing acutely ill people or those whose health rapidly deteriorated.

The service had guidelines, pathways and screening tools that were based on national guidelines for the management of maternal sepsis, including neonatal sepsis. Staff understood how to identify and manage sepsis in line with policies and national guidelines.

Training in aspects of sepsis management was included in the practical obstetric multi-professional training (PROMPT) undertaken by staff, and this included sepsis simulation exercises, training on administering intravenous medicines and the sepsis 6 care bundle.

The maternity infection report (April 2025) showed 74% of people suspected of sepsis received antibiotics within 1 hour during the past 6 months and 73% compliance was achieved in the 6 months prior to that. This showed most people with suspected sepsis received timely treatment in line with national guidance, but the hospital's 100% target had not been achieved.

Individual staff identified with poor compliance in completing sepsis pathway records received further training to aid learning and improvement. A new sepsis task and finish group had been implemented as part of the deteriorating patient collaborative improvement programme.

The intrapartum theatre teams followed local safety standards for invasive procedures (LocSSIPS) that included swab and instrument counts to minimise the occurrence of never events. The LocSSIPS compliance in the intrapartum areas averaged 95% during the past 12 months, indicating good levels of staff compliance. Compliance was reviewed as part of routine intrapartum working group meetings and additional training around swab counts had been included in PROMPT training to aid learning and improvement.

The design, maintenance and use of facilities, premises and equipment kept people safe. All the areas we inspected were well maintained and free from clutter. There was sufficient space for storage of equipment and consumables. All areas were easily accessible, including for wheelchair access.

A `security policy' and an `infant security policy and the management of suspected or actual infant abduction' was in place to provide guidance for staff. Security risk assessments were also in place to identify and mitigate key risks.

Access to the maternity services was secure, with controlled access and video monitoring. All babies wore an electronic tag which triggered an alarm if the baby was taken outside a set parameter and the alarm triggered an automatic lockdown of security doors. Staff had received training in the baby tagging process and understood what actions to take if an alarm was triggered. A baby tagging daily audit was completed by the maternity bleep holder.

An abduction simulation exercise was undertaken every 6 months. A simulation on the maternity base ward (November 2024) showed effective systems were in place and additional learning was identified around staff awareness of tailgating and for greater vigilance and challenge around entrance / exit to the ward.

People who used the service told us they felt safe and had not experienced any issues relating to equipment and premises.

The majority of equipment we saw was clean, well maintained and within the service, calibration and electrical safety test due dates. Equipment such as beds, trolleys and stands were visibly clean, and staff used disinfectant wipes to clean and decontaminate equipment.

Single use items and consumables were stored safely and were kept within expiry dates. Medical gas cylinders (such as oxygen) were stored securely. Risk assessments and routine testing was undertaken to minimise the risk of occupational exposure to nitrous oxide and anaesthetic gases in the maternity services. There were suitable arrangements for the safe handling, storage and disposal of clinical waste, including sharps.

The service had enough suitable equipment to help them provide safe care and treatment. There was a planned maintenance schedule in place that listed when equipment was due for servicing. Equipment servicing was managed by the hospital's electronic and biomedical engineering teams. Staff told us equipment needed for care and treatment was readily available and any faulty equipment could be replaced promptly.

The medical engineering performance summary report (May 2025) showed most equipment (over 90%) had completed planned preventative maintenance schedules. Maintenance and servicing of overdue equipment was prioritised by risk.

Emergency resuscitation equipment for adults, children and newborns was available in all the areas we inspected, and this was checked daily and weekly by staff. Emergency resuscitation trollies were tagged to minimise the risk that items could be tampered with.

Staff used an electronic system to log equipment checks, including missing / faulty items and expiry dates. The system notified managers if any checks had not been completed and compliance was monitored through routine monitoring and reviewed at maternity resuscitation committee meetings. Records showed average compliance ranged between 85% and 100% during the past 12 months, indicating high levels of staff compliance in undertaking equipment checks.

Staff maintained up to date risk assessments in relation to premises and equipment, health and safety risks and control of substances hazardous to health (COSHH) assessments. There were suitable arrangements in place for fire safety, including clear instructions for staff to follow in the event of a fire. Guidance for staff in the event of a major incident was available in the maternity services and staff were aware of how to access this information when needed.

People who used the service told us there were enough staff to provide safe care and treatment. Some staff on the mat base ward reported workload pressures during periods of increased staff sickness or absence. However, most staff told us staffing levels had improved since our last inspection and their workloads were manageable.

We found there were sufficient numbers of midwifery, medical and support staff in all the areas we inspected. We observed staff interacting with people and saw staff were friendly, calm and polite when communicating with them and delivering care and treatment. We saw staff responded promptly when called for assistance.

Midwifery staffing levels were reviewed against minimum compliance standards, based on a national acuity tool. The expected and actual staffing levels were displayed on notice boards in each area we inspected, and these were updated daily.

The midwifery workforce report (March 2025) reviewed the midwifery and support worker staffing establishment against birth rate plus standards. The report highlighted the clinical (non-specialist) establishment was 334.2 whole time equivalent (wte) staff, which was 2 wte posts above the midwifery plus recommended establishment of 332.2 wte staff.

The report also highlighted the current establishment for management and non-clinical midwifery roles was 22.6 wte which was below the birth rate plus recommendation of 39.9 wte staff. The head of midwifery had submitted a paper to the hospital's management board with suggested areas for improvement. Senior managers reported that recommendations within the staffing paper had been agreed and progress within the division was being made to address the shortfall.

Most pregnant women received 1:1 midwifery care in labour, in line with national guidelines. Between April 2024 and March 2025 audit records showed 1:1 care in labour compliance was at 100% in 9 of the 12 months. Compliance ranged between 99.5% and 99.7% in the 3 months where 100% compliance was not achieved.

Shift fill rate records between February 2025 and April 2025 showed the maternity services achieved average fill rates above 85% for midwifery staff and above 75% for care support workers and healthcare assistants during the day and night shifts.

There were no vacant midwifery staffing posts across the division. There were 14 wte support worker / healthcare assistant vacancies and all vacant posts had been recruited to following interviews held at the end of April 2025.

There was sufficient medical staffing cover across all medical grades. Staff were also supported by a team of advanced clinical practitioners. There was sufficient on-site and on-call consultant cover over a 24-hour period including cover outside of normal working hours and at weekends. There were no vacant consultant posts at the time of our inspection.

Sickness and leave cover was provided by the existing staff and through the use of bank and agency staff. Where bank or agency staff were used, managers made sure they had a full induction and understood the service.

Staff sickness rates in the maternity services were above the trust target of 4.5%. However, the rate had reduced from 7.2% in November 2024 to 6.32% in March 2025. Staff turnover rates were low (5.4% in April 2025) compared with the trust target of 13%.

Staff received and kept up-to-date with their mandatory training. Most staff (93%) had completed mandatory training and the hospital's training completion target of 90% had been achieved.

Staff received a full induction before they started work and had regular clinical competency checks. Most midwifery and support staff (88.5%) across the maternity services had completed annual appraisals within the past 12 months. There was only 1 overdue medical staff appraisal, and this had a planned completion date scheduled. The services reported there were no outstanding issues relating to staff recruitment checks, including disclosure and barring service (DBS) checks.

Staff received competency-based training and development as part of their continual professional development. Competency-based training was provided by trained individuals (such as practice based educators). Competency based training compliance for clinical mandatory training (93.5%) and local mandatory training (91.2%) was above the hospital's compliance target of 90%. Staff were positive about on-the-job learning and development opportunities and felt confident to do their role.

All the areas we inspected were visibly clean and had suitable furnishings which were clean and well-maintained. Cleaning schedules and daily checklists were in place and up to date, and there were clearly defined roles and responsibilities for cleaning the environment and cleaning and decontaminating equipment.

There were enough hand wash sinks and wall mounted hand sanitising gels. We observed staff following hand hygiene and 'bare below the elbow' guidance. Staff used personal protective equipment, such as gloves and aprons, while delivering care. Visitors were encouraged to wash their hands. People identified with an infection were isolated in side rooms.

People who used the service told us they did not have any concerns relating to the cleanliness of the environment and equipment.

Staff understood the processes managing risks associated with infection prevention and control (IPC). They were able to describe how they cleaned and decontaminated equipment. They told us they could seek advice and support from the hospital-wide infection control team when needed.

Staff completed mandatory training in infection prevention and control and aseptic non-touch technique (ANTT). Training compliance was above the hospital's 90% target.

There had been no IPC outbreaks reported by the maternity services during the past 12 months.

The number of healthcare-associated infections (HCAI) attributed to the maternity services during 2024/25 was low. The services reported 1 case of Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia, 2 cases of Clostridium difficile (C.Diff), 3 cases of Escherichia coli (E. coli) and 5 cases of Klebsiella bacteraemia during this period. A multidisciplinary review was undertaken for each HCAI case to aid learning and improvement. All cases had been determined as not preventable.

Routine infection control and hand hygiene audits were carried out to check compliance against infection prevention and control policies and guidelines.

Infection control audits relating to the environment, decontamination of equipment, mattresses and flushing of water outlets (to minimise risk of Legionella) undertaken between January and March 2025 showed high levels of compliance (above 89%) across the maternity services. Hand hygiene audits showed staff in the maternity services consistently achieved average compliance between 94% and 97% during this period. Managers told us shortfalls in hand hygiene or infection control compliance were discussed with individual staff members to improve compliance and followed up at subsequent audits.

Staff followed policies for medicines management and antimicrobial prescribing guidelines. Staff completed mandatory training in medicines management, with a completion rate of 86.5% for medical staff and 98% for midwifery staff. People who used the service told us staff prescribed and administered appropriately.

Medicines including controlled drugs were stored securely and in line with manufacturers guidance and legislation. Temperatures of treatment rooms where medicines were stored and medicine fridges were monitored electronically.

Pharmacy staff support was not provided across all areas of the maternity service and a 5-day service was available to ward areas. Staff told us that they had access to support and advice about medicines when needed including out of hours and on units that had no ward-based pharmacy support.

Following a recent medicine incident there was evidence of investigation and actions taken. Staff on wards were able to discuss learning from incidents and the deputy chief pharmacist had shared the learning nationally.

Medicines were stored securely. We saw rooms that stored medicines were kept locked.

The service had a process for supply of medicines on discharge. Pharmacy staff had audited the service and had piloted a ward-based discharge service to improve the timely supply of medicines on discharge. A different coloured form was used for patients who had experienced a bereavement to avoid any upsetting questions being asked by the dispensing staff.

People were not supported to manage their own medicines if they wanted to whilst an inpatient on the ward. The service currently had no process to be able to do this.

There was a process for medicines to be administered by midwives under the midwife exemption which supports women getting the medicines they need promptly.

The service used an electronic prescribing system to prescribe and administer medicines (EPMA) and a separate system for recording of people’s care records. The EPMA system contained the record of medicines and discharge summary however this was not used when communicating with the GP about medicines, so they did not always get the full information. People’s weights were not always documented on the prescribing system meaning that staff would need to check both systems before prescribing. This meant there was a risk that women’s GPs would not receive up to date information about their medicines whilst in hospital. There was a longer-term plan to implement a single electronic patient record system across the hospital to address this issue.

The ward-based pharmacist on the maternity inpatient unit was trained in counselling and administration of long-acting contraception and this was offered to women post birth.