Macclesfield District General 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

At our last assessment we rated this key question Requires improvement. At this assessment the rating has changed to Good.

This meant women were safe and protected from avoidable harm.

The service worked well with women to understand and manage risks. staff knew how to recognise and report abuse and worked well with other agencies.

The service had made improvements since our last inspection and had plans to recruit additional staff to support the service.

We saw mandatory training compliance had improved since our last inspection.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

At the time of our assessment the service had 103 open incidents on their electronic reporting system of which 47 were overdue. These were overseen by a recently appointed maternity governance lead who was working through the overdue incidents. Incidents were reviewed and investigated by staff with the appropriate level of seniority, such as clinical leads, ward managers and matrons.

The maternity unit had made two referrals to the maternity and newborn safety investigations in the last 12 months. One was referred for trust concerns and the other was for parental concerns. Recommendations were identified and an action plan had been devised.

Some staff we spoke with were unsure how to report an incident but were confident to raise concerns. The service used the patient safety incident response framework (PSIRF) but learning and improving patient safety had not been fully embedded. We saw learning and improvement in the reduction of post-partum haemorrhage (PPH). Staff told us there was little time for educational activities to support learning due to staff rotas and workload.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Pregnant women self-referred into the service using an online form to collect all the essential information so their needs could be met safely. Bookings were reviewed and allocated to midwifery teams or consultants depending on the needs and support of the pregnant women. The service had exclusion criteria and pregnant women were referred to other hospitals for specialist support when needed.

The service ensured continuity of care through the service pathway and staff reviewed and supported people’s care plans where possible. Staff used hospital passports to support women with individual needs and preferences.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff had completed level three safeguarding training for adults and children. Staff knew how to raise a safeguarding concern, and we saw that safeguarding concerns were discussed as part of daily huddles.

There were clear safeguarding systems and processes and practices to protect people from abuse. This included working in partnership with other agencies. We saw examples of safeguarding and multi-agency working during our assessment.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff communicated with pregnant women, so they understood their care and treatment options and risks associated with giving birth. The service offered pregnant women the choice of births at home, in the midwifery led unit or with consultant led care. The level of risk of the pregnancy was reviewed and depending on the required level and frequency of fetal monitoring and auscultation (listening to the baby’s heartbeat during labour) staff escalated care plans if required.

Pregnant women had access to a 24 hour telephone triage service. We saw improvements had been made since our last assessment. A standardised prioritisation process was in place and triage telephone assessments were carried out in a confidential space. The trust had completed an audit to monitor the new pathways and processes within the triage assessment to ensure that pregnant women attending triage received appropriate timely review. From the audit completed 96% were seen within the Birmingham symptom specific obstetric (BSOTS) specified 15-minute initial triage target.

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

Risk assessments were completed and the service had guidelines, pathways and screening tools that were based on national guidelines for the management of sepsis. Training for sepsis management was included in the practical obstetric multi-professional training (PROMPT) undertaken by staff.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The antenatal and maternity units were located on the first floor. At the time of the assessment the maternity emergency theatre had been temporally located to the day case theatre whilst the theatre refurbishment was completed. Two birthing pools were available in the delivery suite.

Access to the maternity unit was restricted by swipe access for staff and buzzer entrance for pregnant women and family. We observed some people following others through open doors into the unit and raised this with the provider during our assessment. The provider made changes during our assessment to address these issues.

All babies wore an electronic tag which triggered an alarm if the baby was taken near the security door. Staff had received training in the baby tagging process and understood what actions to take if an alarm was triggered. During our assessment the tagging system failed, and the provider took appropriate actions to secure the unit until the tagging system was back online. The service had completed simulations to ensure their procedures were safe. These included a women delivering a baby in the emergency department, a post partum haemorrhage and a collapsed newborn. Future simulations included baby abduction and birthing pool evacuation.

The majority of the equipment was clean, maintained, calibrated and electrical safety tests had been completed. A maintenance log was kept including repairs carried out.

Emergency resuscitation equipment for adults, children and newborns was available in all areas we inspected and were tagged to minimise the risk the items could be tampered with. Daily and weekly checks were completed and leaders audited these for compliance. Some of the daily emergency resuscitation trolley checks for June 2025 had been missed, in the antenatal clinic. Following this the task was allocated to a specific member of staff to ensure compliance.

There was a fault with the call bell system for one room. This had been raised and added to the risk register as it kept sounding intermittently, staff continued to check the alarm even when the room was empty.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

The provider had a robust recruitment process to ensure staff were suitably qualified, experienced and competent. Staff training included simulations and emergency drills which were carried out each quarter. At the time of our assessment, a birthing pool evacuation drill had not been conducted and was planned to be completed by March 2026.

Midwifery staff told us there was pressure during periods of staff sickness or absence to ensure adequate cover to keep people safe. Staff worked across the antenatal, delivery and postnatal units. Managers regularly reviewed staffing and reallocated staff to meet the needs of the service. A staffing review was in progress for the service in line with national recommendations. A bi-annual maternity staffing report went to board May 2025 which identified a potential staffing deficit of 8.3 whole time equivalent funded midwifery staff. The maternity service was waiting for a board decision.

Staff appraisals were due annually. Staff appraisal overall compliance was 58.7%. The service had a plan in place to address this.

Training compliance for cardiotocography (CTG) was 93% for midwives and 86% for obstetric doctors, Practical obstetric multi-professional training (PROMPT) compliance was 90% midwives and 93% obstetric doctors, basic adult life support 94% midwives and 84% obstetric doctors, neonatal life support 98% midwives and 100% for Neonatal Specialty Training doctor level 3 or above and special care baby unit staff.

There was adequate 24-hour medical cover. An on-call rota was in place. This included duty cover and obstetric clinics.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection.

We saw exposed instruments such as suction equipment that had not been identified as an infection risk. We found dust on the resuscitation trolley and around the computers on the delivery suite. We raised this with the ward manager at the time of our assessment who took action to address this.

Infection prevention compliance for maternity staff for level 1 as of June 2025 was 100%. However, infection prevention compliance for level 2 was 76.5% for antenatal staff, 54.8% for midwifery teams/ward and 20% for obstetric and gynaecology staff as of June 2025.

Staff used personal protective equipment such as gloves and aprons while delivering care. We saw the wards were generally clean and tidy.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The pharmacy department provided support with medicines supply and stock control.

The service used paper medicines records to prescribe and administer medicines. People’s allergies and medicines were recorded correctly. We spoke with one patient who told us that pain relief was given promptly when requested.

Medicines including controlled drugs were stored securely. If required, emergency medicines for eclampsia and postpartum haemorrhage were accessible and according to Trust policies.

The antenatal unit had enabled the use of Patient Group Directives (PGDs) to allow certain medicines to be supplied in a timely manner without the need for prescription.

Prepackaged medicines which were frequently required to be supplied to patients upon discharge were kept on the ward to facilitate an efficient discharge process.