Great Western 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

We looked for evidence that women had the best possible outcomes because their needs were assessed. Women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question good. At this inspection effective has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

We scored the service as 3. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff told us they were supported by senior colleagues, and they worked together to make sure women made informed decisions based on best practice guidance. Staff were able to describe how they assessed and reviewed women’s needs from the antenatal to postnatal period to provide holistic support.

Women were involved in the assessment of their needs, and support was provided to maximise their involvement. Women’s needs were individually assessed at each point of contact and care plans were available to identify and review women’s care and any ongoing conditions. Personalised care plans were made if women needed individualised care and they were referred to specialist clinics. For example, birth choices and diabetes.

Staff used daily situational, background, assessment and recommendation (SBAR) to communicate important information about a woman’s condition and to determine risk.

Staff carried out risk assessments for women during antenatal care in line with national guidance. Assessment tools were used to support the assessment of women and their baby’s health and care needs. For example, maternity staff used the Modified Early Obstetric Warning Score (MEOWS) to recognise women who were becoming unwell.

Women’s needs were assessed in triage by experienced midwives and doctors using a recognised national risk review tool, but not all women were seen within the initial assessment timeframe of 15 minutes.

The lead bereavement midwife was undertaking a gap analysis of bereavement care provided within the trust using the national bereavement care pathway audit tool for women who had experienced pregnancy loss. The aim of the pathway was to align standards of care for all women who had experienced pregnancy loss from 14 weeks gestation. The current pregnancy loss care was prior to 20 weeks.

The perinatal mental health team consisted of a perinatal mental health consultant lead and a lead specialist midwife. The perinatal mental health midwife was linked to the Ocean birth trauma and loss team and there was also a clinic twice monthly to support women with complex mental health needs. The Ocean team worked with women who were experiencing mental health difficulties related to pregnancy and birth.

We scored the service as 3. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided up to date evidence-based practice in line with national guidance make sure patients had good outcomes. Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. These included National Institute of Health and Care Excellence (NICE) and Royal College of Obstetricians and Gynaecologists (RCOG). Staff had access to guidelines on the trust’s intranet system.

Polices and guidelines were updated by the multi-disciplinary team and once a policy was reviewed, it was circulated across all staff within the maternity and neonatal department for a consultation period of four weeks.

The trust participated in the maternity incentive scheme and had reported that it would be declaring compliance within all 10 maternity safety actions. The maternity incentive scheme is a financial incentive program designed to enhance maternity safety within NHS trusts.

The service benchmarked maternity data against other local maternity units to improve variations in the quality of care and improve safety outcomes for women and their babies.

We scored the service as 3. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they worked well as a team and there was a good culture between midwives and obstetricians. Staff reported effective working relationships, and we saw teams took part in well-structured and informative handovers.

Staff considered women’s individual needs, circumstances, ongoing care arrangements, with maternity safety huddles on the delivery suite.

Senior leads were reported to be responsive when there was challenge within the team and there was e-learning available for staff around team working and dynamics.

Medical handovers took place twice daily and was framed using the SBAR tool, all staff introduced themselves and attendance was recorded. Handovers included the obstetric, anaesthetic, midwifery and patient safety team. Activity in all areas of the maternity unit was discussed including elective caesarean sections and inductions of labour.

The virtual midwifery safety situation meeting was well attended by all staff groups and chaired by the inpatient services matron. The meeting included teams from maternity governance, IT, community leads, antenatal and postnatal service, safeguarding and the neonatal team. Updates regarding staffing and on call status were provided. Incidents which had been reported overnight were shared by the governance team and the community matron gave updates relating to the number of booked homebirths within the community.

The service had a homebirths safety prompt to ensure the safe operational running of the homebirth service. The prompt detailed the homebirth team’s access to the senior on-call midwife and the acute unit coordinator, hot week consultant and an escalating process.

We scored the service as 3. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff assessed women's health when admitted and provided support for any individual needs to live a healthier lifestyle. Women were asked about their smoking status at their booking appointment, and all women were offered carbon monoxide screening. The trust website had a page dedicated to advice and support during pregnancy including health in pregnancy service, family planning and a page dedicated to parent resources.

During our inspection we saw health promotion and advice throughout the maternity service for women and their families on information boards.

The service was proud in the work they had achieved regarding supporting infant feeding and were recognised for improved infant feeding support by the Royal College of Obstetricians and Gynaecologists. The service facilitated an infant feeding support group on Hazel ward which gave women the opportunity to attend to ask questions, gain advice and support. The infant feeding team were in the process of working towards the infant feeding gold award. The gold award is a prestigious accolade awarded by UNICEF to services that have achieved the highest standards of feeding care.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff were supported by leaders to take steps to improve patient outcomes, through a variety of methods. This showed the service regularly reviewed the effectiveness of care and treatment through local and national audits.

We saw daily huddles and multi-disciplinary handovers to support safe transition of care between teams during shift changes. Potential and planned discharges were also supported through daily meetings, with referrals made prior to discharge.

The service used a live dashboard to measure performance which was accessible to senior leaders. Leaders monitored outcomes on the maternity scorecard, which provided statistical information monthly. When these statistical figures were outside national standards, they were discussed at risk meetings. The director of midwifery (DOM) reviewed and analysed monthly data to ascertain where there was a need to focus and improve.

Leaders shared accurate and up-to-date information about effectiveness internally and externally and took steps to make sure staff understood it. They regularly monitored safety outcomes in maternity services through reviewing data from MBRRACE-UK reports, National Maternity and Perinatal Audit reports, Friends and Family test and surveys.

The service worked closely alongside the MNVP and the local, maternity and neonatal systems (LMNS) to listen to women and used local data to monitor and identify variations in women’s access, experience, and overall maternity outcomes. Ethnicity and deprivation were monitored when reviewing maternal and neonatal outcomes to ascertain how this impacted care delivery.

From August 2025 the service used the perinatal quality oversight model to provide a structured framework for identifying and responding to quality and safety risks. The model used the maternity outcomes signal system to enable real time monitoring of critical safety issues within intrapartum care. The aim of the system was for the service to identify adverse maternity outcomes. For example, still births and neonatal deaths.

Due to previous higher levels of post-partum haemorrhage (PPH) rates the service introduced a PPH working group in February 2025 which provided multidisciplinary oversight and a targeted action plan. The team included an obstetrician, senior midwife and the patient and quality team for overall oversight. The service had seen a reduction in PPH rates above 1500ml, and the service was no longer an outlier. However, the rate for January 2026 was higher than the national average with the trust rate being 44 per 1000 births compared to the national average of 32 per 1000 births. To ensure continuing improvements the MDT group continued to have oversight and an ongoing action plan for monitoring.

There had been a deep dive obstetric anal sphincter injury (OASI) re-audit completed between January to May 2025. Data showed the number of 3rd and 4th degree tears between October 2025, and January 2026 were either in line or below the national average for women.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

All women we spoke with felt they had been given enough information, including risks and benefits, to make an informed decision about their care and treatment and were able to give informed consent.

Midwives understood how to assess women’s capacity to make decisions. When women lacked capacity, staff supported women to make decisions within their best interests.

Women’s records found consent forms for caesarean sections were completed, and verbal consent was gained when providing care.