Basingstoke and North Hampshire 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

Staff assessed women, so the care and treatment met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered.

We observed active discussions around women with complex care who required support to have the birthing experience they wanted, and teams worked with other agencies to develop a multi-agency birth plan.

Staff worked in a culture of evidence-based practice. Staff worked together and with others when assessing women’s needs and shared information to maintain continuity of care.

The effective key question was not rated in the last assessment. During this assessment we rated the service as ‘Good’.

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.

The service always made sure women’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff told us they were well supported by senior colleagues, and they worked together to ensure women made informed decisions based on best practice guidelines.

Staff told us they felt well supported by senior colleagues when women chose care outside of guidance. This meant high risk women who wanted to have a different pregnancy, labour or birth which did not meet trust guidance.

They told us there was a clear policy and process to follow. The maternity service had a consultant midwife whose main remit was personalised care and supporting women who chose care and birth outside of guidance.

Staff referred women to the consultant midwife who triaged the referrals and saw the women with most risk. A detailed care plan was agreed between the pregnant woman and consultant midwife/senior midwife which was communicated to the multidisciplinary team and outlined in clinical notes. Teams worked together to ensure women made informed decisions based on best practice guidelines and supported choice.

The service made sure women’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service planned and delivered women’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

There were systems to communicate changes in national guidance through monthly risk management newsletters, flash alerts and presentations to staff. On this assessment we saw this good practice had continued and was embedded. We also found practice development midwives made use of noticeboards to communicate best practice guidance.

The service planned and delivered women’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff prioritised women needs and supported where safe, women to have the birthing experience they wanted.

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. A maternity guideline committee developed guidelines in the light of new evidence.

Following on from our previous assessment the service had put in place clinical guidelines for reduced fetal movements, out of hours attendance and the triage system. Staff followed up-to-date policies to plan and delivered maternity care according to evidence-based practice and national guidance. We reviewed a sample of maternity policies and found these were in date and referenced appropriate guidance.

The service collaborated with the Local Maternity and Neonatal Systems (LMNS) and other local maternity services to share evidence-based practice in areas to improve the health of women through their maternity journey. For example, there was a new perinatal pelvic health service as part of a regional team. Women with pelvic health dysfunctions in pregnancy or the postnatal period were referred to the pelvic health physiotherapy team.

The maternity service always worked extremely well across teams and services to support women. They shared thorough assessments of women’s needs when they moved between different services.

All staff we spoke to were positive about the teamwork in the service and staff were spoke very highly of the senior leadership team and always felt supported. Staff told us there was no inequity between the two locations we assessed, and staff felt they were treated fairly.

All relevant staff, teams and services worked collaboratively in assessing, planning and delivering women’s care and treatment.

The service worked well across teams and services to support women. Twice daily huddles and multidisciplinary handovers were held to support safe transition of care between teams during shift changes. Potential and planned discharges were supported through daily meetings with referrals made prior to discharge.

Student midwives were extremely well supported by the trust, with daily student huddles in place to give students the opportunity to escalate any concerns or feedback. There was a focus of ensuring the students workload did not affect the student’s experience whilst on the unit.

Staff reported positive working relationships between medical teams and maternity teams. We saw and heard many examples of effective team working between teams.

The maternity service offered choices to improve women’s choices and personalise their care and worked closely across the Local Maternity and Neonatal Systems (LMNS). The service was part of the LMNS personalisation and choice steering group and were piloting choices of integrated care plans into the electronic records.

Consultant midwives worked alongside obstetricians and specialist teams and midwives to provide a birth planning advice and support for women who had complex pregnancies for example, previous birth trauma, or medical and social concerns.

The service worked with the maternity mental health service psychologists to create trauma informed care plans for women and the maternity continuity teams prioritised women with additional complexities. The continuity teams worked with women who were non- English speaking, teenage mothers, learning difficulties and alcohol and substance misuse.

The service supported women to manage their health and wellbeing to maximise their independence, choice and control. Staff supported women to live healthier lives and where possible, reduce 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. All women who declared their smoking status, had a raised CO score or those women who had quit smoking in the last 2 weeks received smoking cessation support from a trained tobacco dependency advisor.

The electronic system did not support recording smoking status at 36 weeks; therefore, the service had agreed at region to add this as a mandatory field to the electronic notes system and were awaiting a system’s fix at the time of the visit.

The service had a well-established 24-hour, 7 day a week maternity triage telephone line partnership with other maternity services in the local maternity and neonatal systems (LMNS).

The service was using an NHS healthier together app to enable women with antenatal or early labour concerns to self-triage and be signposted to information and personalised advice. The app was available in multiple languages.

The oak team provided specialist and enhanced care during antenatal and postnatal period for women with a higher risk of poor outcomes in pregnancy. The team had a midwife champion who taught midwives how to provide resources and guidance to women. The team provided healthy start vitamins and aspirin take home packs for vulnerable women postnatally to ensure barriers to healthcare for them were reduced.

The maternity, neonatal voice partnership (MNVP) had established a birth equity group to gather and shared feedback from families to drive improvement within maternity services.

The maternity service delivered mandatory anti-racism/ unconscious bias training to multi-professional teams based on Hampshire Hospital Foundation Trust case studies.

The service routinely monitored women’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of women 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.

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.

There was an ongoing internal programme of monitoring and assurance with divisional and executive oversight. There was a clear focus to improve the quality and safety of maternity care by analysing and sharing outcomes. As part of the perinatal mortality review toolkit the service completed monthly meetings as part of a multidisciplinary team to review and grade care provided during pregnancy, labour, birth and postnatally. The review enabled the team to identify areas of improvement as well as identify areas of good care.

An example, of improving outcomes was the recognition that the service had a high number of babies treated for physiological jaundice and were being readmitted for treatment postnatally. Following identification, the service changed the way blood samples were analysed, and all samples were sent for laboratory testing rather than locally resulting in a significant reduction in babies readmitted for treatment of jaundice. The outcome was a clinical change in practice across both acute sites, and all tests are now sent for laboratory testing only.

The maternity service had clear performance measures and monitored key performance indicators (KPIs). The maternity dashboard was presented in a format to enable it to be used to challenge and make improvements.

Data indicated the trust had a higher-than-expected incidence of Obstetric, Anal. Sphincter Injury (OASI) occurring across the service. OASI is an obstetric anal sphincter injury that can occur during vaginal birth, it is also referred to as 3rd or 4th degree tears. The service completed a thematic review of OASI to identify the cause which took into account maternal demographics and risk factors for OASI such as previous history, speed of birth and interventions used.

Women from ethnic groups are more at greater risk of OASI due to risk factors such a communication. To increase the support given to women from ethnic groups the service had a higher focus on providing perineal care for women from ethnic groups.

Staff had clear guidelines on the use of the maternity risk review tool. Staff compliance of key performance indicators was monitored via an electronic dashboard. Leaders reviewed weekly compliance reports including key performance indicators at the weekly safety summit.

Post partum haemorrhage (PPH) rates above 500ml and above 1500ml were monitored monthly and reported locally through the LMNS dashboard. The service found the PPH rates for women at Basingstoke and North Hampshire hospital were around the national average of 4%. The service had identified a difference in PPH rates between the two obstetric locations, with the other location just above the national average at 4.7%.

A new trust PPH guideline that included a PPH risk assessment was produced and a thematic analysis of all PPH rates above 1000ml at planned caesarean births were presented to the monthly governance meetings. The analysis was reported to have shown there had been an increase in the complexity and higher number of pregnancies for women birthing there. Further teaching on PPH during prompt training as well as updates during safety huddles. We saw PPH flowcharts on managing 3rd stage labour in all clinical areas.

The maternity service completed a thematic review of the maternity and neonatal safety investigation (MNSI) recommendations from cases to look for themes regarding fetal monitoring and hypoxic-ischemic encephalopathy (HIE). MNSI case numbers were small, and the service reported it was difficult to identify a theme as each case was uniquely individual.

The fetal monitoring leads reviewed fetal monitoring and HIE audits and found themes around incomplete documentation by the obstetric team such as a lack of detail. There were gaps in audit regarding communication between the obstetric and neonatal teams in preparing birth equipment and escalation when baby requires further resuscitation. The matrons were working with teams to ensure equipment was clean and fully stocked before and after every use. During our assessment we found all emergency equipment was fully stocked and clean.

TThe service told women about their rights around consent and respected these when delivering person-centred 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 that they were able to give informed consent.

Midwives understood how to assess women’s capacity to make decisions.

On our review of women’s records we found completed consent forms for caesarean sections as well as when gaining verbal consent when completing care.

There were up-to-date policies and procedures, which were accessible to staff through the trust’s intranet site.