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Northampton General Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 October 2019

Our rating of services went down. We rated them as requires improvement because:

We rated safe and well led as requires improvement and effective, caring, and responsive as good. We rated two of the hospital’s eight core services as requires improvement and six as good. In rating the hospital, we took into account the current ratings of the five services not inspected this time dating from 2017.

  • The trust provided mandatory training in key skills to all staff but did not ensure that everyone completed it.
  • The design, maintenance and use of facilities, premises and equipment generally kept people safe. However, staff did not always manage clinical waste or hazardous chemicals well.
  • The trust did not always have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. However, managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, and up to date, however, they were not always easily available to all staff providing care.
  • Trust staff did not always follow its systems and processes to safely administer, record and store medicines.
  • The trust managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents although they did not consistently share lessons learned with the whole team and the wider service. However, when things went wrong, staff apologised and gave patients honest information and suitable support.
  • Managers did not always ensure that actions from patient safety alerts were implemented and monitored.
  • The trust provided care and treatment based on national guidance and best practice. However, some guidance on the trust intranet was not always up to date.
  • The trust planned and provided care in a way that met the needs of local people and the communities served. However, it did not always work effectively with others in the wider system and local organisations to plan longer term care needs.
  • People could not always access services when they needed it and as a result did not always receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were consistently worse than national standards. The trust did not achieve NHS constitutional standards in its urgent care service.
  • The trust treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. However, complaints were not always managed in line with the trust’s own timescales. Not all clinical areas displayed information about how to raise a concern or make a complaint.
  • Leaders had the, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They supported staff to develop their skills and take on more senior roles. However, not all staff reported that senior leaders were visible and approachable.
  • Staff did not all feel respected, supported and valued, staff feedback and experience showed a culture of bullying behaviour. However, staff were focused on the needs of patients receiving care. Not all staff felt that they were kept fully informed or had their views listened to and acted upon.
  • Leaders and teams generally used systems to manage performance effectively. However, quality measures were not consistently collected in the maternity service.

However:

  • Staff understood how to protect patients from abuse and services worked well with other agencies to do so. Most, but not all staff, had training on how to recognise and report abuse, and they knew how to apply it.
  • The trust generally controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The trust made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The trust provided services that were inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Leaders operated effective governance processes, throughout the trust and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • The trust collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • The trust promoted equality and diversity in daily work and provided opportunities for career development for those with protected characteristics. The trust had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.
  • Staff identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
Inspection areas

Safe

Requires improvement

Updated 24 October 2019

Effective

Good

Updated 24 October 2019

Caring

Good

Updated 24 October 2019

Responsive

Good

Updated 24 October 2019

Well-led

Requires improvement

Updated 24 October 2019

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 24 October 2019

Our rating of this service went down. We rated it as requires improvement because:

  • Mandatory training in key skills was not completed by all staff. In particular, medical staff were not up to date with their safeguarding training, mental capacity training and mandatory training.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. However, we found clinical waste, such as aprons and gloves, in black bags in some medical wards we visited and there was insufficient assurance that this was appropriate. Chemical products deemed as hazardous to health were in locked cupboards but, some locked cupboards had the access code to the cupboard clearly identified, so unauthorised people could access hazardous chemicals.
  • The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
  • The Heart Centre often had medical outliers occupying their beds. However, the facilities or the environment were not suitable for medical outliers. We also found medical outliers were not seen in a timely manner. We found the current system to review medical outliers was not effective, as some patients on outlier wards were not reviewed by a consultant daily.
  • The use of beds in the Heart Centre for outlying patients meant heart patients could not be seen. There was inequity in the management of NHS and private patients within the centre as a result.
  • Ambulatory care and the renal rooms did not have local safety standards for invasive procedures (LocSSIPs).
  • Not all patients’ medical records were stored securely. We saw some medical notes trolleys left unlocked and unsupervised. This was raised as a concern during our last inspection.
  • While the service provided care and treatment based on national guidance and best practice, some policies and guidance had expired their review date. This meant there was a risk that staff were referring to out-of-date guidance.
  • The service culture did not always support staff to raise concerns. We generally observed good working relationships across the service and it was evident that staff morale was good in most areas we visited. However, in a few areas we visited, staff expressed low morale and lack of support from their managers. In addition, we observed poor staff interactions in some medical areas we visited.
  • Although leaders understood and managed the strategic priorities and issues the service faced, there was lack of oversight in some operational matters.

However:

  • The service generally had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well.
  • The service generally controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could generally access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Services for children & young people

Good

Updated 8 November 2017

We rated this service as good because:

  • There was a well-embedded culture of incident reporting and staff said they received feedback and learning from incidents.
  • Safety thermometer data from the last 12 months reported 100% of “harm free” care in the child health directorate.
  • There were clear arrangements in place to safeguard children and young people from abuse, which reflected relevant legislation and local requirements. The majority of staff had undertaken the required level of safeguarding training.
  • The service performed well in a number of national audits including the National Neonatal Audit (2015) and the epilepsy 12 audit (2014). Gosset ward was working towards achieving Bliss accreditation.
  • Staff had the clinical skills, knowledge, and experience they needed to carry out their roles effectively. Mandatory training and appraisal levels were above trust targets.
  • Actual nurse staffing levels met planned rotas during our inspection and patient’s needs were met. Medical staffing was appropriate and there was an effective level of cover to meet patients’ needs.
  • Feedback from children and parents was consistently positive and parents told they were treated with dignity and respect.
  • Services were responsive to the needs of patients, parents and families and were working towards delivering sustainable seven-day services.
  • Staff felt that local leadership was strong with visible supportive and approachable managers.
  • The child health directorate was continually developing patient services to ensure innovation, improvement, and sustainability.

However:

  • There were not always effective systems in place regarding the storage and handling of medicines in the children’s outpatient department. The trust took immediate action to address this once we raised it as an urgent concern.
  • Children or young people on Paddington ward could access the corridor to the delivery suite. This was a risk particularly for patients who may be at risk of self-harm or suicide. The trust took immediate action to address this once we raised it as an urgent concern.

  • The pathway for patients who needed to cross the road between buildings had not been reassessed to ensure opportunities to prevent or minimise further harm were not missed. The trust took immediate action to address this once we raised it as an urgent concern.
  • The child abduction policy was in draft and awareness was lacking in some areas of the service. The trust took immediate action to address this once we raised it as an urgent concern.

Critical care

Good

Updated 8 November 2017

We rated this service as good because:

  • There was a strong culture of reporting, investigating and learning from incidents. Learning was shared throughout the team.
  • Adequate medical and nursing staff was provided to meet the recommended staff to patient ratio, as defined in the core standards for intensive care units.
  • There were effective systems in place to protect patients from avoidable harm and improve compliance with standards on a continuous basis. The principles of the duty of candour were well understood by all staff.
  • There was clear evidence and data upon which to base decisions and look for improvements and innovation. The unit participated in the Intensive Care National Audit and Research Centre (ICNARC) audit and performed better or as expected in six out of eight indicators.
  • The critical care outreach team provided 24 hour cover seven days a week cover and assisted with the monitoring and treatment planning of deteriorating patients throughout the hospital, ensuring risks were responded to appropriately.
  • Staff were very caring and kind and provided emotional support for patients and relatives, for example, through the use of patient diaries.
  • Leadership was well established and there was a clear focus on improvements and patient safety.
  • Structured meetings were held throughout the directorate to review all aspects of quality, risks and performance and high risks were escalated and monitored effectively.
  • Effective governance arrangements were in place. There were structured meetings to review all aspects of performance, quality and risks and high risks were escalated through the directorate. Innovation throughout the staff team was encouraged.

However:

  • The pharmacy team were aware of the shortfall in band 8a specialist pharmacist support and were providing cover with a band 7 pharmacist. A business case had been put forward, which if successful, would ensure standards were being met.
  • Medicines were not always stored safely behind locked doors or in restricted areas. We raised this with the trust and this was rectified immediately by the trust.
  • The unit did not comply with the Department of Health’s Health Building Note 04-02 critical care unit’s standards; however, this had been risk assessed and was under review. Refurbishment plans were in place to address this.
  • Not all medical staff had completed the required mandatory training.
  • Hospital wide bed capacity affected the ability of the service to discharge patients to wards at the most appropriate time. Over eight hour delayed discharges were higher than the national average, however, action had been taken and improvement observed for patients waiting 24 to 48 hours.

End of life care

Good

Updated 23 May 2017

We rated the service as good overall. Many improvements had been made to raise the profile for the end of life care service in the trust and this had led to improvements in the way patients received safe, compassionate care in their last days. However, more work was required to collect performance information about the service and ensure that mental capacity assessments underpinning decisions about cardiopulmonary resuscitation were being evidenced in patients’ records.

Outpatients and diagnostic imaging

Good

Updated 8 November 2017

Overall, we rated outpatients and diagnostics as good. We inspected but did not rate the effectiveness of the service, as we are currently not confident that we are collecting sufficient evidence to rate this key question for outpatients and diagnostic imaging. We rated this service as good because:

  • Staff were aware of their responsibilities and understood the need to raise concerns and report incidents. Staff told us they felt fully supported when raising concerns.
  • Generally, the design, maintenance, and use of facilities and premises met patients’ needs. The maintenance and use of equipment kept patients safe from avoidable harm. Improvements had been made in some areas in the outpatient environment, which included the expansion of the chemotherapy suite and new equipment in the diagnostic imaging department.
  • Appointments were prioritised according to referral requests from GPs with urgent requests and cancer referrals booked within two weeks. The imaging department prioritised reporting higher risk examinations not seen by other clinicians.
  • We found that medical and nursing staffing levels and skill mix were planned and reviewed so that patients received safe care and treatment.
  • Care and treatment was delivered in line with national guidelines. Staff within the service had the appropriate skills, qualifications, and knowledge to complete their roles safely.
  • All teams reported effective multidisciplinary working.
  • Patients were treated with compassion, dignity, and respect.
  • Feedback from patients and those close to them was positive about the way they were treated.
  • Staff made patients’ appointments according to the needs of the individual. This included moving them to allow work and other appointments to take place.
  • The service consistently met the referral to treatment standards over time. Waiting times for diagnostic procedures was lower than England average. The service was meeting cancer targets for referral to treatment times at the time of the inspection.
  • The "did not attend" (DNA) rate for the trust from June 2016 to May 2017 was 7% and this was same as the England average of 7%.
  • Outpatient specialties ran additional evening and weekend clinic lists to reduce the length of time patients were waiting. The radiology department offered a walk in service for all plain film examinations.
  • Services were tailored to meet the needs of individuals and offered flexibility in choice with appointments being flexed across a seven day service within the diagnostic imaging department.
  • The service had a challenging and innovative strategy that supported the trust vision. This included redesign of departments, introduction of support systems to improve performance and repatriation of services to improve patient experience.
  • Staff had awareness of the trust vision and strategy. Staff were aware of the risks within their departments. Staff were proud to work at the hospital and passionate about the care they provided.
  • The service had leadership, governance and a culture which were used to drive and improve the delivery of quality person-centred care.
  • Staff felt that managers were visible, supportive and approachable. Specialties were focused on developing services to improve patient care.

However, we also found that:

  • We found concerns about the fire exit in the fracture clinic. This had been addressed by the unannounced inspection and we found the service had also reviewed all fire exits throughout the service.
  • We observed poor infection control practices in both the blood-taking unit and the pain relief clinic. We raised this with the service, and immediate actions were taken to review infection control precautions to mitigate risk. This had been addressed by the unannounced inspection.
  • We found issues with the storage of controlled drugs in the pain relief clinic. However, when we raised this with the service, senior managers took immediate action to address storage of these drugs. This had been addressed by the unannounced inspection.
  • Not all staff had received the required frequency of mandatory training, including safeguarding. Plans were in place to address this.
  • We observed poor infection control practices in both the blood-taking unit and the pain relief clinic. We raised this with the service and this had been rectified by the time of our unannounced inspection.

Surgery

Good

Updated 23 May 2017

We rated the service as good overall. Many patient outcomes were better than the national average and a strong safety culture was prevalent in wards and theatres. Staff delivered safe, effective care and treatment with compassion and respect. 

Urgent and emergency services

Good

Updated 24 October 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service provided mandatory training in key skills including the highest level of life support training to all staff and made sure everyone completed it.
  • Staff completed risk assessments for each patient promptly. They removed or minimised risks and updated the assessments. Staff identified and quickly acted when patients were at risk of deterioration.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

  • Safeguarding children level 3 training compliance for medical staff was worse than trust targets. However, when we spoke with staff, all knew about the processes and policies to protect patients from abuse and worked well with other agencies to do so.
  • Patient group directions were not updated on the trust internal website.
  • The paediatric emergency department was too small to accommodate the numbers of children’s attendances. However, children were kept safe.
  • People could access the service when they needed it but did not always receive care promptly. The trust did not meet national standards for the percentage of patients admitted, transferred or discharged within four hours from August 2018 to March 2019. The median time from arrival to treatment was worse than the national average. However, during the inspection period they met the targets and no patients were at risk.

Maternity

Requires improvement

Updated 24 October 2019

  • Staff did not always follow systems and processes when safely prescribing, administering, recording and storing medicines. Medicine waste and returns were not stored securely. Which was a breach of Regulation 12; Safe care and treatment 12 (2) (g)- The proper and safe management of medicines. Staff must follow policies and procedures about managing medicines, including those related to infection control. These policies and procedures should be in line with current legislation and guidance and address storage, and disposal.
  • It was easy for people to give feedback about care received. However, we did not see information displayed about how to make a complaint. Which was a breach of Regulation 16: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Receiving and acting on complaints (2) .The registered person must establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity. Information and guidance about how to complain must be available and accessible to everyone who uses the service.
  • The service did not always have enough maternity staff with the right qualifications, skills, training and experience to provide the right care and treatment. However, managers recognised current budgeted staffing levels were not sufficient to meet increased activity and births and managers regularly reviewed and adjusted staffing levels and skill mix. An escalation plan was in place to address staffing issues.
  • Complaints were not dealt with in the timescales set out by the trust and we were not sure they shared lessons learned with all staff.
  • Although the service worked with others in the wider system and local organisations to plan care, we were not sure they planned and provided care in a way that met the needs of local people and the communities served.
  • We were not sure that people could access the service when they needed it and receive the right care promptly. Managers did not always monitor waiting times in clinics so we could not be sure women could access services when needed and receive treatment within agreed timeframes.
  • Although there were examples of evidence where staff were committed to learning and improving services, for example, work being carried out to reduce the number of stillbirths and undiagnosed small for gestational age babies, there were a number of examples where opportunities had been missed. For example, the service did not formally monitor delayed discharges or how frequently induction of labours or elective caesarean sections were delayed or cancelled. This meant there was no analysis to monitor trends and plan the service.
  • Although the service had managers who demonstrated an awareness of the performance and challenges, prompt action was not always taken to address the concerns identified within the service. Staff feedback about ward managers and matrons was positive. However, feedback about the senior leadership team was variable. Not all staff were able to describe the management structure. Not all staff were able to identify divisional leaders. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.

However:

  • The service provided mandatory training in key skills to all staff and made sure most medical and midwifery staff completed it.
  • Staff understood how to protect women from abuse and the service worked well with other agencies to do so. Most staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect women, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon women at risk of deterioration.
  • Staff kept detailed records of women’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service generally managed patient safety incidents well. Staff generally recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, women and visitors.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of women subject to the Mental Health Act 1983.
  • Staff gave women enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for women’ religious, cultural and other needs.
  • Staff assessed and monitored women regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for women. They compared local results with those of other services to learn from them. The service acted promptly to address any patient outcomes that were not in line with trust thresholds or national averages, for example, the caesarean rate had improved and were reported to be similar as expected.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, midwives, nurses and other healthcare professionals worked together as a team to benefit women. They supported each other to provide good care.
  • Staff gave women practical support and advice to lead healthier lives.
  • Staff supported women to make informed decisions about their care and treatment. They followed national guidance to gain women’s consent. They knew how to support women who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit women' liberty.
  • Staff always had access to up-to-date, accurate and comprehensive information on women’ care and treatment. All staff had access to an electronic records system that they could all update.
  • Staff treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to women, families and carers to minimise their distress. They understood women’ personal, cultural and religious needs.
  • Staff supported and involved women, families and carers to understand their condition and make decisions about their care and treatment.
  • The service was inclusive and took account of women’s individual needs and preferences. Staff made reasonable adjustments to help women access services. They coordinated care with other services and providers. However, we did not see all information leaflets were available in all languages spoken by the women and local community.
  • The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued by local management. They were focused on the needs of women receiving care. The service provided opportunities for career development. However, there had been a number of concerns raised about leadership in the maternity service and actions were being implemented to address issues in the directorate, including a values in practice session and the setting of behavioural house rules.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities, however we could not evidence that all frontline staff had regular opportunities to meet, discuss and learn from the performance of the service. While we saw risk issues and themes were discussed, we did not see evidence of detailed discussion about actions taken in minutes reviewed.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff engaged with women and staff to plan and manage services. They collaborated with partner organisations to help improve services for women. However, although staff felt they were always kept informed and consulted about changes to the service provision, they did not always feel their views were listened to or acted upon.