Leeds General Infirmary

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At this inspection we rated this key question as good.

Babies’ and families’ needs were assessed in accordance with up-to-date best practice. Families had options available to them to support involvement in their babies’ care. Leaders supported joined up team working. The service used current outcomes and recognised audit tool measures to create improvement plans.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Families were encouraged to be involved in the assessment and planning of their babies’ needs and their own needs. We saw and heard that the family integrated care team actively worked to encourage parent and carer involvement. Families could download an application to access a daily diary. This would allow families to stay up to date with their babies’ care.

We reviewed National Neonatal Audit Programme results and saw that Leeds neonatal services scored above average for documented consultation between senior clinician and parent within 24 hours of admission. However, the proportion of reported baby care days that had a consultant led ward round with at least one parent included fell below the national proportion. We saw there was consideration to include parents when they were present on the ward with consultant reviews whether this fell into normal ward round times or outside of the planned round. We observed multidisciplinary ward rounds involved parents and families, in particular those with babies requiring specialist surgical care. The trust reported there was also consideration to use video calls for ward rounds where parents could not be present. We did not see that this had been put into practice at the time of inspection.

We reviewed notes and saw that babies needs were reviewed throughout the day and family’s needs were also taken into consideration. For example, mental health needs.

There was a multi-disciplinary approach to care planning. We observed a weekly board round that involved a range of professionals and supported holistic care planning.

Daily assessments were recorded on electronic records and some on cot side paper records. Assessments were up to date and accessible by all staff. However, three different electronic recording systems were in use. These systems did not interface with each other. Although the trust told us staff were used to working across these systems, there was a risk that information could be missed.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The neonatal service had developed local guidance for management of their preterm infants. This set out processes for care from pre-birth through to the early days of life. A range of evidence-based practice and national guidance was referred to in the development of this document and underpinned all aspects of nursing and medical practices. We reviewed a range of individual procedure guidelines that were underpinned by up to date evidence based practice and would be reviewed at regular intervals by appropriate neonatal team members. The compliance rate was 94%. However, we reviewed children’s CSU meeting minutes and saw that eight sets of guidelines relating to care of neonates were overdue for review by more than six months.

The team were working in collaboration with other neonatal services in neighbouring Yorkshire NHS trusts to develop a passport that would promote a bundle of evidence-based interventions across the area for preterm babies.

We spoke to allied health professionals during inspection who were dedicated to providing care that was evidence based and spoke with confidence about their valued role within the service. However, allied health professional staff recognised that there were challenges to sharing evidence-based practice and supporting colleagues to learn new approaches as staffing levels fell short of the recommended levels for the unit. There was a risk that not all babies would receive the full extent of neurodevelopmental support they required or that families could access all support on offer.

Evidence based guidance was in place for neonatal parenteral nutrition. There was a consultant with a specialist interest in nutrition who worked closely with the MDT to review growth on a weekly basis. Nutrition and feeding were discussed daily in ward rounds and hand over and at weekly board round meetings.

Pain management techniques such as breastmilk, comforting and containment were routinely used during procedural events.

Staff discussed opportunities in place to support and manage care for parents and babies expecting subsequent births.

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

The neonatal unit was located adjacent to the delivery suite theatres. This supported effective team working between maternity and neonatal staff. We observed a transfer of care between the two units during our inspection. We saw that the handover took place smoothly with all procedures being explained to a family member. Families we spoke to during inspection all told us that they had been kept fully informed about the care of their babies.

We observed ward handovers and daily huddles and saw good communication and detailed discussion regarding babies.

Staff worked across hospital sites. Staff were supported to work in all areas of the neonatal service to ensure a consistent approach and maintenance of skills. This supported team working.

Staff and leaders told us about a range of multidisciplinary team meetings that provided essential communication opportunities. These meetings supported babies and families as they moved between services and when they had involvement from a range of teams and care providers.

The neonatal unit had direct links with local hospices for joined up working when such support was needed.

The outreach team worked closely with health visitors and social care services when needed. Specialist surgery teams worked closely with referring hospitals and specialist staff within the region. Babies were repatriated to either their home region or the referring service as soon as they were well enough for transfer.

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, reduce their future needs for care and support.

The team provided a range of information about health and wellbeing for families and babies. We saw posters displayed in the unit and education sessions co-ordinated by the family integrated care team. These sessions were available for all families and carers to book themselves on to.

There were posters on breast feeding support and mothers were provided with detailed information on how to provide nutritional care for their babies according to their individual needs and choices. Parents were encouraged and supported to provide care for their baby to provide a smoother and possibly faster discharge home. Skills taught by neonatal staff included administering medicines, bathing and weighing their baby.

The team ensured appropriate health screens were carried out in a timely way. Families were supported to access immunisations for their babies.

The outreach team also held specialist clinics including a respiratory syncytial virus (RSV) clinic.

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

There was a quarterly audit programme in place. This formed part of the mandatory annual audit programme for the trust.

The trust ensured delivery of evidence based practice interventions to improve outcomes for pre-term infants. Clinical monitoring tools included a skin condition tool to avoid skin damage, central line, and pain management.

The service worked closely with the Yorkshire and Humber Operational Delivery Network (ODN) and were active in reviewing their current position of service provision against recommendations from national guidance. Actions were identified as part of this work.

The service actively submitted data to the National Neonatal Audit Programme. This allowed for benchmarking against other organisations and identification of any outlier areas. We saw some positive outlier areas that were recognised and shared as good practice across the neonatal service within the trust. We also saw areas for improvement that had been identified by the neonatal teams following the audits. We saw action plans were put in place when areas for improvement were identified.

The trust had achieved the UNICEF UK Baby Friendly Initiative (BFI) neonatal unit standards in June 2024.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Plans of care were discussed as routine practice and where possible families were involved in discussions. Consent was documented for routine procedures such as immunisations. Where complex care such as surgical procedures were provided detailed information was discussed with parents and carers allowing informed decisions to be made. Parents told us the team were informative, supportive, and took care to explain risks and benefits of surgical options before obtaining consent. They said they never felt pushed to give consent.

A consent for common neonatal investigations, interventions and treatments checklist had been agreed for use by a working group.

Consent audits were completed. There were no results for the most recent consent audit available at the time of inspection.