St James's University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. At our last inspection we rated this key question as good. At this inspection the rating is good.

This service scored 64 (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 are at the centre of their care and treatment choices and decided, in partnership with them, how to respond to any relevant changes in their needs

The service had a standard operating procedure for supporting informed choices through maternity care for women. Staff actively encouraged people using the service to make informed choices about their care and treatment and worked with them to plan their birth choices. They made reasonable adjustments for them to receive coordinated care with other services and providers where required.

Where women wished care to be delivered outside of guidance, there was a process in place to counsel women and discuss alternative options, including a referral to the birth choices clinic.

For example, where the preferred choice was a home birth and the pregnancy was determined to be too high risk, they would explore whether they could be safely delivered on the midwifery led unit, which was a more relaxed and homely environment than the main delivery suite.

This was a similar approach when there were changes in needs and therefore adjustments to be made to their plans either during pregnancy or during labour. Staff actively engaged with them to honour their preferences where possible and involved other services where appropriate.

Care planning was person centred including vulnerable people and those who required a wider multi-disciplinary approach.

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

The service actively worked to meet the needs of local people and families travelling from outside of the area as well as the diverse community it serves. The service actively engaged with families to understand the changing needs of those using the service.

There were a number of events held by the service so that they were able to understand the diverse health and care needs within the community. For example, the service held targeted focus groups in partnership with the Maternity and Neonatal Voices Partnership (MNVP), a group of parents, volunteers and professionals who work together to help shape and develop maternity services and whose chair is also a service user. They also held the ‘Diverse Mum’s Group’ and 15 steps amongst other methods.

The response from their most recent ‘Through My Eyes’ event was overwhelmingly positive. More than 70 people attended with lived experience to give the service a broader perspective of challenges faced and ways to improve their experiences.

Staff made adjustments to support people with protected characteristics. The hospital passport was frequently used for those with a learning disability and, or autism. This involved individualised care planning with inpatient areas to ensure they were cared for in the most appropriate and safe environment for them. For example,if a woman is unable to tolerate the lighting or noise on the ward environments, they are offered a longer stay on delivery suite.

Post natal support was available for women. The service offered care in the community and in people’s homes. They also provided post-natal drop-in centres across the city up to 28 days post birth.

The service had access to enhanced teams for example, Haamla, teenage pregnancy, perinatal mental health and multiple births. These services offered support up to 6 weeks pre and post-delivery. There was also access to a specialist bereavement team, support could be provided in a woman’s home for up to 6 weeks with the option of extending to 12 weeks if a postmortem was required. The chaplaincy service provided support for all who required it and did not offer support unless requested.

There was an elective theatre list every day, alternating between each site daily and there was a dedicated obstetric and anaesthetic cover to run these lists.

The service provides appropriate, accurate and up-to-date information in formats that are tailored to individual needs.

We saw information in various formats and languages to ensure that all people using the service had up to date and accurate information to help them to make informed choices and play an active part in their care, treatment and birth planning.

Spoken language interpreters were available 24/7 and delivered by an external provider. We saw from data provided by the service, that this was used frequently.

The provision was available face to face, and virtually through telephone interpreting either on demand or pre-booked, through spoken video or audio interpreting (via interpreter on wheels or app).

The Trust’s spoken language interpreting provider also offered a translation service for written information in languages other than English.

The Trust had access to a separate external provider for people who were deaf or blind. They could access face to face British Sign Language (BSL) interpreting, Video relay BSL interpreting, BSL users also had support to telephone the hospital when this was necessary.

There was access to Easy Read Leaflets, which could be found on the Trust external website. There was an active Trust programme of Easy Read Leaflet development led by the Learning Disability and Autism team.

The PALS service had a text phone number for patients and The Learning Disabilities and Autism team were able to support care for patients who communicated through Makaton.

The Trust had conducted a self-assessment against the Accessible Information Standards and was progressing through their governance structure at the time of our assessment.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support.

Managers investigated complaints and concerns thoroughly and made appropriate recommended actions. Managers regularly shared feedback from complaints with staff at various meetings such as the daily safety brief. The service used the learning from complaints and concerns as an opportunity for improvement to local practice and procedures. We reviewed the Quality Assurance Committee chairs report dated June 2024 and saw key themes from the Complaint and PALS annual report were discussed. The report also outlined a Trust reduction in the number of complaints it had received when compared to the previous year.

The service had various ways of gathering feedback and actively sought it so that they could improve services and make meaningful changes as a result of it. The service welcomed feedback from women and families through surveys, complaints and compliments and through the local MNVP, with which leaders were actively involved.

There was a maternity experience measure QR code and leaflet, they linked in with other sectors, engaged regularly with SANDS and the local hospice as well as reviewing data from specialist midwives.

As a result of feedback, the service produced a checklist of useful things to know, they developed a guideline for lactation and information leaflet and held an action tracker for all feedback.

The service had good links with the MNVP, and they were involved in the governance of the service, including the bimonthly safety champions meetings. The MNVP informed us feedback was collated into a six-monthly voice report and the service responded to the report within a six-month timeframe. The service provided an update on what had been actioned as a response to the feedback raised. These updates were added to a report as a ‘You Said, We Did’ segment allowing tracking and progress to monitor areas that needed further work.

We reviewed the last six-month voices report. Themes and trends raised in the voices report (January to June 2024) showed:

The issue of consistency with interpreter services and translated resources was raised as a consistent theme. There were gaps in provision, particularly for women who speak regional dialects which was not always catered for by interpreter services. Women reported feeling more confident that they would be understood if a family member translated for them however this is not in line with best practice and can increase risks to women due to poor translation, confidentiality and accuracy. Safeguarding can also be a problem.

Printed resources, such as appointment letters, were sent out in English, which could lead to missed or delayed appointments, and the 15 steps walk around found that many information posters and signage in the hospital reception, antenatal ward, and maternity assessment centre were in English only. The Trust were aware of this and were working on making information in more accessible formats.

The service made sure that everyone could access the care, support and treatment they needed it. However, we did see that clinics were sometimes cancelled.

People told us they could access care, treatment and support when they needed to and in a way that worked for them. There were many examples given of reasonable adjustments being provided when needed, and this was timely and in line with best practice. We saw evidence of hospital passports in use. Staff were able to talk us through examples and we heard about individual experiences where adjustments had been made.

>

Transitional Care was staffed by both Neonatal Nurses and Band 6 midwives and has 24-hour midwifery cover. This helped minimise separation of mums and babies as they could remain together and be admitted to transitional care from birth. Midwives were recruited by transitional care and were not part of the funded midwifery establishment.

The perinatal services had a clear pathway for Transitional Care services which was aligned with the British Association of Perinatal Medicine (BAPM) Transitional Care Framework for Practice.

>

The service worked hard to understand the community's needs to ensure that all women had access to care, support and treatment in the way that they required and when they required it.

>

We saw data relating to triage calls and access to timely assessment. The data showed that calls were mostly answered within 2 minutes and women had access to assessments in triage or directed straight to the delivery ward where required.

>

However, there was not a process in place to monitor delays in antenatal attendance. The midwife in charge was responsible for communicating any unforeseen delays including an apology when they arose.

The community midwife team worked across a large area and worked flexibly to meet the needs of the service, despite vacancies within the team.

>

The chaplaincy services provided support 24 hours a day in the event of a loss, to provide a naming ceremony or emergency baptism for example. It provided support to all faiths and were by the bedside within an hour out of hours. There was always someone on each site during normal hours and available by emergency bleep and various clinics were held to provide care, support and treatment regularly and for a wide spectrum of needs.

>

The service used posters around the maternity unit to promote ongoing work for ‘Improving Equity in Leeds Maternity Services'.

The service did not always actively seek out or listen to information about people who are most likely to experience inequality in experience or outcomes.

The MNVP lead attended the Women’s Quality Assurance monthly meeting to raise feedback themes and areas of escalation. The MNVP lead worked on an ad hoc basis with trust staff members on projects, particularly from the health equity specialist team and the birth trauma team.

The service had a Health Equity for Athena Group which supported women with a body mass index of 40 or over, as well as a Diverse Women’s Group and were in the process of creating a group dealing with loss and bereavement.

Issues around health inequity had been raised, whether when speaking to those with experience of the care system, young mums, or racially minoritized women. Care experienced and young mums felt that assumptions were made about them and their capabilities, with staff making decisions without including them.

Racially minoritised women from different communities felt it was difficult to advocate for themselves, particularly when an interpreter or translation service was not used. They needed staff to be proactive in checking in with them to see if there was anything the woman was concerned about and making sure the women understood what was happening.

The service had set a clear focus on how they intended to address the concerns raised. For example, the service continued to run focus groups with women from specific communities to hear about their experiences with maternity care. This included meeting Black African groups, diverse women with experience of perinatal mental health, and women with protected characteristics.

We saw and heard about many avenues used to collate feedback from women, and families which included targeted focus groups where the service had identified sectors of the community who were underrepresented or had experienced inequality in experience or outcomes. They held an ‘Equity Education’ event which was well attended and provided the service with valuable feedback and learning opportunities to improve service delivery for such people.

As a result of the feedback from such groups, the service provided additional clinics to identify needs at the earliest opportunity.

One example of feedback from the local Asian community was that they felt they had the support of their community and therefore wouldn’t access maternity services as early or frequently as some. The service increased their engagement with the Asian community as a result and provided tailored support to meet their specific needs.

National feedback identified that black women continued to experience inequalities in care and outcomes. The service used this national level feedback to engage with black women locally to improve care and outcomes for those within their service provision.

The MNVP lead held monthly highlight meetings with the deputy head of midwifery, colleagues from the Integrated Care Board, the health inequities specialist midwife and a colleague from the Trust’s communications department. A report was drafted and submitted monthly summarising feedback themes. Themes were then discussed at the highlight meetings.

We saw processes in place led by specialist staff to support families through times when significant decisions needed to be made, for example, advanced decision making and planning for babies born with life limiting conditions. This also included parallel planning to allow planning for different possible outcomes.

The service provided information and clinics to support women including for multiple births, births following previous loss, vagina birth after Caesarean, high risk pregnancies and for women who were vulnerable or required enhanced care and treatment.

Where the service was supporting women who had concerns regarding their pregnancy and birth journey, they determined what additional support could be put in place early on in pregnancy to mitigate some anxieties later on.

They held multi-disciplinary meetings throughout the pregnancy with other agencies in order to ensure all available support was in place ahead of time.

The service had access to chaplaincy and Imam services. This service was available 24/7, staff could access the service to support people in times of need.