Gloucestershire Royal Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

This is the first inspection since maternity became a standalone service group. This key question was not included in the 2024 inspection of maternity services.

This key question has been rated good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

We have not awarded this service a score for Caring.

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

The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Women consistently reported during the site visits, staff treated them with kindness, compassion, and dignity. We noted staff listened attentively and communicated in a clear and accessible manner, including explaining medical terminology in ways women could understand. Staff demonstrated a commitment to person-centred care by taking time to understand individual needs. For example, during an elective caesarean procedure, staff were observed engaging with the woman in theatre, clearly explaining the process and offering reassurance to reduce their anxiety.

Feedback received since the 2024 inspection highlighted varied experiences of care. While many women spoke positively about staff and the support they received, some told us communication could have been more consistent, particularly in relation to updates about their care. A small number of women also reported delays in receiving pain relief or felt their concerns were not always addressed as promptly as they would have liked.

During staff handovers, we observed team members consistently demonstrated respect for the individual needs of each woman. Staff approached care discussions with empathy and a non-judgmental attitude, particularly when addressing sensitive issues such as mental health or safeguarding concerns. We observed team members being kind and respectful to each other.

We observed staff greeting women, introducing themselves and were courteous and respectful. Overall, women spoke highly of staff, describing them as caring, respectful, and attentive to individual needs. Staff consistently involved women in decisions about their care, upheld their privacy and dignity, and maintained confidentiality in handling personal information.

Staff had access to interpretation services and understood how to use them in both hospital and community settings. During our observation of a midwife-led clinic, interpretation services were effectively used to support women and their families in asking questions and understanding the purpose of their appointment.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Women’s needs and preferences were understood and reflected in their care throughout pregnancy and birth. Women mostly reported feeling listened to and involved in decisions about their care and treatment.

Staff respected individual needs and demonstrated a non-judgmental approach, including when supporting women with mental health concerns. Emotional support was available, and the service provided a bereavement suite with specialist midwife support.

Information on spiritual support, treatments, local services, patient rights, and feedback processes was accessible. The labour suite included a noticeboard with resources for partners. Interpretation services were available, with face-to-face support requiring advance booking.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Women told us they had choice and control over their care. We heard staff listened to individual concerns and preferences and did their best to accommodate their individual needs. We observed staff who supported and involved women in assessments and encouraged them to make decisions about their care. For example, we observed midwives discussing with women how to administer an injection themselves and guided them through the process to enable self-administration at home.

Staff spoke with women, and their families in a way they could understand, using communication aids where necessary. In the 2024 CQC maternity survey, people who had used the service gave a score of 8.8 out of 10 (10 being the highest) when asked about whether they were involved in decisions about their care during labour and birth. This score was about the same as other trusts.

Community midwives told us they try to empower women to make their own choices. We observed midwives discussing with women the best way to care for their babies, for example, how best to bottle feed a baby to prevent them from getting wind pains. We observed midwives providing education for women on how to reduce risks to babies for example, having a sterilising machine for bottles when bottle feeding.

Women told us they felt involved in creating their birth plans. There was a birth preference service in place to support women with their birth plans.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff understood people’s needs, views and wishes. We observed women and their families being greeted by staff who told them their names. They were shown to their bed or trolley area. We observed staff listening to women and acting on their wishes. Women told us staff discussed their birthing plans with them. Staff checked it was ok to access closed curtains to maintain privacy and dignity.

Refreshments were provided when needed. However, some women felt there was limited choice if you required a therapeutic diet.

Community staff described how they supported women with specific needs, such as wheelchair users and those living with learning disabilities. They assessed individual requirements and coordinated with health and social care services to provide appropriate support.

Women and their families could give feedback about their care and treatment through the Friends and Family Test and the trust’s compliments, concerns, and complaints process, was available on their website.

The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Overall staff reported feeling supported by leadership and colleagues, describing a collaborative team culture, though they remained concerns around sufficient sustainable staffing levels across all parts of the maternity unit and the impact this had on staff wellbeing. Managers were seen as receptive to concerns, and professional midwifery advocates (PMA) were available for staff development and support.

While staffing levels had generally improved since the last inspection, staff remained concerned about staffing levels and its impact on their wellbeing. Midwives were occasionally redeployed to cover shortages in other areas within the maternity unit.

Recruitment and retention efforts were ongoing by the trust, including initiatives such as a recruitment film that had been recently shortlisted for a national award. However, many new recruits were recently qualified. While the newly qualified staff we spoke with felt supported by their colleagues, some of the experienced staff felt that this impacted on the team as they were required to provide additional support. The trust acknowledged they have a predominately junior workforce and had practice educators on the ward to support junior staff.

Feedback from staff surveys demonstrated that staff being safe and healthy as well as always learning was predominately lower than the trust average. To support staffing, the trust had developed new roles like the flow matron and triage matron which had been positively received. Some staff expressed concern over the discontinuation of the Band 5 nurse role and its effect on their workload. Retention strategies included flexible rostering and career progression opportunities, though concerns were raised by some staff about 12-hour shifts and insufficient rest breaks during the shift.

Training was actively promoted through accessible formats like ‘trolley teaching’ and internal social media. There had been recent training in ‘midwifery fundamentals’ for all staff to attend, leaders reported that feedback had suggested that this was a positive event. Training leads spoke of providing support to the community teams.

Staff had access to psychological and mental health support services, with resources visibly displayed across staff areas. Freedom to Speak up Guardian posters and staff well-being events were displayed. The trust had a monthly newsletter across the division on the actions they were taking to improve maternity services, highlighting good practice and recognition for staff.

Feedback from universities about student midwives was consistently positive, noting that students felt well supported by staff at their placement sites. When issues did arise, senior staff were responsive and worked with the universities to develop action plans. Students we spoke with during site visits also described staff as helpful and supportive throughout their placements.

Comment from the CQC maternity survey 2024 included “There are a clear and worrying sense that the hospital staff were completely overwhelmed, with insufficient staff cover and poor communication between teams. It seemed to me that the staff are trying their best in very difficult conditions but are struggling with a broken system and under huge pressure to deliver without enough resource. My labour and delivery were very fast, and the staff were totally unprepared to deal with it. There were failures immediately post-birth which caused unnecessary stress and worry for me and my partner. My mental health has suffered as a result. I repeat that the staff are all doing their best and I cannot fault any individuals, but they are totally overwhelmed.” Another comment, “staff were clearly overworked and seemed quite stressed” and “I was in hospital for 4 days before my baby was born by induction which due to staff shortages kept being pushed back or delayed.”