Gloucestershire Royal 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

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’s outcomes were consistently good, and people’s feedback confirmed this.

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

Staff completed a comprehensive health assessment of women in a timely manner. We examined 7 sets of records and found all assessment areas were completed, including relevant risk assessments. Staff used a computerised system for most women and babies’ records. Women had access to their records, and this was confirmed when speaking with women. Staff updated care plans when necessary.

Community midwives assessed women throughout their pregnancy for any risks and discussed these risks with them so that they could be incorporated into their birthing plan. If a woman requested a home birth, risk assessments were completed to determine if it was safe. Staff told us they had a process to follow if a woman wanted a home birth but was high risk. We did not see a written copy of this process.

Women were screened for their risk of depression using a recognised tool. Women were referred to the perinatal mental health team if required.

Women’s communication needs were assessed and met to maximise the effectiveness of their care and treatment. Staff told us they had access to translation services via their phones or video for British Sign Language. Obtaining face to face interpreters was more difficult as they had to be booked in advance.

The trust did not consistently meet national guidance for maternity care. However, staff used recognised tools to identify and respond to clinical deterioration, supporting patient safety and outcomes for women and babies.

Staff followed evidence-based good practice and standards. Staff used recognised tools to improve the detection and response to clinical deterioration in women as a key element of patient safety and improving patient outcomes. We were sent evidence following our site visits regarding policies and procedures which were updated and amended as required and when new guidance was issued.

Following our inspection in 2024, we issued conditions on their registration regarding the use of recognised assessment tools, for example, MEOWS and venous thromboembolism (VTE). The trust had been continually monitoring these and provided evidence which demonstrated staff were completing these tools and assessments and meeting trust targets. However, these were not consistently being used in triage.

Staff assessed and met women’s needs for food and drink and for specialist nutrition and hydration. Women confirmed they were able to access food and drink to meet their dietary needs, but 1 woman felt they had limited dietary choice as they were following a therapeutic diet.

The trust had a dedicated midwife who monitored their data in relation to ‘saving babies lives bundle’. The data was shared with staff and members of the trust board. Saving Babies' Lives" (SBL) refers to a major UK NHS initiative. It is a set of evidence-based actions for maternity services to significantly reduce stillbirths, preterm births, and neonatal deaths, focusing on areas for example, stopping smoking in pregnancy, monitoring fetal growth and recognising reduced fetal movement. It is a national framework to improve maternity care quality and outcomes across England, supporting clinicians and families.

The trust participated in The Maternity Incentive Scheme (MIS) Year 7. They had declared themselves non-compliant for 3 safety actions. For example, the Perinatal Mortality Review Tool (PMRT) this was due to not being able to complete reports within the 6-month timeframe. Actions were being implemented to address these short falls. The MIS is an NHS Resolution program rewarding UK hospital trusts for implementing safety actions to improve maternity & neonatal care.

Staff told us they no longer had structured clinical supervision sessions but had access to practice facilitators to support them with their work performance.

Managers ensured that staff had access to regular meetings to keep them updated for example, with any safety information and changes to practice.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. For example, staff received specialist training, including a 1-day fetal monitoring course followed by competency assessments to confirm proficiency.

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

Staff held regular and effective multidisciplinary meetings. We observed an induction of labour (IOL) meeting and saw each woman was discussed and risk assessed and prioritised depending on their clinical need. These meetings took place twice a day.

Staff told us how they could access specialist midwives to support women they cared for and improve outcomes. For example, midwives who had expertise in mental health, safeguarding and bereavement care.

Staff shared information about women at handover meetings within their team. Staff also shared information to community midwifery teams when women were discharged to ensure continuity of care.

Staff involved, but not always in a timely manner, all the necessary healthcare and social care services. This was to ensure women and their babies had continuity of safe care, both within the service and post-discharge. We observed, both in hospital and in the community setting, staff working with other agencies to make sure women and babies were safe.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation.

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.

Staff assessed women’s health on admission and supported individual needs. Smoking status was checked at booking, using carbon monoxide monitoring. Women were offered cessation advice and referral to specialist services.

Women were mostly supported to initiate breastfeeding in hospital and after discharge where able. The service provided an online platform with feeding and nurturing resources for parents. Information boards and printed materials promoted healthy lifestyles and offered guidance on topics such as breastfeeding.

The service routinely monitored people’s care and treatment to continuously improve it. However, they did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of women themselves.

The trust monitored performance using a systematic audit system. Audit results were reviewed by senior leaders within the maternity unit and were shared with staff through updates. Some audit results were above national averages when compared to other trusts.

Staff participated in benchmarking and quality improvement initiatives. Clinical Quality Improvement Metrics (CQIMS) are a set of metrics derived from the Maternity Services Dataset for the purpose of identifying areas that may require local clinical quality improvement. In the most recent month of data (May 2025) Gloucestershire Hospitals NHS Foundation Trust were higher than the national average and in the upper 25% of all organisations for one metric, women who had a 3rd or 4th degree tear at delivery. The trust result was 49 per 1,000 births compared to a national average of 30. A midwife and physiotherapist were appointed to support staff with the management of 3rd and 4th degree tears. Although a care bundle was available, staff had not received training on its effective use. A care bundle is a set of interventions that, when used together, significantly improve patient outcomes.

The rate of women with Postpartum Haemorrhage (PPH) of 1,500ml or more had shown significant fluctuation over time. Between March and September 2025, the rate of women experiencing a PPH of 1500mls of more ranged between 31 (April 2025) and 40 (September 2025) per 1000.

The rate of babies born with an APGAR score between 0-6 had also fluctuated over time. Between March and September 2025, the rate of babies with an APGAR score 0-6 ranged between 14 (May 2025) and 18 (September 2025) per 1000.

Staff used technology to support women effectively. Women were able to access their computer records and information regarding their care and treatment.

Feedback from women and staff about delays in induction of labour (IOL) for overdue pregnancies led to a pilot scheme limiting daily IOLs. Previously, women were often called in and experienced long waits due to high demand and ward capacity pressures. The pilot limited the number of women being induced in each 24-hour period to 6 to prevent delays for women and to promote. This was ongoing during our site visits and therefore results were not yet available.

We were sent copies of the Newborn Early Warning Trigger and Track (NEWTT) audit for August and September 2025. This demonstrated they met 100% of the standards. NEWTT2 was due to be implemented in November 2025. NEWTT is a standardised monitoring tool for early intervention for deteriorating newborns.

Key performance indicators were incorporated into the perinatal dashboard for monitoring and oversight. As part of this dashboard, they also monitored the number of babies born before arrival at the unit.

The service did not always document when they told people about their rights around consent and did not always respect their rights when delivering care and treatment.

Women reported mostly receiving sufficient information, including risks and benefits, to make informed decisions about their care and treatment. Staff discussed birthing plans and respected individual wishes.

Midwives understood how to assess decision-making capacity. Our review of records confirmed consent forms were completed for caesarean sections, and women said consent was obtained before treatment. An audit of randomly selected records by the trust showed consent documentation was completed in 60% of booking records and 77% of community follow-up records. There was no date of when this audit was taken in the information we received. Senior staff acknowledged this section cannot be made mandatory in the electronic system and have an action plan to improve compliance.

Staff told us they had access to up-to-date policies and procedures, which were accessible to them through the trust’s intranet site.