Horton General 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.

At the last assessment in 2024 we did not assess this key question.

At this assessment the key question has been rated as 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.

The trust had implemented a digital maternity system, replacing paper records, which had improved the quality of documentation and strengthened audit oversight.

We reviewed eight patient records of women who had given birth at the MLU and were therefore classified as having low-risk pregnancies. We found that staff had completed holistic antenatal booking risk assessments, which included psychological, social, and medical needs, and had placed women on appropriate care pathways.

The service assessed women at every contact to identify any changing risk factors, supporting safety and the early detection of potential problems. Where changing needs were identified, care plans were updated accordingly.

We saw that midwives had completed diagnostic tests, such as blood sampling, and had made ultrasound referrals. Staff told us that women identified as having more complex needs were referred to relevant maternity specialist teams and outpatient clinics, for example for mental health support, dieticians or disability services.

The records we reviewed were complete, and all information required to support women’s care was clearly documented across the antenatal, intrapartum, and postnatal periods.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Care and treatment followed evidence-based guidance. Clinical guidelines and policies used in the service were developed and reviewed in line with national guidance from the National Institute for Health and Care Excellence (NICE), with clinical standards set by the Royal College of Obstetricians and gynaecologists (RCOG) and safety frameworks defined by NHS England, such as the saving babies lives care bundle.

Policies and protocols were accessible on the trust’s intranet for staff to access when required.

The process for the development, revision and withdrawal of policies and procedures was as per the trust policies. This ensured they contained current and best practice guidance. Governance meetings provided evidence of updates being made to procedures and policy documents.

Staff were informed of changes to clinical and operational practice through a range of communication methods, including clinical bulletins, staff meetings, and information update boards within the MLU. The maternity safety board for October 2025 identified four guideline changes that staff needed to be aware of. However, there was no clear mechanism in place to ensure that individual staff had read and understood these guideline updates. Responsibility for keeping up to date with changes appeared to rest with individual staff members, which created a potential risk that important updates might be missed.

The service, and the maternity service as a whole, used clinical audit to ensure that care and treatment were delivered in line with evidence-based maternity standards. Audits were used to identify gaps or discrepancies in practice, and actions were implemented to address any deficiencies, such as providing additional training, updating protocols, or amending clinical pathways.

Re-auditing was undertaken to ensure that improvements had been made, compliance was sustained, and patient care had improved. We reviewed audit information relating to the MLU and found that audit activity was used to maintain standards, monitor adherence to guidelines, and support continuous improvement.

The service worked well across teams and services to support people.

The service worked with many teams both internally and externally to deliver their purpose of providing maternity care to the local community. Staff we spoke with told us open communications, mutual respect and keeping the patient at the centre of what they did helped the teams work together.

The standby ambulance crew were integral members of the team and attended daily handovers with MLU staff to remain up to date with activity within the unit.

MLU staff and the community midwifery team had a close working relationship. Community midwives used the unit to run clinics, support births, and provide professional support to colleagues working within the MLU.

Multidisciplinary meetings were held for women with comorbidities and complex social and mental health needs, involving input from specialist maternity teams. We spoke with specialist midwives working in outpatient clinics, who described how these services operated and how teams worked collaboratively to provide effective care and treatment for women.

Staff explained how referrals could be made to community social services to support pregnant women. These referrals were often part of the "Think Family" approach, providing early help and focusing on the social aspects of pregnancy.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported women to live healthier lives and where possible, reduce their future needs for care and support.

The service proactively supported women to live healthier lives throughout pregnancy and the postnatal period, promoting positive health outcomes for both mother and baby. Women were supported by a named midwife who developed and regularly reviewed personalised care plans based on individual needs, risks and preferences.

Midwives provided clear, evidence-based health promotion advice, including healthy eating, appropriate supplementation, weight management and safe exercise during pregnancy. Women received guidance on avoiding alcohol to prevent fetal alcohol spectrum disorder (FASD), alongside support to reduce or stop substance use where required. Access to routine vaccinations, including whooping cough, RSV and influenza, helped protect women and babies from preventable illness.

The service supported physical and mental wellbeing through regular screening, monitoring and timely referrals to specialist services, including perinatal mental health teams and pelvic health specialists. Antenatal education empowered women to prepare for labour, birth and early parenting, supporting informed decision-making.

Continuity of care was prioritised, with women seeing the same midwife or small team throughout pregnancy, improving outcomes and satisfaction. Social wellbeing was supported through antenatal groups and by providing a safe environment for women to discuss sensitive issues, including domestic abuse.

Postnatal care focused on promoting healthy early relationships and infant development through breastfeeding support and skin-to-skin contact, helping to improve bonding, feeding, emotional wellbeing and long-term health outcomes.

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

The maternity service had effective systems and processes in place to monitor, audit and benchmark the quality of care and outcomes for women and babies. Outcomes were monitored through continuous review of adverse events, routine performance monitoring and targeted scrutiny of key risk areas. This enabled the service to identify risks early, respond to incidents effectively and take timely action to improve safety and outcomes.

Performance data was routinely reviewed, analysed and tracked over time to understand how the service was performing against key performance indicators, national guidance and clinical standards. This supported informed decision-making and ensured improvements were based on clear evidence and trends.

Quality and effectiveness were monitored through clinical audit, professional supervision and structured governance arrangements. Learning from audits, incidents and reviews was shared with staff and used to improve practice and reduce the risk of recurrence.

The service used the National Perinatal Mortality Review Tool (PMRT) to ensure all perinatal deaths were reviewed in a consistent and transparent way. Outcomes and learning were reported to the trust board. Data was submitted to the maternity services data set (MSDS), supporting national benchmarking and local improvement. This ensured accurate monitoring of care from booking to discharge and contributed to service planning and quality improvement.

The midwife-led unit (MLU) collected and reviewed outcome data including rates of normal birth, major obstetric haemorrhage (MOH), obstetric anal sphincter injury (OASI) and transfers to the obstetric unit. This data was recorded on the maternity performance dashboard and used to monitor safety and effectiveness. Emerging trends and themes were identified and escalated for further review where required. The inclusion of ethnicity data enabled the service to monitor outcomes across different population groups and identify any potential inequalities.

Review of the maternity dashboard for births at the MLU in September 2025 demonstrated positive outcomes, with no reported cases of MOH or OASI. There was one transfer to the obstetric unit due to shoulder dystocia. The case was being reviewed to identify learning and ensure continued safe practice.

The service also monitored outcomes and quality through patient feedback. Friends and family test results, feedback via the patient experience team and engagement with the Oxfordshire maternity and neonatal voices partnership (MNVP) were used to understand women’s experiences. This feedback informed service improvements and supported the sharing of learning and good practice, ensuring care remained responsive to the needs of women and families.

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

Women who did not have the capacity to consent would not be birthing at the unit, but staff understood the principles of best interest decisions.

Children between the ages of 16-17 years of age could give birth at the unit but it depended on a multidisciplinary team assessment of the young person’s pregnancy. We saw consent in children was included in the Safeguarding children level 3 training, which 90% of staff had completed.

The midwife-led unit (MLU) had up-to-date policies and procedures in place to support consent to care and treatment, including compliance with the Mental Capacity Act (2005). Policies covered assessing and recording capacity and best interest decision-making. Staff received Mental Capacity Act (MCA) training as part of the trust’s safeguarding training programme which was mandatory for maternity staff.

Staff understood the importance of obtaining valid consent and demonstrated this in practice. Women were asked for consent prior to examinations, assessments and care being provided. For women receiving care at the MLU, consent was usually implied and ongoing, reflecting the low-risk nature of births and the absence of surgical procedures. Where care needs changed or additional interventions were required, staff understood the importance of revisiting consent and ensuring women were fully informed.

Midwives supported women to make informed decisions by explaining care options, risks and benefits in a clear and accessible way, and by encouraging questions. Women were supported to make choices about their care, and their decisions, including the choice to decline interventions, were respected.

The service took steps to ensure consent processes were inclusive and equitable. Staff were aware of the need to adapt communication and involve interpreters or additional support where required, to ensure women understood their care and could make informed decisions.