Horton General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At the last assessment we rated this key question as requires improvement.

At this assessment the rating has improved to good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had processes to collect data from various sources, including incident reporting, performance and outcome data, and feedback from patients and staff. There were policies, procedures and meetings to interrogate and investigate data. The results were used to actively learn from findings and drive continuous improvement, and implement changes in practices to improve safety, care and outcomes for patients.

Staff were encouraged to raise concerns and report incidents and near misses in line with trust policies. Staff told us they knew how to raise concerns and could give examples when they had.

Between November 2024 and October 2025, the service reported there had been 80 incidents reported, 83.75% of incidents were rated as no harm, 12.5% rated as low harm (minimal harm – patient required extra observation or minor treatment), 3.75% rated as moderate harm (short term harm - patient required further treatment, or procedure). There were no incidents rated as severe harm (permanent or long-term harm) or deaths. The incidents were categorised to see if there were any themes or trends, analysis showed an increase in missed antenatal care appointments, prompting a focused review of contributing factors. During the same period, there were seven incident reports related to onsite ambulance availability at the unit each occurring when only one ambulance crew was available. This trend led to the implementation of mitigation plans, including pre-planning the use of the local NHS ambulance trust. Incidents were reviewed and investigated according to the trust’s policy and processes and action taken if required.

The trust had implemented NHS England’s Patient Safety Incident Response Framework (PSIRF) in October 2023, which introduced a new approach to incident investigation with a stronger focus on learning and improving patient safety. A patient safety midwife worked from the Horton General Hospital maternity unit which helped share awareness of PSIRF among the staff. Incidents were graded by a rapid review to decide if a full patient safety incident investigation (PSII) was required or if the incident could be investigated via a different approach, for example, by the local team. The service used a multidisciplinary approach to investigations which included involving families in the review process. No incidents at the Horton midwifery-led unit had required a PSII. There were no mandatory training requirements for patient safety for staff, however, training was available for staff if required in their job role. The trust had mandated locally that staff complete the NHS Patient Safety Syllabus – Essentials for all staff. However, the service did not provide evidence of staff completion rates or compliance monitoring for this training. As a result, assurance regarding the extent of uptake and embedding of this training across the workforce could not be fully determined.

Learning and improvement actions arising from incidents were shared with staff through a range of methods, including clinical bulletins, staff meetings, information update boards within the MLU, and face-to-face training sessions delivered by the trust’s maternity education team when required. The service recognised that communicating effectively with a large and diverse workforce could be challenging and had actively engaged with staff to understand their preferred methods of communication. This demonstrated that senior leaders were aware of the difficulties staff faced in keeping up to date with information and were taking steps to address these challenges and improve information sharing.

The service used complaint data to also drive patient safety. Complaints identified as potential patient safety concerns were investigated by the patient safety team. Those not deemed safety-related were reviewed by the patient experience team or investigated by the local team. Learning and improvement actions stemming from complaints varied depending on the investigation route. Complaints managed by the patient safety or patient experience teams had their learning shared in a similar manner to incident-related learning. Locally investigated complaints were typically overseen by team managers who were responsible for sharing relevant learning with their teams where appropriate. Managers reported feeling adequately trained to facilitate these discussions and support staff learning.

Staff understood duty of candour and said they were open and transparent and gave patients and families a full explanation when things went wrong.

The service used the perinatal mortality review tool (PMRT) digital system to carry out comprehensive reviews of the care provided to babies who died from 22 weeks’ gestation. These reviews aimed to identify learning and provide clear answers to bereaved families. Where appropriate, joint agency reviews were undertaken to ensure that all aspects of care across the care pathway were thoroughly examined.

The service reviewed and shared national patient safety alerts and made changed where needed.

The service had systems and pathways in place to support safe care and escalation. However, gaps in standardisation, audit, and oversight reduced assurance that transitions of care were consistently safe and effective.

The maternity unit at the Horton General Hospital was a midwifery-led unit (MLU), providing care for women with low-risk, uncomplicated pregnancies under the care of a midwife. As a result, several aspects of maternity care were not provided on site. These included induction of labour, caesarean section or other major surgical procedures, inpatient maternity care, and neonatal inpatient care.

A woman’s eligibility to give birth at the unit was determined through ongoing risk assessments carried out by midwives and doctors throughout pregnancy. These assessments established whether the pregnancy remained low risk. The unit had clear criteria outlining the types of births that could take place, including an uncomplicated maternal medical history, a singleton pregnancy, and a baby in a suitable position. Discussions about place of birth began at the initial booking appointment and were reviewed at every antenatal appointment. If complications developed, women were advised to plan birth at a consultant-led obstetric unit to ensure access to appropriate care.

Women from the local community could attend the unit for ultrasound scans, consultant-led antenatal appointments, outpatient clinics such as the diabetes clinic, and postnatal appointments. This reduced the need for travel to the main hospital, which was approximately 30 miles away.

The unit also operated a Midwife Assessment Clinic (MAC) between 8am and 4pm, Monday to Friday. This service was available to local women with clearly defined, risk-assessed minor pregnancy complications. Midwives provided additional monitoring and investigations, including blood pressure checks, glucose tolerance tests, blood tests, and cardiotocography (CTG), which is used to monitor the fetal heartbeat and uterine contractions. Appointments could be pre-booked to align with a woman’s usual community midwife or undertaken by the midwife on duty at the Horton MLU. A standard operating procedure clearly outlined eligibility criteria for attendance at the MAC.

A 24‑hour telephone advice and screening service was available for women planning midwifery‑led unit (MLU) and community births, enabling them to contact experienced midwives with urgent pregnancy‑related concerns. Calls were documented on the digital maternity system using structured communication forms. Midwives assessed symptoms and determined whether women should attend the MLU, be referred to the consultant‑led obstetric unit at another hospital site or be given advice or follow‑up arrangements. While the provider described this as an advice and screening service rather than formal maternity triage, the process involved clinical assessment and decision‑making about urgency, risk and place of care. Formal maternity triage in line with the Royal College of Obstetricians and Gynaecologists (RCOG) Maternity Triage Good Practice Paper No. 17 (December 2023) was undertaken at the consultant‑led maternity assessment unit at another hospital, and women were provided with information on how and when to access this service. The telephone advice service did not use a standardised triage prioritisation framework, such as RAG‑rating or acuity classification, to formally categorise the urgency and risk of calls prior to onward direction or advice. However, midwives undertook structured clinical assessments to inform escalation and pathway allocation. The provider undertook monthly sample based audits of labour assessment calls for women using the MLU and community birth pathway. These audits reviewed the completeness of assessment, decision making, and appropriateness of care pathways, and were supported by additional review of outcomes such as community birth processes and staffing at birth. Oversight of telephone advice calls that did not progress to labour assessment was more limited. While midwives provided advice and safety netting and documented calls on the digital maternity system, these contacts were not routinely included in audit activity. As a result, there was reduced assurance regarding the consistency and outcomes of advice only calls within initial access pathways.

The service advised that if telephone calls were unanswered, an answerphone message provided alternative contact numbers. Women were advised not to leave messages; however, if a message was left, a red light on the telephone alerted staff.

MLU staff worked closely with the community midwifery team, who provided care for women across the region. The community midwives’ office was located close to the MLU, and they ran antenatal and postnatal clinics within the unit. Community midwives also supported women during labour at the MLU, which helped promote continuity of care for those choosing to give birth there.

Women with additional support needs, such as safeguarding concerns, mental health needs, or diabetes, were identified during the antenatal period and referred to specialist maternity teams and outpatient clinics as required. This ensured that pre-existing medical conditions or complications arising during pregnancy were managed through multidisciplinary input, supporting the safety and wellbeing of both mother and baby.

Midwives monitored women and babies throughout labour and birth. If concerns arose during labour or immediately following birth, guidance was in place to support emergency transfer to an appropriate consultant-led obstetric unit. Midwives accompanied women and babies during ambulance transfers to provide care and support continuity. The Horton MLU had a standby ambulance with two ambulance technicians available for transfers, which was not typical for an MLU, and other MLUs within the trust did not have similar arrangements. Depending on the nature of the emergency, the skill mix of the standby crew may not have been sufficient, and in such cases a 999 call was made to request an ambulance from the local NHS ambulance trust. The service reported that between November 2024 and October 2025, there were 47 transfers undertaken using the standby ambulance and 19 via a 999 ambulance. All ambulance transfers were systematically reviewed to promote shared learning and drive continuous improvement in practice and patient care.

Following birth, staff completed colour-coded newborn risk assessments, incorporating maternal physical and psychological health histories. Babies identified as high risk were admitted to transitional care for enhanced monitoring and feeding support at the main maternity hospital. Prior to discharge, risk assessments were completed, and relevant third-party organisations were notified as appropriate.

Midwife handovers were used to share information between shifts. During the inspection, we observed a handover attended by MLU staff, staff from the maternity assessment clinic (MAC), community midwifery representatives, and the standby ambulance crew. The focus was on staffing levels, cover requirements, and break arrangements. Although a proforma was used to capture equipment issues, staffing shortages, and clinical commitments, the handover did not use a structured SBAR (situation, background, assessment, recommendation) format or follow a safety huddle methodology. There was limited discussion of current women in the unit, including one woman who had recently given birth and another who had become unwell during the MAC clinic, and no observed opportunities for shared learning or updates on changes to practice or policy.

Women and babies were usually discharged within six hours of birth if the birth was straightforward and postnatal assessments confirmed both were well. Where a longer stay was required or concerns were identified, transfer to the postnatal ward at the consultant-led obstetric hospital was arranged.

Postnatally, the service provided outpatient clinics to support parents and babies, including infant feeding support, newborn physical examinations, and hearing screening.

The trust’s maternity services, including the Horton MLU, used a digital maternity system to record care and treatment for women and babies. This system enabled shared access to information across the service, providing healthcare professionals with a comprehensive overview of care. Women could also access their maternity records, care plans, and information in real time via an online portal.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had well-defined, up-to-date, and easily accessible safeguarding policies and procedures. These ensured staff understood how to identify, report, and respond to safeguarding concerns. Staff were clear about their roles and responsibilities in protecting patients from abuse and were able to provide examples of when they had made safeguarding referrals. They described how referrals were recorded via the electronic patient record (EPR) and confirmed that contingency processes were in place should the EPR be unavailable due to technical failure.

Safeguarding formed part of staff induction and mandatory training. All midwives were required to complete level 3 safeguarding training for both adults and children. Training records showed that 91% of staff had completed level 3 adult safeguarding training and 90% had completed level 3 children’s safeguarding training, meeting the trust’s minimum compliance target of 85%.

Staff also received PREVENT training to support the identification of individuals who may be vulnerable to radicalisation. At the time of inspection, 93% of staff working within the maternity directorate had completed preventing radicalisation awareness training and 93% had completed preventing radicalisation basic level training.

The service had named safeguarding midwives for both adults and children who had completed level 4 safeguarding training. These safeguarding leads provided expert leadership, advice, and support across all aspects of safeguarding within maternity services, including child protection, domestic abuse, substance misuse, mental health concerns, and female genital mutilation. They ensured that the service met its statutory safeguarding duties in line with national and local legislation, including the Children Acts and ‘Working Together to Safeguard Children’ guidance.

In addition, the trust had a centralised safeguarding team available to provide advice and support. This team produced quarterly safeguarding reports that were submitted to the trust board for oversight and assurance.

The service worked collaboratively with external agencies. Key staff attended complex case reviews and acted as a link between maternity services and partner organisations such as social care, police, and health visitors. This supported a “Think Family” approach and promoted effective information sharing to safeguard women, babies, and families.

The unit completed baby abduction drills to test emergency response procedures in the event of a suspected infant abduction. These exercises aimed to identify learning and ensure a swift and effective response in a real incident. The most recent drill was completed in July 2025, and no major issues with guidance or procedure were identified.

Staff received training in the Mental Health Act. Women with mental health conditions were supported to give birth at the unit where appropriate. This was dependent on the severity of their condition and informed by an individualised risk assessment completed by the multidisciplinary team to ensure the safety of both mother and baby.

We reviewed eight sets of patient records and found that mental health assessments and domestic abuse screening questions had been completed in all cases. This demonstrated a proactive approach to identifying vulnerable women and enabled early intervention. As a result, women were appropriately cared for and referred to relevant services, including mental health teams, social care, and advocacy services, where required.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, some improvements were needed in documentation.

The service had systems in place to identify, assess and manage risks throughout a woman’s pregnancy journey. Risk assessments were completed at key points to identify potential complications early, such as gestational diabetes and pre-eclampsia, a serious blood pressure disorder that can happen during pregnancy, and to determine the most appropriate level of care. This supported the safety and wellbeing of both the woman and baby and enabled care to be individualised.

Risk assessments were used to determine whether a pregnancy was classified as low or high risk and therefore whether birth at the Horton midwifery-led unit (MLU) was appropriate. Where risks were identified, women were supported to make informed decisions about their care and birth plans based on the outcome of these assessments. This approach helped ensure women received care in the most suitable setting and that resources were allocated appropriately to those with greater clinical need.

The service demonstrated ongoing monitoring of risk throughout pregnancy, labour and birth. Where complications developed during pregnancy, discussions took place between the woman and consultants and midwives to review whether birth at the MLU remained appropriate or whether transfer to birth at the obstetric-led unit was required.

We reviewed 8 sets of patient records for women who had given birth at the MLU. All records showed that risk assessments were completed at every contact. All 8 women had documented venous thromboembolism (VTE) risk assessments, recognising the increased risk of blood clots during pregnancy. Symphysis fundal height measurements were plotted using the auto plot feature on the digital maternity system to assess the fetus's growth and fluid level from 24 weeks onwards, and fetal movements were recorded at each antenatal visit from 24 weeks’ gestation, supporting early identification of potential concerns.

During labour, the modified early obstetric warning system (MEOWS) was used to monitor women’s clinical condition. Two records showed MEOWS scores of 6 and 13, which should have triggered immediate medical review. However, it was unclear from the records what actions were taken in response to these scores or whether the scores had been calculated correctly. This provided limited assurance that appropriate escalation had occurred. The service told us MEOWS charts were audited and provided audit results for the month following the inspection, which showed 95% compliance.

All records showed babies received intermittent auscultation during labour, with fetal heart rate monitored at appropriate intervals, in line with national guidance for uncomplicated, low-risk pregnancies. Six of the 8 records documented that newborn observations were completed following birth. In one record, these observations were not documented. One baby was transferred to the obstetric-led unit following shoulder dystocia at birth.

The service completed the newborn and infant physical examination (NIPE) for babies born at the MLU. This routine screening aimed to identify potential problems with the eyes, heart, hips and testes (in boys). Completion of NIPE supported early detection of congenital conditions and timely referral for further assessment and treatment, reducing the risk of long-term harm. Records showed that all eight babies born at the MLU in September 2025 had their NIPE completed within 72 hours of birth, in line with best practice.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The maternity unit was located in a standalone, single-storey building arranged around a central vestibule with three corridors leading off. All corridors were secure with a monitored entry and exit system. The midwifery-led unit (MLU) was located to the right of the vestibule, while the remaining two corridors led to areas used for antenatal outpatient services and postnatal clinics.

Within the MLU, there were 6 clinical rooms, 2 of which were birthing rooms. One birthing room included a birthing pool and had been renovated in May 2025. The refurbishment included the installation of a new birthing pool with an improved water-filling system, allowing better temperature control and enabling more efficient and effective cleaning. This was the only birthing room that had ensuite facilities. Staff received training on the safe evacuation of women from the birthing pool in the event of an emergency. Training records confirmed staff compliance, and the most recent training session had been completed in the month prior to the inspection.

The physical environment of the MLU had not been fully reconfigured to reflect the unit’s transition from an obstetric unit to a midwifery-led unit. This resulted in underutilised large spaces and limited capacity in high-use areas, such as the waiting room and midwifery office. The layout did not fully support the comfort of women or staff efficiency and the disconnect between the waiting room and midwifery team identified safety risks for patients.

The midwife assessment clinic was also delivered from within the MLU and women used the small waiting room when attending this clinic. However, due to its location and layout, staff were unable to directly observe women waiting in this area. This meant there was a risk that a woman who became unwell while waiting, particularly if unaccompanied or unable to use the call bell, may not be promptly identified.

During the inspection, a woman did become unwell while waiting in this area, and staff had to be alerted to this by another patient waiting in the room. This risk had been identified at the previous inspection and had not been mitigated, meaning women continued to be exposed to the same safety concerns.

At the time of inspection, redevelopment work had started in the maternity outpatient clinical area, which was currently clean and tidy but showing signs of age. The area was getting two new clinic rooms, a redeveloped clinic room incorporating scanning facilities, upgraded bathroom facilities, including a new accessible toilet, a new midwifery station in the waiting area, improving visibility, support, and communication, full redecoration of the clinic area, and improved handwashing facilities in every clinic room. Outpatient clinics were still running during the redevelopment work, which meant additional noise and disruption but both staff and patients were excited to have improved facilities for future care and treatment of women.

All areas were visibly clean and clutter free. Equipment was clean, stored appropriately and maintained. Safety checks were performed on emergency equipment according to policy. Equipment was serviced, maintained and records kept ensuring equipment operated correctly and reliably, with a central team being responsible for this. If issues were identified with equipment, such as items missing or not working staff would log these on the incident reporting system and they would be investigated.

Consumables, including hazardous substances, were stored appropriately and consumables checked were in date.

Managers completed annual environmental risk assessments for the unit, including ligature risk assessments, with clear actions and associated timelines identified. The most recent assessment was undertaken in March 2025. In addition, monthly environmental walk-rounds were carried out by the community and MLU matron. Any issues identified were escalated promptly to the ward manager and the estates department, where appropriate, to ensure timely action.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care to meet people’s individual needs.

All staff with professional qualifications were subject to pre-employment checks to ensure their registration was active and unrestricted. New staff underwent a comprehensive induction programme tailored to their role, including both trust and service orientation. This involved e-learning and face-to-face training, which staff reported as effective and supportive in preparing them for their responsibilities.

The unit was open 24 hours a day, 7 days a week, with 1 midwife supported by a midwifery support worker (MSW) or maternity assistant practitioner (MAP). In hours the midwife was responsible for overseeing the midwife assessment clinic (MAC) and the triage telephone line, in addition to being available to support the birthing experience of women attending the unit. Out of hours, the midwife was also responsible for triaging the community midwives on call across the county. The core MLU staff were supported by on call community midwives, who attended the unit to ensure 2 midwives were present to support women at the point of delivery or cover when a woman needed to be transferred to the main hospital site. Due to the autonomy and experience of the role the unit was staffed by senior midwives. Newly qualified midwives would need to complete their 12-month preceptorship before moving to a community or midwifery-led unit role. Staff were also supported by the MLU midwifery manager, community and MLU matron and an on-call senior manager. The Horton midwifery-led unit (not including outpatients) was recruited to establishment.

The outpatient clinics were mainly staffed by outpatient midwifery staff and visiting obstetricians from the trust’s main hospital site.

We reviewed 8 sets of patient records and found that in 7 cases a second midwife was present at the time of the birth. In one case, documentation indicated only one midwife was present. Staff told us that, on occasion, particularly out of hours, babies were born before the on-call midwife had arrived at the unit. They explained that the on‑call midwife was contacted once the woman was in established labour. However, this sometimes resulted in only one midwife being present at the time of delivery.

It was standard safety protocol within the MLU for a second midwife to be present during the second stage of labour and birth. One midwife provides continuous care throughout labour, while a second midwife attends specifically for the birth to support the delivery, manage the newborn and provide additional safety oversight. Between October 2024 and September 2025, there were 86 births at the unit and between November 2024 and October 2025, 6 babies were born at the unit without a second midwife present. Of these, one was due to the woman arriving unannounced, 4 were due to rapid deliveries, and one occurred because the second midwife did not arrive until after the birth. A maternity support worker was present at all 6 of these births.

The trust reported maternity red flag staffing incidents in line with National Institute for Health and Care Excellence (NICE) guideline NG4 Safe midwifery staffing for maternity settings. A midwifery red flag event is a warning sign that something may be wrong with midwifery staffing. Information about red flags and safe staffing was reported to the trust board quarterly. The information covered the whole of the maternity service, with a focus on main hospital site. There was no specific information about red flags which occurred at the MLU. Leaders told us women would not be birthing at the Horton MLU if 1:1 care was not available.

Staff followed an escalation process if actual staffing levels fell short of the requirements. In case of shortfall against planned staffing, leaders redeployed staff to support any maternity area in line with the escalation policy. If additional staff were needed, they were taken from other areas, including via on-call availability. Intrapartum care (care provided to a woman during labour and birth) at the MLU was suspended on 2 occasions overnight within the past 12 months, in October and November 2024, due to staffing pressures and redeployment of staff in line with the escalation policy. This meant that women who wanted to have their birth experience at the MLU would not be able to during the time the unit was temporarily closed to intrapartum care. However, these temporary closures had not affected any women who had wanted to give birth at the MLU.

The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Managers supported staff to develop through yearly, constructive appraisals of their work. All core staff who worked at the unit had completed an annual appraisal. The trust monitored and reported on vacancy, turnover rates at the MLU.

The practice education maternity team supported midwives, maternity support workers and students across the whole of the maternity service at the trust. The team was responsible for ensuring that all maternity staff were competent, confident, and up to date with evidence-based practices. Their primary goal was to improve safety and quality of care for patients by providing education, training, and professional development. This included skills and drills training, evidence-based practice and clinical upskilling. Staff were also supported by a team of professional midwifery advocates (PMA), with an emphasis on staff wellbeing and psychological safety.

Mandatory training was provided to staff with protected time allocated for completion. The trust reported training compliance across the maternity service as a whole. Overall compliance among staff was 91%, with 16 of the 18 required modules meeting or exceeding the trust’s compliance target of 85%. Two modules were below the target: moving and handling Level 2, compliance rate of 79% and infection prevention and control Level 2, compliance rate of 83%. Equality, diversity and human rights training formed part of the mandatory training programme. Mental Capacity Act (MCA) and modern slavery training were incorporated into the trust’s mandatory safeguarding training programme for maternity staff. Compliance exceeded the trust target of 85%, providing assurance that staff had the required knowledge to support safe and lawful practice.

All staff required to undertake Practical Obstetric Multi‑Professional Training (PROMPT), which included mental health and bereavement care, had completed this training within the previous 12 months. In addition, all relevant staff had completed cardiotocography (CTG) and intermittent auscultation training for fetal monitoring in the same 12-month period.

Learning disability and autism training was mandatory for staff in designated roles in line with regulatory requirements. Overall compliance at the time of review was 83%.

The service assessed and managed the risk of infection. They mostly detected and controlled the risk of it spreading.

The trust had a dedicated infection, prevention and control (IPC) team that worked with the service, to prevent and reduce healthcare-associated infections. Their role involved assessing risks, auditing practices and providing the service with infection prevention guidance.

All areas within the midwifery-led unit (MLU) and outpatient areas were visibly clean and well maintained, with suitable furnishings throughout. Housekeeping staff followed an established cleaning schedule, and cleaning equipment was stored securely in locked cupboards in line with the Control of Substances Hazardous to Health (COSHH) regulations. Cleaning records were up to date and demonstrated that all areas were cleaned regularly.

Staff used appropriate equipment and control measures to protect women, themselves, and others from infection. Clinical-grade equipment wipes were used to clean equipment after each use. Some items used within the unit were single use, meaning they were designed for use on one patient only and were disposed of immediately after use. Staff followed guidance for the correct use and disposal of these items.

We found hazard tape applied to the resuscitaire to prevent the use of the oxygen pressure setting. This measure had been introduced in response to a British Association of Perinatal Medicine (BAPM) patient safety alert issued in 2022, which highlighted the risk of unsafe oxygen flow when using this device. The resuscitaire remained a vital piece of equipment and continued to be used. However, the hazard tape was in place to disable the oxygen flow function and had been used since 2023. A Neopuff device had been introduced for use instead when oxygen delivery was required. Staff had received training on this arrangement and were able to clearly explain the rationale for the hazard tape and the need to use the Neopuff device where appropriate. This temporary control measure was recorded on the service risk register and remained in place at the time of the inspection. These measures reduced the risk of unsafe oxygen delivery to newborn babies. However, the use of hazard tape created an infection control risk, as it could not be effectively decontaminated and was not aligned with safe IPC standards, which state equipment must remain fully cleanable, and any tape should only be used on a single-patient basis where clinically necessary. Following the inspection, we were informed that the risk had been formally reviewed in June 2025 and a task-and-finish group had been established to identify and implement a permanent solution, with the aim of removing the need for hazard tape.

Since the last inspection, the unit had installed a new birthing pool. Staff told us this was easier to clean, supporting compliance with the trust’s policy on cleaning and decontamination of birthing pools. Records showed that pool water run checks were completed to minimise the risk of bacterial contamination.

Staff adhered to infection control principles, including being bare below the elbows, wearing personal protective equipment (PPE), and maintaining good hand hygiene. Handwashing basins and hand sanitiser stations were available in all clinical areas, with hand sanitiser dispensers located at all entrances. Records confirmed that hand hygiene audits were completed monthly, with compliance rates of 99% between October 2024 and September 2025.

Staff maintained the cleanliness of their uniforms in line with trust policy. They explained that if a uniform became heavily soiled or contaminated, it would be disposed of in the appropriate waste bin and a replacement uniform would be requested.

The service used audits to monitor and improve compliance with infection prevention and control (IPC) standards. This included visits by the care assure team, who assessed clinical areas against specific measures, including IPC. At their last visit, completed in September 2025, no issues were identified. Staff told us if issues were found, actions would be recommended with clear timeframes, followed by re-audits to ensure that improvements had been achieved.

Staff managed clinical waste safely. The sluice area was clean and tidy and displayed information on the correct disposal of clinical waste in line with guidance. Sharps bins were used appropriately for the disposal of needles, syringes, and other sharp instruments. These were correctly dated and used as intended. Placental tissue was stored securely in specialist, security-tagged canisters in line with trust policy. A dedicated portering system was used for the safe collection, transport, and disposal of placental tissue, reducing the risk of contamination and ensuring compliance with infection prevention and waste management guidance.

Infection Prevention and Control (IPC) training is part of the trust’s mandatory training programme. Among maternity staff, 91% had completed IPC Level 1 training, while 83% had completed IPC Level 2 training. The Level 2 completion rate fell short of the trust’s compliance target of 85%.

The service, in collaboration with the Maternity Public Health team, operated a vaccination programme, including the annual influenza vaccine, to protect staff and reduce the spread of infectious diseases within the workplace and the wider community. Data provided by the service showed staff working at the MLU had received the influenza vaccine.

The service made sure that medicines and treatments are safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

At the previous inspection at Horton General Hospital concerns were identified about staff following the trust’s policies for medicines records and storage. At this inspection improvements had been made.

Processes were in place for the secure storage of medicines including controlled drugs and medical gases. These processes provided assurance that medicines were stored within their recommended temperature ranges and medical gases were safely stored. Emergency medicines boxes prepared centrally across the trust were available, tamper evident and in date.

Staff described the medicines and equipment contained in grab bags for home deliveries. Trust policies provided staff guidance on how to safely carry these items in the vehicles.

At Horton General Hospital, we reviewed four sets of patients’ dual records specifically to assess medicine information. These records were held across the trust’s electronic care record system, including prescribing and medicines administration records, and the dedicated maternity information system. The records reviewed contained sufficient detail regarding the patients’ care, including prescribing, administration of medicines, and discharge information. Staff described the operational necessity of maintaining two parallel clinical record systems but also highlighted the associated challenges of operating two parallel clinical record systems

Over labelled medicines were available for staff to supply against discharge prescriptions. However, the quality of the over labelling of the medicines in the TTO (To Take Out) cupboard was variable including appropriate over labelling and incomplete labelling. Therefore, there was a risk that patients on discharge may receive medicines with incomplete labelling and directions.

Trust guidance was available to support the record keeping of controlled drugs and controlled stationary. The records for controlled drugs and controlled stationary we reviewed showed staff were following trust guidance.

Legislation supported by trust guidance allowed midwives to administer an agreed list of medicines via "midwife exemptions" and patient group directions (PGDs).