Royal Lancaster Infirmary

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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

This means we looked for evidence that the service involved women and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

We looked for evidence that women were always treated with kindness, empathy and compassion. We checked that women’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 women’s wishes into account and respect their choices, to achieve the best possible outcomes for them. Women felt well-supported, cared for and treated with dignity and respect.

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.

We always treat women with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.

We scored the service as 3. The evidence showed a good standard of kindness, compassion and dignity. The service always treated women with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We looked at the results of the latest National Maternity Survey published in 2024. The results were trust wide and were not available split by site. These showed that the trust scored about the same as expected (9.3/10) for women ‘Being treated with respect and dignity during labour and birth”.

The Trust also scored better than expected (9/10) for “Being treated with kindness and understanding by staff after the birth”.

We spoke with 22 women who were using or had used the service recently as part of our overall assessment. They told us staff attitudes and behaviours when interacting with them were discreet, respectful and responsive, providing them with help, emotional support and advice any time they needed it. They told us staff were kind and helpful and took time to speak with them and reassure them about any concerns they had about any part of their pregnancy.

We spoke with staff about meeting the religious or cultural needs of women and they told us they treated women as individuals, did not make assumptions and asked women how they wished their care and treatment to be delivered.

We treat women as individuals and make sure their care, support and treatment meets their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The evidence showed a good standard of women being treated as individuals. The service treated women as individuals and made sure women’s care, support and treatment met women’s needs and preferences. They took account of women’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff told us they considered individual needs when care planning, this included being aware of cultural backgrounds and protected characteristics such as sexuality. Staff also gave us a few examples of this, including ensuring interpreting services were provided as soon as they were identified as being required.

Women’s cultural and spiritual needs and traditions were respected and staff worked with women and families to make sure these were met, including making sure food and hydration was appropriate and cultural traditions were understood and supported.

Staff had access to an electronic interpreting tool available in many differing languages and made sure that any information given to women and their families was accessible and in a format they could understand, specific to their communication needs whether it be language or other communication needs.

Staff and women told us information about support services was readily available and shared to make sure women and families knew where to turn for support and advice.

Quality Statement Score: 3

We promote women’s independence, so they know their rights and have choice and control over their own care, treatment. and wellbeing.

The evidence showed a good standard of women being supported to be independent and have choice and control. The service promoted women’s independence, so women knew their rights and had choice and control over their own care, treatment and wellbeing.

Feedback from women and their families described involvement in decisions about their care. This included themes such as being included in the decision to induce labour and how timely this would be. Midwifery staff told us there were sometimes delays in women's induction, due to other clinical priorities within the department and the availability of staff to oversee the process.

In the 2024 National maternity survey, in the questions about Labour and birth, the trust scored “About the same” overall and were “Somewhat better than expected” for giving advice on benefits of induction.

Staff told us they made time to ensure women remained at the centre of their care planning. We saw information and education aids across all wards and departments we visited to support this. We observed staff in discussion with women and their families and we saw active and interactive care planning processes which considered the wishes and preferences of women and their families.

We listen to and understand women’s needs, views and wishes. We respond to these in that moment and will act to minimise any discomfort, concern or distress.

The evidence showed a good standard of people’s individual needs being responded to. The service listened to and understood women’s needs, views and wishes. Staff responded to women’s needs in the moment and acted to minimise any discomfort, concern or distress.

Women were managed in the most appropriate place to have their immediate needs met.

We looked at the National Maternity Survey published in 2024 for the trust and saw that the trust scored “About the same” overall for questions relating to staff care. The trust scored “Somewhat better than expected” for not being left alone and “Better than expected” for attention during labour and birth. Additionally, nearly 100% of women surveyed felt that the midwife or midwifery team always listened to them.

We also looked at the results of the survey relating to care in hospital after birth and found the trust scored “Better than expected” overall, “Better than expected” for care after birth, kind and understanding care and pain management and “Somewhat better than expected” for receiving information and explanations after the birth, and for how long partners could stay with them.

Staff told us they were able to respond to women’s individual needs in a timely way. For example, staff told us they ensured enough time was available for breast feeding support.

We heard positive feedback from women we spoke with. Women were very happy with the care, treatment and support they received and had their needs attended to in a timely way.

The results from the National Maternity Survey 2024 showed the trust scored ‘About the same’ as other trusts for women being able to raising concerns.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback. For example, women and carers had opportunities to give feedback on the care they received in a manner that reflected their individual needs. Women were given the opportunity to meet with a staff member to discuss their birthing experience, especially if the experience was not what they had wanted or expected. This gave women the opportunity to ask questions and understand why, and also gave the trust the opportunity to learn from experiences and make improvements.

We care about and promote the wellbeing of our staff, and we mostly support and enable them to always deliver person centred care.

The evidence showed some shortfalls in who and how staff were supported. 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.

Staff we spoke with were passionate about their work and were motivated to provide the best possible care for women and babies.

The service promoted the wellbeing of their staff to support and enable them to deliver person centred care. Most staff felt supported by their colleagues, coordinators, ward managers and the heads of midwifery as well as the director of midwifery when required. Staff we spoke with said they felt supported by the band 7 staff most of the time. However, staff also told us there were individuals who were not always supportive and sometimes the culture within the team meant they were not supported to be their best selves at work. The trust was aware of challenges in the culture and had developed a Harmony Project to try and make improvements to culture amongst staff.

Staff told us that leadership was present and available as the head of midwifery was based on the unit and therefore, saw first-hand any challenges staff faced and provided immediate support. Staff also told us that they felt well represented at board level by the director of midwifery, which made them feel that they were listened to when they raised concerns such as safety or staffing for example. The trust had a Non-Executive Director aligned to maternity services who was also the board safety champion for maternity.

Following inspection, the service submitted the Support and Retention of Disabled Colleagues policy, which outlined reasonable adjustment support for all staff and states line managers should “Ensure that any staff who declare a disability is supported with reasonable adjustments which will enable them to perform to the best of their ability at work”, and “Explore sensitively with a member of staff whether they may be eligible for the provisions of this policy if they appear to be having difficulties at work which may be related to an undeclared disability.” Some staff told us they felt some managers did not follow the policy or fully support them and had escalated this through HR processes.

We asked the trust for information about annual appraisals. This information showed that not all staff were up to date with annual appraisals and that some departments were not meeting the 85% trust target. For example, W17 midwives were at 76% and midwifery support workers (MSW) were at 82%, labour ward MSW were at 50% and community midwives were at 71%. Medical staff were also below the trust standard at 83%. The trust told us there were aware of the shortfalls and had an action plan in place to make sure staff received an appraisal as soon as possible.

The trust had 13 PMAs (Professional Midwifery Advocates) in post, a role designed to improve the quality of maternity care by supporting midwives and enhancing their wellbeing. PMAs provide confidential, reflective conversations, personal action planning, and supportive challenges to midwives. The aims to reduce burnout, improve the overall quality of care, and promote a more compassionate and supportive environment within maternity services.