Royal Lancaster Infirmary

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 women and communities had the best possible outcomes because their needs were assessed. We checked that women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women 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 our last assessment we rated this key question Good. At this assessment the rating has remained good. This meant women’s outcomes were consistently good, and women’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.

We maximise the effectiveness of women’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

The evidence showed a good standard of patient needs being assessed. The service made sure women’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There were systems and pathways which ensured support for vulnerable women or women who lacked capacity. Anyone identified at antenatal appointments as potentially needing more support were immediately referred to the enhanced service for screening. Referrals that met a threshold for enhanced support were referred to the enhanced support midwife, typically at booking. This included teenage pregnancy, people misusing substances, people experiencing domestic abuse, asylum seekers and refugees, non-English speakers, those in financial deprivation and families being supported by children’s services.

Specialist midwives worked closely with community midwives, and they shared some caseloads of complex and high risk women to provide continuity of care. All documentation for these women were recorded in a confidential section of the electronic notes. The enhanced support midwife continued care and contact for up to 28 days from first interaction and sometimes longer if necessary for safety.

Any needs or potential risks were identified, and individualised management plans were created. Referrals were made as required to partner agencies such as children’s social care, adult social care, and the learning disability team. The service had access to a learning disabilities lead for advice and support 24 hours a day, 7 days a week. This was usually the band 7 coordinator who was supernumerary.

If a woman’s first language was not English, they were also referred to the enhanced support midwife to assess any additional support needs they may have. Additional communication aids were available and a more specialist assessment was considered. Information and communication aids were available for those with specific communication needs. These included easy read information with simplified terminology, letters for dyslexic women printed on green paper, and interpreting and translation services both audio and visual, using a screen. Translation services were used to make patient information leaflets available in alternative languages. Staff were aware of the importance of never using family members. This was to make sure women were not being coerced or threatened by family members and also to make sure there were no breaches of confidentiality. Staff said they ensured they always had time alone with the women to determine whether there were any safeguarding issues they needed to be aware of such as domestic violence.

The trust had information available to staff about topics such as beliefs, values (including religious, cultural, moral or political) and how they could influence women’s decision making. Best interests documents we saw included the views of women and where appropriate, others.

We plan and deliver women’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

The evidence showed a good standard of delivering evidence based care and treatment. The service planned and delivered women’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.

The service planned and delivered women’s care and treatment with them and in line with legislation and current evidence-based good practice and standards such as National Institute for Health and Care Excellence (NICE) and The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. They also followed WHO (World Health Organisation) guidelines in theatre. We saw that staff could access both internal and external guidelines and standard operating procedures easily online. There were computer terminals staff could access should they need to check policies or standard operating procedures. Staff were also able to access support from a range of staff from different clinical disciplines such as dieticians and physiotherapists and specialties if they needed advice about specific patient conditions.

Staff took part in clinical audits to ensure guidance was being followed and multi-disciplinary meetings took place to discuss and promote quality improvement within the department.

Escalation protocols were clearly displayed and when we reviewed maternity related policies, we found these were regularly reviewed by appropriate clinicians and based upon up-to-date evidence-based practice.

Managers dealt with poor staff performance promptly and effectively.

We work effectively across teams and services to support women, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

The evidence showed a good standard of how staff, teams and services worked together. The service worked well across teams and services to support women. They made sure women only needed to tell their story once by sharing their assessment of needs when women moved between different services.

The service worked effectively across teams and services to support women, making sure they only needed to tell their story once by sharing their assessment of needs when they moved through their birthing journey. Twice daily handovers were attended by multi-disciplinary staff, and patients were discussed in detail particularly when there were additional concerns, or higher risks associated with them.

When women received care from a range of different staff, teams or services, it was co-ordinated effectively. Relevant staff, teams and services were involved in assessing, planning and delivering women's care and treatment and staff worked collaboratively to understand and meet women's needs.

Staff had access to the information they needed to appropriately assess, plan and deliver women’s care, treatment and support using electronic records.

Staff we spoke with told us that teams worked well together and that due to midwives rotating across different wards and departments within maternity services, staff had a good understanding of the work of each other. This helped with the flow of patients and assisted smooth transfers.

Plans for transition, referral and discharge considered women’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When women were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when women were referred between services due to additional health needs. The service used the SBAR (situation, background, assessment and recommendation) method of handover.

We support women to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

The evidence showed a good standard of women being supported to live healthier lives. The service supported women to manage their health and wellbeing to maximise their independence, choice and control. The service supported women to live healthier lives and where possible, reduced their future needs for care and support.

Wards and units had information available for mothers to help them to make informed choices. There were posters and leaflets on how to keep healthy and keep babies safe and well. For example, we saw posters encouraging women to stop smoking and the importance of healthy eating as well and promoting breast feeding. Staff gave women practical support and advice to lead healthier lives. Resource sheets were also available which included information on telephone help lines, websites, and apps.

Community midwives worked with women to support them to lead healthier lives during pregnancy including delivering support for healthy eating, reducing and stopping alcohol and drug intake, and stopping smoking. Staff assessed each woman’s health at every appointment and supported individual needs.

The service considered the mental health and wellbeing of women, and patients whose mental health gave rise to concern were discussed at handovers, including whether onward referral or additional support should be sought.

Staff were trained to support women with newborn infant feeding. Mothers requiring additional support were identified through routine post-natal care and information was documented in the post-natal notes. Breastfeeding women were signposted to local breastfeeding charities and leaflets were available. The trust also had an award winning breastfeeding support worker who held weekly support meetings on each site, where women could come together and receive ongoing support and peer support in relation to breastfeeding. The trust were delivering UNICEF level 2 breastfeeding support.

We routinely monitor women’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of women themselves.

The evidence showed a good standard of the department monitoring and improving outcomes. The service routinely monitored women’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of women themselves.

The service had developed an annual clinical audit programme based on national, local and incident specific requirements. Clinical audits identified when staff were not following guidelines and action plans were used to support staff to improve their compliance. We reviewed patient safety and clinical quality meeting minutes for maternity services and saw incidents, complaints and quality concerns were discussed and assigned to specific staff for responsibility.

The organisation submitted performance information to Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). We reviewed this data which was for maternity services across the trust and not split by site. The latest report was published in 2024 and covered activity between 2021 and 2023. The trust performed about the same as the England average for rate of still births, neonatal mortality and perinatal mortality.

The service carried out multiprofessional and midwifery led clinical audits covering a wide range of subjects for example HIV in pregnancy, postnatal bladder care, epilepsy and pregnancy and sepsis documentation and management. The trust also submitted NHS screening programme key performance indicator data to NHS England. The most recent submission showed that for almost all metrics, the acceptable thresholds were met.

The trust undertook PMRT reviews to scrutinise events leading up to deaths to identify whether anything different could have been done that may have changed the outcome for the mother or baby. We reviewed these as part of our inspection and found the notes to be comprehensive. Women and families were included in reviews and offered the chance to ask any questions and seek clarity about decisions made about the care and treatment they received. Lessons learned were identified and named individuals were given responsibility for making sure action plans were developed and progressed. We reviewed the action log which showed actions were regularly reviewed and progressing. The action log also identified actions from cases referred to MNSI.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

We tell women about their rights around consent and respect these when we deliver person-centred care and treatment.

The evidence showed a good standard of gaining consent deliver care and treatment. The service told people about their rights around consent and respected their rights when delivering care and treatment.

Staff understood how and when to assess whether a woman had the capacity to make decisions about their care. They gained consent from women for their care and treatment in line with legislation and guidance.

Staff could access relevant policies including Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The consent policy was overdue review, however, it referenced current relevant best practice guidance, such as making best interests’ decisions and Gillick competency.

Staff made sure women consented to treatment based on all the information available and clearly recorded consent in the woman's records. We observed staff gain consent before obstetric surgery and consent was recorded in all of the maternity records we reviewed where applicable. The department followed the WHO (World Health Organisation) audit which further confirmed 100% compliance with recording of consent.

We also observed staff requesting permission to examine women and explaining what they planned to do and why. They waited for women to respond before beginning examinations.

The service had developed post-mortem consent boxes in line with national guidance to obtain informed consent. The boxes provided information on post-mortem examinations and gave support and guidance for women and families.