Royal Lancaster Infirmary

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met women’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant women’s needs were met through good organisation and delivery.

We looked for evidence that women and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of women and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that women could access care in ways that met their personal circumstances and protected equality characteristics.

We have not awarded this service a score for Responsive.

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

This means we looked for evidence that the service met women’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant women’s needs were met through good organisation and delivery.

We looked for evidence that women and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of women and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that women could access care in ways that met their personal circumstances and protected equality characteristics.

The evidence showed a good standard of care provision, integration and continuity. The service understood the diverse health and care needs of women and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service actively worked to meet the needs of the communities it served. The service actively engaged with families to understand the changing needs of those using the service.

This involved individualised care planning with inpatient areas to ensure they were cared for in the most appropriate and safe environment for them. For example, if a woman was unable to tolerate noise on the ward environments, they are offered a longer stay on delivery suite or a quieter area of the ward.

Post natal support was available for women. The service offered care in the community and in women’s homes as well as support groups in the hospital. The service also provided postnatal drop-in sessions across the bay.

Women and families could make an appointment with a member of the maternity team using the ‘Birth Reflections Service’ to feed back their experiences, especially when they were not positive and learning was used to affect change and refine services.

There was an elective theatre list every day, alternating between elective (planned) obstetric and gynaecological procedures. A second theatre was available 24 hours a day, 7 days a week for unplanned and emergency obstetric work. There was dedicated obstetric and anaesthetic cover to run these lists.

We provide appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

The evidence showed a good standard of information being provided to women. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed to share information and keep women safe. We discussed with staff how they shared information between departments and external organisations. They gave us examples of how they worked with community midwives, health visitors and external organisations to make sure important information about women and their babies was shared with the relevant organisations to keep them safe.

Information governance systems included confidentiality of patient records. Clinical records were stored securely on an electronic record keeping system that was password protected. As we inspected the department, we did not see any unlocked computer terminals. Staff used their individual logins to access information they needed. Only necessary information was shared between departments and external organisations.

The service complied with the Accessible Information Standard. Patient information was available in different formats including easy read and could be translated into different languages if required. Staff and managers told us the population the trust served had some culturally diverse communities and so information could be tailored to these communities. Patient information could also be provided in alternative formats such as large print if this was needed.

Spoken language interpreters were available 24/7 delivered by an external provider who could be accessed by telephone and sometimes face to face if prebooked. The trust could also access British Sign Language interpreters.

Staff ensured that patients could obtain information on local services, patients’ rights, how to complain. This too was available in different languages and formats and supported by the PALS (patient advice and liaison service) team of the trust.

Staff ensured carers and families were regularly updated about the patient’s progress in line with patient wishes.

We make it easy for women to share feedback and ideas or raise complaints about their care, treatment and support. We involve them in decisions about their care and tell them what’s changed as a result.

The evidence showed a good standard of people being listened to and involved in their care. The service made it easy for women to share feedback and ideas, or raise complaints about their care, treatment and support. They involved women in decisions about their care and told them what had changed as a result.

The service had various ways of gathering feedback and actively sought it so that they could improve services and make meaningful changes because of it. The service welcomed feedback from women and families through surveys, complaints and compliments and through the local MVNP Maternity Voices Partnership, with which leaders were actively involved.

The trust worked with the (MVNP) to gather the experiences of women who used the services and there was a 3 year delivery plan in place to support this. The MVNP made sure women’s voices were at the heart of decisions made about the service and its future and linked with commissioners to influence improvements to safety, experience and quality delivered by the trust.

Through the MVNP women using the service had been involved in coproducing resources such as induction of labour leaflets, the bereavement service at RLI, the maternity strategy and birth infographic.

Managers investigated complaints and concerns thoroughly and made appropriate recommended actions. Managers regularly shared feedback from complaints with staff at various meetings such as the daily safety brief.

Information about how to complain was displayed throughout the ward and delivery suite and the trust complaint procedure was clearly explained on the trust website. Women could submit complaints and feedback using an online form, by telephone or in writing, to the patient complaints team. Responses were provided in writing, and women were offered the opportunity to meet to discuss their complaint face to face.

When we spoke with patients as part of our inspection, we discussed if they knew how to raise concerns either informally or formally and they told us they did. When we spoke with staff about whether they knew how to manage patient feedback, complaints and concerns they assured us they understood the processes in place and who and when to involve others. We were assured that both patients and staff were equipped with knowledge about complaints processes.

The service used the learning from incidents, complaints and concerns as an opportunity for improvement to local practice and procedures. We reviewed the Health Quality Board, Labour Ward Forum, ATTAIN (Avoiding term admissions into neonatal units) and Perinatal Audit minutes and saw themes and trends were identified and acted upon.

We make sure that everyone can access the care, support and treatment they need when they need it.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service worked hard to understand the community’s needs to ensure that all women had access to care, support and treatment in the way they required and when they required it. Staff made reasonable adjustments for patients – for example, women with sensory needs or mobility issues were supported with their needs and worked with them to make sure their place of delivery was safe and appropriate. Community midwives worked with women to make sure they were seen and supported regularly and provided with advice to keep them safe.

The service further worked to support women to deliver where and how they wanted to deliver. Women were given full information to enable them to make decisions about delivery such as the pros and cons of waterbirth and home delivery. Women were also provided with information about induction of labour. We asked the trust about delays to induction of labour and they told us it usually happened due to staff or bed shortages.

We asked the trust to send us information about incidents relating to delayed care over the previous 12 months. RLI had reported 58 incidents, 56 of which were no harm and 2 were low harm (requiring additional observation or minor treatment). The data showed that the department at RLI sometimes missed the BSOTS target of assessment within 15 minutes of arrival due to staff or bed shortages and level of acuity. However, there had been no incident reports of moderate or serious harm as a result of the delays. BSOTS is the Birmingham Symptom-specific Obstetric Triage System (BSOTS) and is a standardised system used in maternity triage to assess and prioritise women with unexpected pregnancy-related concerns. The department collected and analysed information about the reasons for delays to identify any themes and trends so they could look at how to reduce delays for women.

Women’s care, treatment and support were mostly accessible, timely and in line with best practice. However, audit data for September 2024 showed that only 52% of women met the target for being reviewed by a doctor in under two hours. In October and November 2024 this figure was 48% and 50% respectively. No subsequent data was provided for December 2024 to February 2025 due to documentation issues.

Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators and community staff to make sure women were supported post discharge.

The community midwife team worked across a large area and worked flexibly to meet the needs of the service.

The perinatal services had a clear pathway for Transitional Care services which was aligned with the British Association of Perinatal Medicine (BAPM) Transitional Care Framework for Practice. However, discharge was occasionally delayed for other than clinical reasons such as availability of medication to take home or medical staff to review women and babies before discharge. There was a dedicated intermediate grade paediatric doctor or ANNP (advanced neonatal nurse practitioner) allocated to the postnatal ward each day between the hours of 08.30-17.00 to support with reviews and timely discharges.

Transitional Care was staffed by both Neonatal Nurses and midwives and there was access to an advanced nurse practitioner (ANP). This helped minimise separation of mums and babies as they could remain together and be admitted to transitional care from birth.

The service did not record or audit running times of antenatal clinics and when women were seen in relation to their appointment time. The trust explained women who attended antenatal clinic were seen according to clinical need or at the relevant gestation. If a clinic was full then staff overbooked the clinic or gave them an appointment in an alternative clinic to ensure they were seen at the correct time.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and there were escalation processes in place to make sure that senior medical staff were available should their support be needed.

Until recently we have not actively gathered sufficient data about women who are most likely to experience inequality in experience or outcomes. However, when we identify patients with additional needs, we tailor the care, support and treatment in response to this.

The evidence showed some shortfalls. Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Although the department did not undertake specific audits relating to protected characteristics, they had recently introduced a new Inequalities Dashboard which was being overseen at Safety and Quality Group meetings and monitored for any emerging trends. The new dashboard looks at outcomes aligned to deprivation and ethnicity and the trust is planning to include further protected characteristics as it develops. This will include outcomes to demonstrate equity in experience. The trust sent us a copy of the latest dashboard. It highlighted some areas of disparity which the trust had identified needed further investigation. The trust had also committed to using the Equality Delivery System (EDS2) Published: July 2022. The Equality Delivery System (EDS) is a system that helps NHS organisations improve the services they provide for their local communities and provide better working environments, free of discrimination while meeting the requirements of the Equality Act 2010.

We reviewed the national maternity dashboard from February 2024 to February 2025. This showed that 33% of mothers were in the most deprived decile. The national average was 14%.

In response to the needs of local families, the trust had recruited additional specialist midwives. These included a diabetes specialist midwife who provided one stop clinics for people with Type 1 and Type 2 diabetics, and a maternal medicine midwife who oversaw pregnant women with complex pre-existing or pregnancy-acquired medical conditions, such as cardiac, renal or neurological issues along with the multidisciplinary team. The enhanced support midwifery team worked with local support agencies and charities to support women encountering hardship such as homelessness, domestic violence or food poverty or whose first language was not English such as asylum seekers and refugees. The midwives were able to link women with organisations who could help them.

Staff were trained in equality, diversity and inclusion as part of their mandatory training. Midwifery staff were 98% compliant, obstetricians 100% and midwifery support workers 94% compliant against a trust standard of 90%.

Staff worked with multiple departments and external agencies to support women during their birthing experience to make sure they were able to deliver in an environment that respected their privacy and dignity. When mothers and babies could not stay together after delivery, HOPE boxes were used as a way to bring comfort to those involved. These contained carefully chosen items to try to reduce trauma.

The service and the wider organisation promoted a culture in which the women using the service felt empowered to give their views. It worked collaboratively with women and their representative organisations to gather feedback.

The trust had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable women or women with protected characteristics at a disadvantage.

We support women to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of their life.

The evidence showed a good standard of supporting women to plan for the future. Women were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of women with complex needs. The trust provided us with examples of this which included the local authority, police and others to make sure women and babies were safe.

Women could access specialist mental health services and specialist midwives developed support plans with women during pregnancy and after childbirth. The service also provided information and clinics to support women to plan for various outcomes including multiple births, high risk pregnancies and for women who were vulnerable or required enhanced care and treatment.

The maternity and neonatal voices partnership (MNVP) lead held monthly highlight meetings with the senior midwifery team. Themes from the meeting and a monthly report were shared with colleagues from the Integrated Care Board and LMS and discussed at the meetings.

The trust promoted baby loss awareness and every year held a memorial service which parents were invited to attend. They had a remembrance book, poems, parents could light a candle and a tree with stars where they could write a message.

There was communication between the teams to ensure all appointments were cancelled so not causing unnecessary distress, work was currently underway with the digital midwife to streamline this process. 

The bereavement suite at RLI was closed at the time of inspection due to building safety concerns and whilst building work took place of the replacement facility. Building was underway at the time of our inspection. There remained a limited provision on-site and women were also offered the opportunity to access bereavement facilities remotely, or on other sites such as Furness General Hospital (FGH). The Bereavement Midwife provided a service to women from 16 weeks, antenatally if there was a fetal anomaly and postnatally.

The service worked closely with the chaplaincy service and other religious leaders to provide spiritual care for families. Families were supported by a local charity to provide memory boxes for families. 

All maternity reviews were shared with families; duty of candour was carried out and appropriate referrals made such as to MNSI if required. If there was individual learning then an individual plan was prepared with staff, and the HR process followed.

The service provided information and clinics to support women including for multiple births, births following previous loss, vaginal birth after caesarean, high risk pregnancies and for women who were vulnerable or required enhanced care and treatment. Where the service was supporting women who had concerns regarding their pregnancy and birth journey, they determined what additional support could be put in place early on in pregnancy to mitigate some anxieties later on. Multi-disciplinary meetings were also held throughout the pregnancy with other agencies in order to ensure all available support was in place in advance.