Westmorland General Hospital

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• 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 assessed 6 quality statements. The service routinely monitored women’s care and treatment to continuously improve it. The service ensured that outcomes were positive and consistent and that they met both clinical expectations and the expectations of women themselves. The service planned and delivered women’s care and treatment with them, including what was important and mattered to them.
Staff did this in line with legislation and current evidence-based good practice and standards. The service worked well across teams and services to support women. The service supported women to live healthier lives, or where possible, reduce their future needs for care and support. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good.

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.

Staff told us they were well supported by senior colleagues, and they worked together to ensure women made informed decisions based on best practice guidelines.

Staff felt very well supported by senior colleagues when women chose care outside of guidance. There was a clear policy and process to follow. The maternity service had a consultant midwife whose main remit was personalised care and supporting women who chose care and birth outside of guidance. Staff referred women to the consultant midwife who triaged the referrals and saw the women with most risk. A detailed care plan was agreed between the pregnant woman and consultant midwife/senior midwife which was communicated to the multidisciplinary team and outlined in clinical notes. Teams worked together to ensure women made informed decisions based on best practice guidelines and supporting individual choice was important to them.

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

At the last inspection, the service did not always have access to up-to-date and evidence-based guidelines and policies. At this assessment, we found that policies had been reviewed and updated. Staff followed policies according to evidence-based practice and national guidance.

Guidelines and policies were easy to locate on the trust’s intranet. There was a midwife dedicated to reviewing guidance and guidelines to ensure that they were up to date and that they were mapped to relevant standards such as the National Institution for Healthcare Excellence (NICE).

We reviewed policies and guidelines on site and off site following the inspection and found that they were in date and in line with relevant national and local guidance. Only 1 policy was technically out of date which was the Helme Chase Policy but leaders had an agreed extended time for completion of its review and ratification.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff reported healthy working relations between staff groups. We saw and heard many examples of effective team working which was based on mutual respect and trust.

The maternity service worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care and make improvements across the maternity service.
Staff spoke positively about the enhanced support midwives who supported women with complex needs or any vulnerabilities. There was a comprehensive policy, appropriate training, and multi-disciplinary involvement for joint working for the benefit of women.

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

The maternity unit participated in initiatives to promote the health and wellbeing of women and babies. Examples of this included access to mental health provision for pregnant women and mothers and access to specialist clinics.

The unit held a smoking cessation clinic. Midwives routinely discussed healthy eating and safe sleeping for new babies. Health and wellbeing messages were reinforced on the trust website and displayed in clinical areas. Leaflets were available in communal areas on a variety of health initiatives, support groups held locally and guides for new parents. Newborn babies were automatically referred to the onsite hearing screening clinic.

Posters were displayed to raise awareness of vaccinations. The service had supported the NHS roll-out of the respiratory syntactical virus (RSV) vaccine for pregnant women. Other vaccines included RSV, whooping cough and flu.

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

The maternity service had clear performance measures and key performance indicators (KPIs), which were effectively monitored. These included the maternity dashboard where parameters were presented in a format to enable it to be used to challenge and make improvements. The parameters had been set in agreement with local and national thresholds, which allowed the service to benchmark themselves against other NHS acute trusts.

The service participated in relevant national clinical audits. The service submitted data to external bodies as required, such as the National Neonatal Audit Programme and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK). This enabled them to measure their standards and performance against other providers and national outcomes. Data showed that their outcomes were within the national average. These reports were regularly reviewed during governance meetings.

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

Staff understood consent and we saw staff involved women in the decision-making process.

Staff had access to mental health/deprivation of liberty safeguards guidelines on the trust intranet. Staff were aware of their responsibilities under the Mental Capacity Act. Staff obtained and recorded verbal consent where appropriate, such as before a vaginal examination and written consent was recorded in care records