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Inspection Summary


Overall summary & rating

Good

Updated 11 February 2015

 North Bristol NHS Trust is an acute trust located in Bristol that provides hospital and community services to a population of about 900,000 people in Bristol, South Gloucestershire and North Somerset. It also provides specialist services such as neurosciences, renal, trauma and plastics/burns to people from across the South West and in some instances nationally or internationally. The trust has five main locations that are registered with the Care Quality Commission. It provides healthcare from Southmead Hospital, Cossham Hospital, the Frenchay Hospital site, the  Riverside Unit and Eastgate House. The main hospital at Frenchay closed in May 2014 when the new hospital at Southmead opened. The trust also provides community healthcare for children and young people across Bristol and South Gloucestershire. Cossham Hospital consists of a midwife-led birth centre, which had 556 deliveries between January 2013 and March 2014, and an outpatients department, which provided 19,603 appointments in 2013/14.   Overall we have rated Cossham Hospital as good. Services in all the areas we inspected were good, and caring and responsiveness in the maternity service was outstanding.  Our key findings were as follows:

  • Staff were clear about the processes for reporting incidents, received feedback and learning was shared.
  • The hospital was clean, tidy and well maintained. Staff were seen to be bare below the elbow in line with trust policy and washed their hands before and after carrying out patient care.
  • Access and uptake of both mandatory training and further training was good. In addition, training in obstetrics and neonatal emergencies was extended to the wider team, including paramedics and community midwives.
  • Staffing in outpatients and diagnostic imaging was good. Although staffing in the maternity service was clearly meeting patients’ needs, the ratio of midwives to births was only recorded at overall trust level. This showed a midwife-to-birth ratio of 1:33.9, which was below the England average of 1:29.
  • Staff provided care and treatment based on national guidelines such as those produced by the National Institute for Health and Care Excellence.
  • In the maternity service, patient outcome data was recorded and fed back to staff on a monthly basis, enabling staff to review and if necessary take action to improve practice.  
  • Staff were caring and provided kind and compassionate care. In the maternity service this extended to the whole family and women with complex needs were embraced into the service.
  • In outpatients, referral to treatment times were consistently met.
  • In the maternity services were tailored to meet the needs of the individual woman and her family, and were delivered in a way to ensure flexibility, choice and continuity of care.
  • Services were well led. Staff were positive about the leadership and management of the maternity service. Governance systems were embedded.

  We saw several areas of outstanding practice including:

  • Half-day training sessions were run for all trust staff (midwifery and medical) as well as paramedics from the local ambulance service. These were in addition to the annual updates provided.
  • Facilities for women in labour were outstanding, and promoted the use of water for both pain relief and delivery and care, in a calming and relaxing environment for normal births.
  • The kindness, compassion and holistic approach to care at the birth centre was found to be outstanding, with strong person-centred care and support clear to see.
  • There was very clear evidence of learning from incidents, complaints and concerns. Actions were taken and learning was shared both internally and across the wider maternity service.
  • Efforts to engage hard-to-reach members of the community and overall public engagement were outstanding. Strong networks existed and staff used a wide variety of methods to encourage and promote public engagement.

 However, there were also areas of poor practice where the trust needs to make improvements.

 The trust should:

  • undertake a staffing review and report on staffing at the Cossham Birth Centre separately from the main unit at Southmead to ensure that the midwife-to-births ratio is within the limits set by the Royal College of Obstetricians and Gynaecologists and that one-to-one care in labour is provided 100% of the time
  • review the number of supervisors of midwives to ensure a supervisor-to-midwives ratio of 1:15 is met
  • ensure that the availability of a chaperone is displayed for patients in the outpatients and diagnostic and imaging departments.

Professor Sir Mike Richards

 Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 11 February 2015

Effective

Good

Updated 11 February 2015

Caring

Good

Updated 11 February 2015

Responsive

Good

Updated 11 February 2015

Well-led

Good

Updated 11 February 2015

Checks on specific services

Maternity and gynaecology

Outstanding

Updated 11 February 2015

The maternity services provided at Cossham Birth Centre were found to be outstanding. The services were found to be good in the safe, effective, the well led domains, and outstanding in both the caring and responsive domains. Staff were encouraged to report incidents and there was very clear evidence of learning from incidents, complaints and concerns. Actions were taken and learning was shared both internally and across the wider midwifery service. Risk assessments were undertaken ensuring the suitability of women delivering in a free-standing midwifery unit. The midwife-to-birth ratio was not recorded separately for Cossham Birth Centre, but were included in the overall trust. Trust data showed a midwife-to-birth ratio of 1:33.9, which was below the England average of 1:29. One-to-one care in labour was provided between 93.8% and 100% of the time. Care was delivered in line with guidelines and was subject to ongoing audit. There were specific policies relating to a free-standing midwife-led unit. Women had access to a wide variety of pain relief. Use of water in labour and for birthing was good. There was evidence of outstanding multidisciplinary working with the ambulance service as well as obstetric and neonatal staff at Southmead Hospital. Facilities for women in labour were outstanding, and promoted the use of water for both pain relief and delivery and care, in a calming and relaxing environment for normal birth. There was a caring culture fully embedded across the service. Throughout our inspection we saw exemplary patient-centred care being given, and this was confirmed in patient feedback. Time spent with women was not rushed, and care was delivered with kindness, compassion and understanding, which extended to the whole family. Women were fully informed and involved in choices, and feedback was actively sought. Women with complex social needs were not excluded from delivering in the birth centre, with protocols in place to ensure the involvement of specialist midwives as required.Information was available in formats to meet the needs of the local population, and translation services were easily accessible. There was clear evidence that when complaints or concerns were raised, action was taken and learning occurred. The maternity services were well led. The vision and strategy was well known and promoted throughout by all staff. Clear governance pathways existed, ensuring learning from incidents within the birth centre as well as the wider organisation. Leadership within the birth centre was strong and supportive. Efforts to engage hard-to-reach members of the community and overall public engagement were outstanding. Strong networks existed and staff used a wide variety of methods to encourage and promote public engagement.

Outpatients

Good

Updated 11 February 2015

The outpatients department at Cossham Hospital was found to be good in all the domains rated. Cossham Hospital outpatients department was clean, hygienic and well maintained. There were comfortable waiting areas for patients, with refreshments available in the main hospital waiting area near the entrance and main reception desk. The x-ray and diagnostic department was also clean and well maintained, and had its own reception and waiting area for patients. Patients were positive about all aspects of their treatment and the care and professionalism of the staff. Clinics generally ran on time and when there were delays patients were kept informed. The clinic specialities and the diagnostic department at Cossham were meeting the national targets for their referral-to-treatment times. National targets for the referral-to-treatment times were being met. The direct access systems for patients to come for x-rays, after seeing their GP, worked efficiently and effectively. Staff were provided with good local leadership.