William Harvey Hospital

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

People were involved in assessments of their needs. Staff reviewed assessments and took account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with agencies to support best outcomes. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent and involved partners and people that were important to women. Staff made decisions in people’s best interests when they did not have capacity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service always made sure people’s care and treatment was effective by thoroughly 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 told us they felt well supported by senior colleagues when women chose care outside of guidance. They told us 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 supported choice.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

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.

Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. These included National Institute of Health and Care Excellence (NICE) and Royal College of Obstetricians and Gynaecologists (RCOG). Staff had access to guidelines on the trust’s intranet system. A maternity guideline committee developed guidelines in the light of new evidence.

There were systems to communicate changes in national guidance through monthly risk management newsletters, flash alerts and presentations to staff. On this inspection we saw this good practice had continued and was embedded. We also found practice development midwives made use of noticeboards to communicate best practice guidance. For example, we saw noticeboards displaying best practice guidance to support responsive breast and bottle feeding.

When we visited there was a power outage on some aspects of the digital system. To mitigate risk the data team visited each ward to ask if they needed access to any policies.

Midwives and obstetricians attended annual fetal monitoring training, which was a full day and post course assessment. Staff had 1-1 support if they did not pass the competency test and were required to retake the assessment.

Cardiotocography (CTG) cases were reviewed at the weekly multidisciplinary (MDT) training sessions and during investigations of reported incidents. CTG is used during pregnancy and labour to monitor fetal heart rate and uterine contractions and as part of a holistic assessment of fetal wellbeing.

We reviewed 10 labour records for evidence of ‘fresh eyes’ and saw compliance in all records. It is best practice to have a ‘fresh eyes’ or buddy approach for regular review of CTGs during labour. The fetal monitoring team performed ‘spot checks’ on labour notes to ensure a risk assessment was performed at the onset of labour. They recently ran an intermittent auscultation awareness week and developed infographics, which were shared across teams. The infographics provided a summary of key facts in a visual and simplified way. Audit results showed 89% of birthing people had ‘fresh eyes’ hourly in labour during 2024 and the updated policy was launched in June 2024.

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 medical teams, midwives and other staff groups. We saw and heard many examples of effective team working which was based on mutual respect and trust. This was an improvement since our last visit.

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. The MNVP told us they had easy access to the senior leadership team to escalate any concerns promptly. They completed a regular walk-around of the unit and their feedback was used to drive improvements. They contributed to staff training, the design of user information leaflets, information packs, the maternity website, guidelines and outreach work

Leaders told us they worked in partnership with their Local Maternity and Neonatal System (LMNS) to develop a system-wide fetal monitoring strategy. This included updated guidance, which reflected national guidance and rolled out across the LMNS in June 2024. This helped to maintain consistency.

The service provided some multidisciplinary clinics such as the gestational diabetes clinic. All relevant staff, teams and services worked collaboratively in assessing, planning and delivering people’s care and treatment.

The service was supported by senior obstetric, anaesthetic and midwifery staff 24 hours-a-day. Staff told us they felt confident to seek assistance at any time of day or night. Details of the on-call team were updated daily on white boards. These were displayed in the staff office for all clinical areas.

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. For example, they had a smoking cessation midwife and advisors, they routinely discussed the importance of vitamin D supplementation during pregnancy, healthy eating and safe sleeping for new babies. Health and wellbeing messages were reinforced on the maternity website and displayed in clinical areas.

The maternity unit participated in initiatives to promote the health and wellbeing of women and babies. There was access to mental health provision for pregnant women and mothers and access to specialist clinics including diabetes and weight management. Parents were offered BCG vaccination for their baby.

The service routinely monitored women’s care and treatment to continuously improve it but the current process for obtaining blood samples following nuchal translucency (NT) scans was not effective. A NT is an ultrasound that measures the amount of fluid behind the fetal neck to help calculate the chance that the fetus has a chromosomal or genetic variant.

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 used monitoring results to improve safety. These indicators were scrutinised at monthly maternity clinical governance meetings and provided assurance at the executive-led quality committees and trust board quality committee.We noted in the maternity clinical governance minutes (November 2024) that the postpartum haemorrhage rate was higher than the local and national average, (although the rate was not confirmed). However,a ‘deep dive’ and thematic review was completed by The patient Safety Team in November 2024. This included all cases between Sept-Oct 2024.

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 MBRRACE-UK. This enabled them to benchmark performance against other providers and national outcomes.They had reviewed the trust’s performance in relation to national outcomes in October 2024 and evidence showed their outcomes were within the national average. These reports were regularly reviewed during clinical governance meetings.

The trust had completed an internal review of 14 recent neonatal deaths. The review appeared to demonstrate a high proportion of the deaths related to severe prematurity. However, the trust had commissioned an external independent review to confirm any actions needed.

We also saw there was 100% compliance with external reviewers for the perinatal mortality review tool (PMRT). The PMRT is a tool designed to support the review of baby deaths, from 22 weeks' gestation onwards.

The trust was compliant with all 10 standards for the Maternity Incentive Scheme (MIS) although the standard for workforce planning and in-house training included action plans to support compliance. The Maternity Incentive Scheme is a financial incentive program designed to enhance maternity safety within NHS Trusts. It rewards trusts who can demonstrate they have implemented a set of core safety actions, ultimately aiming to improve the quality of care for women, families and newborns

However, the current process for obtaining blood samples following nuchal scans was not effective. The pathway required women to attend a separate appointment (in another location), to have the necessary blood test. The blood test was required to enable calculation of risk regarding the genetic disorders screened for. Leaders had identified that approximately 33% of women did not have the blood test and scan on the same day. This meant their screening was incomplete.

The antenatal screening team identified missed and delayed blood tests for the combined screening tests and had completed a review of all women affected. They had completed the duty of candour, and all women affected had been offered an alternative method of screening. However, we saw many women had been contacted but not completed their tests and it was not clear if this was because they wanted to decline testing. The head of midwifery and screening coordinator were trained in genetic counselling. The trust told us (during the factual accuracy process) that 1 midwife had also completed the training at the end of 2024, and another 2 midwives were starting training in May 2025.However, we have not seen evidence of this.

Leaders had asked the Maternity and Neonatal Voice Partnership (MNVP) to reach out to service users for feedback on how this service could be improved. A proposal was being considered to set up a maternity support worker in a room next to scanning to take the blood tests and offer vaccines.

The service always carefully explained to women what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

Staff understood consent and we saw staff involved women in the decision-making process. Leaders had developed a mandatory multidisciplinary study day called ‘The Birthday.’ This covered informed consent, supporting trauma informed care, birth law and personalised care plans.

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. We saw staff obtained and recorded verbal consent where appropriate, such as before a vaginal examination and written consent was recorded for procedures such as a caesarean section.