William Harvey Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had a good learning culture where people could raise concerns. Managers investigated incidents thoroughly. Women and babies were protected and kept safe. Staff understood and managed risks. The maternity areas were clean and well-maintained, and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

However, the design and environment did not follow national guidance or effectively meet the needs of women and families. The overall capacity of the estate did not adequately support the activity and because of the geography and limitations of the estate, it was not always possible to support care that was compassionate and dignified.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice and we saw and heard significant improvements regarding the learning culture. Staff told us they felt well supported and the culture had shifted from one of blame to learning and improvement.

Staff knew what incidents to report and how to report them. This included but was not limited to all obstetric emergencies, care issues, missed appointments and staffing issues.

Leaders reviewed incidents daily so they could identify immediate actions. Incidents which required immediate attention were prioritised to ensure potential safety concerns were addressed and mitigated.

There was a clear process to ensure all staff were supported following incidents. This included immediate support with a professional midwifery advocate (PMA) or mental health first aider.Staff were referred to the TRIM (Trauma Risk Management) maternity team who completed a meeting within 48 hours to assess those involved and the level of support required.The wellbeing team where then contacted to provide additional support.

Leaders shared learning from incidents by email, newsletters and during meetings. We saw themes and trends from learning were shared during handovers and safety briefings and a maternity message of the week was shared during safety huddles we attended.

The team had a weekly ‘Stop the Clock’ meeting. This was chaired by the director of midwifery and had a live action plan. Staff discussed risks, environmental audits, infection prevention and control, room temperatures, intentional rounding, equipment safety checks, fire exit routes and medicines. The risks were rated according to severity.

The service always worked with families and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. However, there were sometimes delays in transition through the service and the IT systems needed further development to benefit women.

Bed capacity and high activity and acuity often impacted flow throughout the unit and caused delays. Leaders told us they had made some changes to improve flow and discharges. For example, they had implemented discharge coordinators to support with discharge paperwork. Staff were familiar with the escalation process to support staffing and acuity. However, we were told beds were frequently blocked due to delayed medicines to take home and delayed medical reviews which caused delayed discharges.

There was a cross site daily sitrep meeting which we attended during our inspection. The meeting was chaired by the head or director of midwifery and followed a set agenda. This included staffing, bed capacity, safeguarding, staff wellbeing any escalation pressures and key messages to share with staff. For example, any learning form recent incidents.

We attended staff handovers during our inspection and saw staff used an evidenced based approach known as Situation, Background, Assessment, Recommendation (SBAR). Leaders shared their most recent audit of compliance to SBAR although we could not see the date the audit was completed. This was a very small sample of 12 SBARs which highlighted poor compliance but no date to re-audit to determine if actions were effective.

The medical team had a twice daily board round where they discussed the care and treatment of all in-patients and women that were due to be admitted for their labour to be induced or planned caesarean sections. The labour ward consultant and coordinator prioritised inductions of labour (IOL) dependant on clinical need and plans were updated in records of care. We were told the process worked well and did not see or hear any delays during both days of our inspection although we did not see how delayed IOL were reported as red flags.

The service had implemented a triage telephone line since our previous inspection. Women who were 16 weeks pregnant and over could call with any concerns 24 hours-a-day. This number was a single point of contact for both hospitals and staff reported it had made a significant improvement.

Leaders had implemented a triage tool based on a nationally recognised model to ensure women were triaged according to clinical need and urgency. This was an improvement from our previous inspection. They had recruited protected staff to manage the triage telephone line 24-hours-a-day. Leaders audited compliance to the triage tool and results showed that 961 women were seen in triage during November 2024 and 81% were triaged within 15 minutes and 98% within 30 minutes. At the last data refresh (December 2024), 2163 women had attended triage, and the main reason was for their scans to be reviewed (476)

Records were a mixture of paper and electronic which meant staff could not always have complete oversight of women’s plans and care. Staff also had to duplicate some documentation from paper to electronic records, which was not efficient use of their time and created opportunities for error.

Staff also told us the IT connectivity could be variable across the hospital and mostly in the community. This added additional stress to their workload and could mean documentation was not always recorded. In addition, community midwives used diaries to book appointments, which meant there was no oversight of their workload. There was a power outage during our inspection which impacted on some aspects of the digital system. However,the data team visited each ward to ask if they need access to any policies to mitigate this risk.

Leaders told us they were in the process of procuring a new digital system and had recently installed an electronic patient tracking system. This flagged pregnant women and new mothers who attended other departments in the hospital and may need support from the maternity team. We saw a pregnant woman had booked into the accident and emergency department (A+E) and the staff immediately contacted A+E to offer support in managing the woman’s care. Staff told us this initiative had been shortlisted for a Royal College of Midwives Award.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. Overall, there was improved and effective process to safeguard families.

Staff followed safe procedures for partners and family visiting the wards. Partners were required to wear a pink wrist band to highlight their suitability to visit.This practice was embedded across the Trust. Access to the wards was by a video entry system and we saw staff checking personal details and for the pink wristband to allow access.

Postnatal staff told us baby abduction drills were included in skills and drills. The most recent drill was 6-8 weeks earlier. They completed online training in baby abduction and told us they gave all parents an information leaflet regarding baby security.

Staff knew how to identify abuse and neglect, and how and when to make safeguarding referrals. Staff routinely asked women about domestic abuse and recorded concerns in a mandatory field in electronic records. The service was supported by a Hospital Independent Domestic Violence team and safeguarding matters were recorded as an alert on women’s electronic notes.

Staff had access to a Kent-wide safeguarding alert app which they used to record and share major safeguarding concerns. Staff could access the app to determine if there was any previous history of neglect or abuse.

There was an associate director of safeguarding who supported the named midwife for safeguarding. The service had a consultant lead for perinatal mental health supported by a perinatal mental health midwife. The division took a multidisciplinary approach to reviewing safeguarding referrals and follow up support for women. This included a social worker, named midwife, lead for mental health, and the perinatal mental health consultant.

Staff could access support from the safeguarding team during office hours and on-call support out-of-hours. They told us the safeguarding team were supportive and responsive, and visited the wards to support staff with safeguarding matters and update safeguarding plans.

We were told the trust wide safeguarding team were trained to Level 4 for adults and children. Role specific safeguarding training on how to recognise and report abuse had improved since our last visit. Compliance for safeguarding children Level 3 had improved to just above 90% for midwives, and 83% for consultants and 100% for maternity support workers for safeguarding Level 2 training. Overall compliance was 92% for annual maternity updates, which included perinatal mental health and midwives received regular supervision particularly when supporting families with safeguarding concerns.

There was a clear process to follow when women did not attend their appointments. The community midwife made a home visit if a woman did not attend her appointment twice. This was recorded on the woman’s electronic records and flagged on the system.

Staff completed psychosocial assessments and risk assessments for women thought to be at risk of self-harm or suicide. The health and safety team had completed ligature risk assessments throughout the service and ligature cutters were stored securely on all adult resuscitation trollies.

We noted that safeguarding was included during all handovers and staff received a safeguarding newsletter every quarter.

The service always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Women were informed about any risks and how to keep themselves safe. We spoke to 12 women during our inspection who told us they felt listened to, risk was explained, and they were involved in decisions about their care and treatment.

Staff used national tools to assess women during the antenatal period. A full assessment was completed at their booking appointment (the first full assessment at the beginning of the pregnancy). We reviewed 10 sets of maternity records and saw these were completed in full.

Staff completed newborn risk assessments when babies were born using recognised tools and reviewed this regularly. They provided transitional care for babies who needed additional care. Staff caring for babies who needed additional care used a Neonatal Early Warning System (NEWTT2) tool to record observations and feeding. The most recent audit of NEWTT2 compliance was only 60-70% (in October 2024). An educational awareness video was developed and shared with maternity workforce to support an immediate response to improve the completion and compliance. Compliance to NEWTT2 was monitored daily by the Band 7 midwife and weekly by matrons. Results were discussed during ‘Stop the Clock’ meetings to focus on continued improvements.

Staff completed a risk assessment and care-plan for all babies within 1 hour of birth and put a colour coded hat on every baby, to indicate level of risk. For example, a baby would wear a red hat if they needed extra care such as antibiotics, amber if the birth was complicated or green if they had fed within the first hour of birth and no risk factors. The hats were a visual aid to alert staff to which babies required additional support.

Staff completed risk assessments prior to discharging women into the community. Third party organisations, such as the health visitor and GP, were informed of the discharge. Women received a physical and emotional risk assessment before discharge and were given the contact details of emergency services, the health visitor and infant feeding groups.

The service did not always control potential risks in the care environment. Leaders did not have all the solutions to support the delivery of safe care especially on the labour ward.

The design and the environment did not effectively meet the needs of women and families, and did not follow national guidance. The estate was built in 1977 and was no longer fit for purpose or adequate to support the increased maternity activity.

The service provided a full range of maternity services. This included antenatal clinics, triage, a midwifery led unit, labour ward, a maternity enhanced care area, 1 obstetric theatre, recovery area and a bereavement suite. The neonatal intensive care unit was close by if a baby’s condition deteriorated and required an urgent transfer.

Leaders had made some improvements and mitigated against some of the environmental risks by generally ensuring areas where decorated, decluttered and space was used as efficiently as possible. However, clinical areas were generally too small, which compromised women’s experience and meant staff were often working within conditions that created additional pressure.

Labour rooms were too small to accommodate essential equipment which included infant resuscitaires. This had been the focus of a quality improvement project to ensure this risk was mitigated. There were 3 infant resuscitaires which were placed to ensure they could be swiftly accessed from every labour room. Leaders told us these risk assessments were completely embedded to ensure this process was safe and staff completed regular drills to ensure they were familiar with the process. However, they could not mitigate for the unavoidable separation of mothers and babies in situations where babies required resuscitation following birth.

None of the labour rooms were en-suite, which meant women had to walk down the corridor to 1 of the 2 toilets that were available. This meant women’s privacy and dignity was not always protected in labour and following birth. In addition, the size of the rooms meant women’s ability to mobilise in labour was restricted and other rooms had space restrictions too. For example, the milk kitchen was not accessible to families due to space restrictions.

When we visited the ‘Twinkling Stars’ bereavement suite was about to be relocated from the day assessment and triage area. The bereavement suite included a double bed, was ensuite and included a small kitchenette. The suite was sensitively decorated and included specialist equipment such as a cold cot so family could spend extra time with their baby. Families had the opportunity for special mementos such as photographs, foot and handprints before they had to say goodbye and there were specific memorial products for people with religious beliefs.

Bereaved families were involved in the consultation of the designs and where the suite should be relocated.The relocation was almost complete at the time of writing this report and in a private area, so the bereaved families were not exposed to pregnant women and crying babies to support their psychological safety.

The obstetric scan rooms were located at different areas of the hospital which made it difficult for practitioners to have peer support for immediate second opinions. We saw this was recorded on the risk register because it resulted in high recall rates which could cause unnecessary anxiety for pregnant women and impacted on efficiency. We saw the main reason women attended triage was for scan reviews.

Staff did not have their own office on triage and the day assessment unit, and they told us they sometimes struggled to review women in a timely way due to lack of available space. Staff told us the lack of space was the main reason for delayed care and treatment. In addition, there was no dedicated training space for staff to practice clinical skills on site.

The midwifery led unit (MLU) had 8 spacious labour/birth rooms, which were all ensuite. One room included a pool and another pool was waiting to be installed. Staff regularly checked birthing pool cleanliness, and the service had a contract for legionella testing of the water supply.

Rooms were designed with a ’home-from-home’ feel and the atmosphere was calm and welcoming. The MLU had a ‘nest room’ for women in early labour and included a double bed, dimmed lighting and the ability to stream music of choice.

Telephones were in every labour room so staff could make an emergency call (for assistance) without leaving the room. Staff told us that when they activated an emergency call bell it was displayed on the labour ward electronic system and highlighted the related room. In addition, the local ambulance service had a direct line to a protected phone on the labour ward.

Staff were clear about the inclusion criteria for care and birth on the MLU and what to do in the event of an emergency. They told us they regularly practised emergency transfers, so everyone was clear about their role and responsibility. The MLU was on a different floor to the labour ward and although there was no dedicated lift, there were 2 lifts opposite the MLU. Staff told us this had never impacted on their ability to transfer women immediately as one of the team would be responsible for calling the lift and ensuring it was protected for the transfer.

The service had enough suitable equipment to help them to safely care for women and babies. This was an improvement from our last inspection. For example, there were pool evacuation nets in pool rooms and on the day assessment unit there was a portable ultrasound scanner, cardiotocograph machines and observation monitoring equipment. Every clinical area had easy access to emergency equipment.

Leaders maintained effective oversight of equipment to ensure it was safe and ready for use and audit results were consistently 100%. This was an improvement from our last inspection. Staff were required to check all equipment daily and replace any missing, expired, or damaged items immediately. Band 7 midwives completed weekly environmental audits through a mobile application. Any concerns were photographed, highlighted, and reported through the application.

Records demonstrated staff carried out daily safety checks of specialist equipment in all areas, although on labour ward we saw the security tag was not correctly attached to the adult resuscitation trolley and a bag of intravenous fluid had passed its expiry date. We highlighted this to the matron who rectified it immediately.

Leaders monitored safety of electric equipment through their Maternity Neonatal Improvement Programme (Work-stream 6). Compliance was 96%-100% and any equipment that was non-compliant was serviced or decommissioned and reflected on the trust online asset register for local review / reference.

Staff disposed of clinical waste safely. Sharps bins were labelled correctly and not over-filled. Staff separated clinical waste and used the correct bins. They stored waste in locked bins while waiting for removal.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. Staff worked together well to provide safe care which met people’s individual needs.

A maternity safe staff workforce review was last completed in October 2024 and leaders told us there were usually enough qualified, skilled and experienced staff. However, this could be challenging due to their vacancy factor and unexpected events such as high acuity and staff sickness.

The service was highly reliant on agency staff. This was expected to significantly reduce in January 2025 when 25 midwifery students were due to qualify and had already accepted job offers at the trust.

The practice development team supported preceptorship midwives and were planning for this large cohort. The team managed their mandatory training, 12-week rotations, 2-week supernumerary period and skills and support sessions.

The service used a nationally recognised acuity tool and had adapted their midwife to birth ratio to 1 midwife to every 21.9 births. This was in response to meet the needs of the local population.

The trust has an escalation policy which sets out criteria for unit closures. The unit had not closed in the last 12 months, but there had been occasions when the unit was on divert between trust sites.

Staf told us there were challenges covering night shifts on the mixed antenatal and postnatal ward and this was mainly staffed by agency staff. Some staff told us agency staff could not always complete a full range of duties because they did not have all their competencies signed off or access to the electronic data base. This added to the workload of substantive staff, and meant these shifts were unpopular. However, leaders told us this issue had been resolved and all agency staff received mandatory training, a security fob and access to the electronic system.

Leaders had made improvements to midwifery and obstetric staffing for triage to support safe process, escalation and timely transfers. This included a dedicated midwife to manage the triage telephone-line. Staff told us this helped ensure women and birthing people had midwifery and obstetric reviews in line with their updated policy and process. Leaders had also provided protected obstetric and consultant cover for triage and although the protected cover was not 24 hours-a-day, it was a significant improvement since our last inspection and reflected in audit results.

Leaders ensured staff received effective support, supervision and development. The trust had completed a training needs analysis and developed a 3-year training plan which was collaborative, multi-professional, and based on local learning needs following staff feedback, incidents, user feedback and audit results. Overall compliance rates for all staff groups were 96% for Practical Obstetric Multi-Professional Training (PROMPT), 97% for fetal monitoring and 95% for neonatal life support (NLS).

Staff completed a training day specific to working in the midwifery led unit (MLU). This included managing emergencies specific to the environment. Pool evacuation training was 88% for midwives.

The service had enough medical staff to keep women and their babies safe. The medical staff matched the plan number. There was a dedicated team to complete elective caesarean sections. Consultants were present 168 hours/week, which audit results confirmed.

The unit did not employ any short-term locums during 2024. There was clear guidance for when consultants should be asked to attend and leaders randomly selected notes and monitored compliance. Results showed that between March- August 2024 consultants had attended 47/54 requests. The consultant was not informed of 1 case, and a decision was made not to attend the remaining 6 because of the seniority of the registrar, although leaders did not record if there was any harm.

There was a resident anaesthetist 24-hours-a-day with senior consultant support. Their workload included the provision of labour analgesia, anaesthesia for surgery and multidisciplinary care of all high-risk women.  However, the increased anaesthetic workload in maternity and other hospital areas had necessitated an extra tier of on-call anaesthetists. The 3rd tier rota commenced in August 2024 and enabled the 2nd tier duty anaesthetist to be immediately available to maternity when needed.

The additional tier of staffing was expected to be fully recruited to between February and August 2025 and remained on the risk register until complete. In the interim, existing escalation guidance applied at time of high acuity and leaders monitored anaesthetic attendance to maternity through audit and oversight of incidents. We saw 91% of epidural requests were completed within 30 mins. This was against a trust target of 80%.

The service ensured all staff were competent for their roles. Managers appraised staff performance and held supervision meetings that provided support and development. The appraisal rate for the maternity service was just above the trust target of 80%.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. This was a significant improvement from our last inspection.

All areas in maternity were visibly clean and had suitable furnishings which were clean and well maintained. Cleaning records were up to date and showed all areas were cleaned regularly and met required standards for the last 3 months. Staff cleaned equipment after contact with women. Staff used ‘I am clean’ stickers to show equipment was clean and ready for use.

Bathrooms and toilets were clean and there were laminated posters explaining hand washing technique and how to take a urine specimen and where to dispense it.

Privacy curtains were clean and labelled with their replacement date. We saw housekeepers going about their duties and they were familiar with the unit and cleaning polices. Staff were familiar with cleaning policies for the labour/birthing pools and cleaning records were up-to-date and demonstrated all areas were cleaned regularly. Oversight was maintained through monthly audits which showed compliance of 98.8%

Matrons oversaw infection prevention and control across the maternity department. Staff followed infection prevention and control principles and included the use of personal protective equipment (PPE). All staff were bare below the elbow, and we observed staff washing their hands or decontaminating them with antibacterial hand gel. We saw visitors were prompted to decontaminate their hands on entering the department. We observed effective hand washing techniques and leaders completed regular and hand hygiene audits.Hand hygiene audits for the past 12 months were 98%- 100% and mostly 100%.

Women were supported to receive their medicines in a timely and effective way. Risks identified during a person’s pregnancy were managed effectively. This included where medicines had the potential to cause withdrawal in a newborn baby or conditions such as diabetes or epilepsy. Staff ensured they understood and considered any cultural needs when supporting people with medicines. The ward had introduced a regular 4- hourly review of people which included ensuring ample pain relief was offered. We were also told there was a policy which supported people to self-administer their medicines; however, staff did not give people on the wards this option to manage their own medicines.

Staff were suitably trained to administer medicines with bespoke training being offered to support staff to manage conditions such as diabetes more effectively. A pharmacist visited the ward daily and staff we spoke too said they valued the expert advice that was available from the pharmacy team. The trust employed an infant feeding team who worked with the pharmacy team when considering how prescribed medicines could affect a person when breastfeeding. Staff had identified that medicines were sometimes omitted when women had gone outside of the ward during medicines round times. Leaders had introduced cards (written in multiple languages) to remind women to find their midwife and get their prescribed medicines. on their return. This had helped reduce the number of medicines omitted this way.

Staff administered medicines safely to people on the maternity wards. Medicines were stored safely and securely in temperature-controlled rooms. Prescription pads were stored safely. Checks ensured prescriptions could be tracked once issued. However, we did observe temperature readings which were consistently high on the mixed antenatal and postnatal ward The air conditioning unit in the clinic room was turned off and the window open. The temperature recorded was below the limit set for the maximum temperature but above what is considered the recommended maximum for some medicines stored in the clinic room. This could impact on the stability of a medicine and mean it may not always work as intended (if stored at high temperatures for an extended period).

Scavenger units were in all areas where medical gases were used. This ensured staff weren’t unnecessarily exposed to medical gases used in childbirth.