Queen Elizabeth The Queen Mother 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

We looked for evidence that women and communities had the best possible outcomes because their needs were assessed. We checked if women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question requires improvement. At this inspection the rating changed to good. Women’s outcomes were consistently good, and women’s feedback confirmed this.

This service scored 71 (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 made sure women’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We found staff carried out risk assessments for women in line with national guidance. Maternity staff used the Modified Early Obstetric Warning Score (MEOWS) to recognise women who were becoming unwell. Staff carried out risk assessments for women during antenatal care in line with national guidance. These included social assessment, risk assessment for blood clots and mental health assessment. Staff made referrals to consultant-led clinics for women with medically high-risk pregnancies. This showed staff were competent to assess and respond to patient risk, and there were reliable systems to support this. There was a plan to install central monitoring in all bed areas that would be displayed in the staff office. This meant staff could monitor all women from a central location of the ward in real time.

Staff had a maternity huddle, which was held twice daily 7 days per week. We attended 1 huddle on and saw this was attended by midwives, midwifery support workers and doctors. Staff clearly communicated key information. Staff used the SBAR (Situation, Background, Assessment and Recommendation) tool to communicate important information about a patient's condition to their colleagues. Staff highlighted patient risk factors such as patients undergoing sepsis treatment, reviews from neonatal teams and patients who required close monitoring due to high blood pressure. The team identified patients who required safeguarding referrals and discussed staffing levels in other areas such as the labour ward. We saw leaders, such as the head of midwifery and lead midwife for risk attended to relay key safety messages. Midwives told us they also held mini huddles throughout the day if issues emerged. Staff reported they found the huddles very useful and helped them to problem solve if there were concerns about a woman’s observations or condition

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 was in use. Practice development midwives made use of noticeboards to communicate best practice guidance. For example, we saw noticeboards displaying best practice guidance for breast feeding.

Audit data was collected in the triage department to assess their performance against national standards. This included time and duration of calls and outcomes for women accessing the service.

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

Staff reported good working relations between the medical team, midwives and other staff. We observed good communication between midwives and obstetricians in delivery of care. On this inspection, we found this good practice remained the same. The service provided some multidisciplinary clinics such as the gestational diabetes clinic. All relevant staff, teams and services worked together in assessing, planning and delivering women’s care and treatment.

The service was supported by senior clinicians 24 hours a day. A consultant obstetrician on site and a head of midwifery on call. Staff told us they felt confident to seek assistance at any time of day and night. The office had a whiteboard with the contact number of the on-call team and the on-call team always attended when asked to.

The team included a fetal monitoring midwife (FMM) who ensured all fetal monitoring guidelines were up to date and staff had undergone training in this area. Fetal monitoring is used to monitor the baby's heart rate and rhythm to assess their well-being and identify any potential problems. This role covered all areas of the maternity unit and staff told us the FMM would come out of hours to ensure equity of access to learning. Staff of all clinical backgrounds attended a regular fetal monitoring huddle to discuss any issues with interpreting the monitoring. Fetal monitoring was regularly audited. We reviewed the risk assessments related to fetal monitoring and they had improved from 59% to 89% in the quarter before the inspection. Key messages were shared with the whole team in a message of the week and a bulletin called ‘Fetal Friday’.

On the day of inspection, a midwife was providing a one-to-one teaching session to a medical student who had expressed a wish to learn more about holistic birthing.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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

Staff were supported by leaders to take steps to improve patient outcomes, through a variety of methods. This showed the service regularly reviewed the effectiveness of care and treatment through local and national audits. Leaders shared accurate and up-to-date information about effectiveness internally and externally and took steps to make sure staff understood it.

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

They knew how to support women who lacked capacity to make their own decisions or were experiencing mental ill health. They used personalised measures that limit patients' liberty.

We found staff had access to mental health/deprivation of liberty safeguards guidelines on the trust intranet. Staff were able to talk about the deprivation of liberty safeguards (DoLS) and how this would impact a woman on the unit. 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 caesarean section.