The Tunbridge Wells Hospital at Pembury

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed all 5 quality statements for this key question. There was a culture of kindness and compassion, and staff made sure people’s care, support and treatment met individual needs and preferences. Leaders provided relevant training to help ensure staff were focused on providing compassionate care and always considered privacy and dignity.

Staff treated people as individuals and made sure people’s care, support and treatment met individual needs and preferences. However, staff of all grades were working under pressure which could impact on their ability to provide timely reviews, care and support.

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 friends and family survey showed a 91% -100% positive response from women and birthing people in the 6 months prior to our visit, with most women and birthing people stating they had either very good or good care and mostly felt listened to and respected.

Results from the CQC survey for women and birthing people who had given birth at the trust showed that 9.7/10 felt happy with their care. This was better than the national average.

We spoke to a family following their baby loss and in response to their request. They described staff as ‘’incredible,’’ ‘’like family,’’ and ‘’going over and beyond’’ their expectations.

Staff told us their focus was on delivering kind and compassionate care to all. However, staff on the postnatal ward told us they sometimes felt under pressure to discharge women and birthing people due to bed capacity.

Leaders told us staff completed training in civility, kindness in action and mentoring, although they did not share compliance. We spoke with staff of all grades and disciplines and were consistently told that they felt well supported by managers and senior leaders and felt confident to raise concerns and they were focused on delivering kind and compassionate care to all.

We received positive feedback from the Maternity and Neonatal Voice Partnership (MNVP) regarding a caring workforce.

The bereavement midwife engaged with national and local bereavement charities to help develop the support services for bereaved families. The service had a purpose- built and designed bereavement suite to support bereaved families in an area of privacy, away from the maternity area. The suite included a double bed and sensitive murals, food storage, and refreshment facilities. It also included cold cots for parent(s) to spend precious time with their baby and a memory box for them to make special keepsakes and an annual service of remembrance was held each year in the hospital chapel.

Staff worked hard to protect the privacy and dignity of women and birthing people. We observed staff routinely using privacy curtains and asking permission before entering. Staff were discreet and respectful. We saw them knocking on doors and waiting for a response before entering and a chaperone service was also available and clearly displayed with the service. Staff ensured they maintained confidentiality during meetings and during any clinical conversations.

There was a chaperone available in the ultrasound department and we saw this service was clearly advertised. We also saw evidence that leaders had agreed to reinstate the ‘lithotomy challenge’ to ensure all staff minimised the time women and birthing people spent in the lithotomy position and thought about how they could try and preserve dignity and privacy.

Results from the CQC survey (2024) for women and birthing people who had given birth at the trust showed that 9.7/10 felt happy with their care. This was better than the national average.

During the inspection we reviewed the notes of 11 women and birthing people and found that staff had taken the time to know their individual circumstances and create an individual care plan. This was confirmed by the women and their families we spoke with too.

Staff treated people as individuals and made sure people’s care, support and treatment met individual needs and preferences. Staff took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Risk assessments were completed and reviewed at every contact to reflect individual needs such as mental health problems, learning difficulties and any other additional needs. Records showed discussions were tailored to provide person centred care and support informed choice and referrals were made in response to individual needs. For example, to the lead nurse for disabilities.

The trust had a perinatal mental health nurse who supported maternity staff to care for the mental health of women and birthing people. They were part of a multi-disciplinary perinatal mental health team to ensure the right professionals were involved with planning and providing care.

We reviewed feedback from the CQC maternity survey (2024). We received feedback from 196 women who given birth at the trust and 9.3 /10 felt they were involved in decisions about their care during labour and birth. This was better than the national average for other trusts.

Staff told us they had routine discussions with all women and birthing people during pregnancy. They told us they discussed all options. For example, antenatal care, place and type of birth, pain relief in labour and baby feeding. This was evident from care notes that we reviewed, and it was clear from conversations that staff supported informed decisions and were advocates for women and birthing people.

We were also given an example of staff finding a private space for someone on the antenatal ward who wanted space to pray.

Staff encouraged all women and birthing people to complete a template known as ‘birth preferences.' This gave staff the opportunity to discuss the preferences of all women and birthing people during pregnancy and review this in labour so staff could provide support to meet individual needs and preferences.

We reviewed feedback from the CQC maternity survey (2024). We received responses from 196 women who given birth at the trust and 6.7/10 felt there were delays with their discharge from the hospital. This was similar to the national average for other trusts.

Staff told us they sometime felt pressure to discharge women and birthing people from the postnatal ward due to capacity. They told us that they could not always provide the breastfeeding support mothers needed and we saw this reflected in other feedback too.

We observed that staff were busy in all areas and working under pressure across both days of our inspection. We saw staff being deployed to clinical areas in most need to optimise safety, but we also observed delayed medical reviews on the antenatal, postnatal and labour ward. This mostly impacted on timely inductions of labour and discharges, but staff told us this happened most days and had become normalised.

However, we observed that staff were responsive and caring to those in their care. They answered call bells in a timely way and introduced themselves on first contact.

The NHS Staff Survey 2023 incorporated the whole of the women’s division rather than just the maternity service. Therefore, the trust was unable to identify survey outcomes for maternity teams. However, during our assessment staff of all different grades and disciplines described a much-improved culture. Staff felt this was largely due to the change in leadership style and the improvement work. The head of midwifery (HOM) was frequently mentioned as someone who had made a significant difference since they took up post 12 months previously. The HOM and matrons were consistently described as visible, responsive and clinically credible.

Staff told us leaders ensured they always received breaks and prioritised them. Staff also told us they recorded if they were late leaving shifts and leaders ensured they received the time back. However, some staff told us they did not report short staffing or high acuity as an incident because they told us both were normalised.

Leaders recognised staff were hard-working, committed and under a lot of pressure. They recognised the importance of providing the right environment, supporting wellbeing and professional development opportunities.

Leaders were compassionate and it was clear that staff wellbeing was a priority. The leadership style meant staff had felt supported throughout their improvement work which enabled them to stay focused, committed and passionate to continually improve.

There had been an increase in pastoral support through the establishment of a pastoral care lead nurse, listening events with the chief nurse and established councils for student nurses and international midwives. There was an established staff recognition reward programmed at local and national level and increased opportunities for external courses to support staff development.

There was always a matron on-call to support staff, and they worked clinical shifts to provide support and maintain their clinical skills, although this often impacted on managerial duties such as completing appraisals.