The Tunbridge Wells Hospital at Pembury

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 assessed all 6 quality statements for this key question. The service routinely monitored care and treatment to continuously improve outcomes for mothers and babies. Leaders had improved their monitoring and management of post-partum haemorrhage, but improvements needed to be embedded, and postnatal discharges needed to be timelier.

Compliance for training had improved and staff worked well together. The service participated in relevant national clinical audits and reported maternity ‘red flag’ staffing incidents since February 2024.

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.

Staff assessed and reviewed women’s health, care, wellbeing and communication needs with them.

Staff worked together to ensure women and birthing people made informed decisions based on best practice guidelines. They referred women and birthing people to a consultant or professional midwifery advocate when they requested care or birth outside of guidance and they told us they felt well supported by senior colleagues.

A detailed care plan was agreed between the pregnant person and consultant /professional midwifery advocate. This was outlined in clinical notes and communicated to the multidisciplinary team. Teams worked together to support informed decisions.

There was a variety of information on the trust maternity website to support women and birthing people make informed decisions based on the best available evidence. This included information leaflets, videos and links to accredited websites. Information included but was not limited to using water to aid labour, active birth and colostrum harvesting.

Leaders told us there were effective systems in place to communicate changes in national and local guidance. These included National Institute of Health and Care Excellence (NICE) and Royal College of Obstetricians and Gynaecologists (RCOG). Staff told us they were updated during handovers, newsletters and the practice development midwives made use of noticeboards to communicate best practice guidance.

Leaders had improved their management and oversight of postpartum hemorrhage (PPH) rates. They had updated their PPH guideline in October 2023, incorporated PPH management into their skills and drills and practical obstetric multiprofessional obstetric training and embedded instrumental vaginal workshops.

Staff completed an incident form for all PPH over 1000mls, and this triggered a review of care. Leaders had made changes in response to learning identified from reviews. For example, scales were on every emergency trolley to weigh rather than estimate blood loss, and support prompt recognition. This could mean they were reporting more events because they recognised hemorrhages that could have previously been unnoticed.

A mother had a PPH when we visited. We saw the team responded promptly and worked well together to manage the emergency. All necessary equipment and medicines were available and in date although the primary midwife had not considered the mother's previous history and increased risk for PPH. This had not been communicated to the team, meant the mother did not have a cannula inserted prior to birth (which could have impacted on the management of the emergency). However, all PPH incidents were reviewed using a standardised proforma which included identification that a risk assessment had been completed and during the factual accuracy process leaders advised this was an isolated issue.

Leaders ensured staff received effective support, supervision and development. Rostering coordinators allocated staff to mandatory training and compliance was monitored through a ‘live’ database. Compliance had improved since our last visit. For example, pool evacuation training was now mandatory for all midwifery staff and compliance was 97.3% for labour ward staff. Overall compliance for Practical Obstetric Multiprofessional Training was 93% and for annual midwifery updates was 92%. Staff spoke highly of the quality of the training and the positive impact of the practice development team.

We reviewed results for the CQC maternity survey (2024). We received feedback from 196 women who had given birth at the trust and 8.8 /10 felt midwives and doctors worked well together during labour and birth. This was similar to the national average for other trusts.

Leaders told us they engaged and worked closely with external organisations to support improvement. We saw evidence that their link for the Maternity and Newborn Safety Investigations joined monthly governance meetings and shared updates and learning from their investigations.

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 and the implementation was supported by video and staff communication.

The fetal surveillance leads told us training was now fully embedded. We saw compliance of 98% for midwives and 95% for consultants. Staff told us the training was effective. They were required to complete a competency test post training and could not provide intrapartum care or any electronic fetal monitoring if they did not pass the test. The most recent pass rate was 85% and the fetal surveillance midwife provided one-to-one support to pass the competency test.

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, were invited to be part of interview panels for key appointments and contributed to the design of user information leaflets, information packs, the maternity website, and guidelines.

We saw and heard many examples of effective team working which was based on mutual respect and trust. We observed clinical handovers, attended ward rounds, staff huddles, meetings and observed discussions and interactions between different staff groups. Without exception we saw and heard evidence of healthy working relationships.

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.

The team implemented a regular monthly audit programme to monitor compliance with the updated guideline. This included 10% of all births for both electronic fetal monitoring and intermittent auscultation. A deep dive had also been completed for non-compliance with intermittent auscultation. During the factual accuracy process leaders confirmed that results had been reviewed through the maternity governance meetings and actions had been agreed, although re-audit was needed to determine if actions were effective.

We reviewed 6 labour records for evidence of ‘fresh eyes’ and saw compliance in 5 out of the 6 records. It is best practice to have a ‘fresh eyes’ or buddy approach for regular review of CTGs during labour. Audit results showed only 30% of birthing people had 'fresh eyes' hourly in labour when the policy was launched in June 2024. Completion of risk assessments (at the start of labour) had improved from 80% to 100%, but results for hourly 'fresh eyes' in labour were below 30% in July 2024 and below 50% in September 2024. Leaders shared results with staff to support improvements.

Staff told us how they supported pregnant women and birthing people to live healthier lives and where possible, reduce their future need for care and support. For example, they discussed the importance of stopping smoking and referred pregnant people to the smoking cessation team with consent. This included 1 smoking cessation midwife and 4 smoking cessation advisors.

Staff routinely discussed the importance of vitamin D supplementation during pregnancy, mental health support and safe sleeping for new babies. Health and wellbeing messages were reinforced on the maternity website, displayed in clinical areas and on social media platforms.

The maternity unit participated in initiatives to promote the health and wellbeing of pregnant and birthing people, and babies. Babies were offered Bacillis Calmette-Guerin (BCG) vaccination and pregnant and birthing people had access to specialist clinics. For example, preterm birth, multiple pregnancy and diabetes. Some clinics were multidisciplinary, this enabled relevant teams and services to work collaboratively in assessing, planning and delivering care and treatment.

However, we saw that women and birthing people could be referred for several obstetric appointments and not be allocated a named obstetrician. This did not support continuity and holistic clinical oversight.

We saw the Birth Thoughts midwifery-led clinic was suspended on 3 October 2024. This was a service to support local mothers to talk about any difficult birth experience and explore their thoughts and feelings with a midwife. The suspension was confirmed on the trust website and included signposts to other resources.

The service routinely monitored women’s care and treatment to continuously improve outcomes for mothers and babies. The evidence we reviewed did not show any concerns about people’s experience of being involved to manage risks although we could not collect the evidence to fully review this category.

The maternity service had clear performance measures and key performance indicators (KPIs). The maternity dashboard parameters were presented in a format to enable it to be used to challenge and make improvements.

Leaders scrutinised outcome data at monthly maternity clinical governance meetings and provided assurance at the executive-led quality committees and trust board quality committee.

The parameters had been set in agreement with local and national thresholds. This allowed the service to benchmark themselves against other NHS acute trusts.

The service participated in relevant national clinical audits and submitted data to external bodies as required. This included the National Neonatal Audit Programme and MBRRACE-UK and enabled the service to benchmark performance against other providers and national outcomes. Leaders 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 service had reported maternity ‘red flag’ staffing incidents since February 2024. A red flag event is an indicator of dangerously low staffing levels. Between April 2024 and September 2024 there were 263 occasions when inductions of labour (IOL) were delayed for women and birthing people. This represented 78% of all their red flags. During our visit we saw IOLs delayed on both days, and this was mainly due to delayed discharges on the postnatal ward.

We were told that feedback had highlighted that women and birthing people did not always feel they had understood information which impacted on their ability to apply informed consent.

There was a project in place called ‘Respectful Vaginal Examinations’ to improve practice and educate women and birthing people about their rights in relation to intimate examinations. The project was coproduced between the maternity service and the Maternity and Neonatal Voice Partnership and in response to feedback from women and staff.

Staff understood the rights of women and birthing people related to consent. They told us they made sure they fully understood their rights and always respected informed choice.

Staff had access to mental health/deprivation of liberty safeguards guidelines on the trust intranet and 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.