The Tunbridge Wells Hospital at Pembury

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed all 7 quality statements for this key question. Staff tailored care in response to individual needs and were committed to supporting choice and informed decisions. The Phoenix Team were an excellent example of how continuity-of care improved experience and outcomes for women and birthing people.

Leaders were more focused on equality, diversity and inclusion but the process for using the translation service was not clear and not embedded.

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.

We spoke to 4 women and birthing people during our visit about care plans and they told us they were involved in planning and making shared decisions about their care and treatment. and understood their treatment options, including any related risks and benefits.

Leaders told us maternity services had a 3-year delivery plan in relation to equality, diversity and inclusion (EDI), which included the appointment of a midwifery lead for EDI. In the interim one of the practice development midwives had been fulfilling the role and they were in the process of recruiting 5 EDI champions.

The Trust provided EDI training which was accessible online. Overall compliance was 96.5%. Tackling health inequalities was also included in Practical Obstetric Multi-Professional Training and a training documentary was shared with staff which explored race inequalities within the NHS maternity system. Leaders had provided an EDI padlet which was an excellent resource and included relevant legislation, best practice guidelines, resources, training opportunities, national and local reports and more.

Staff told us the service promoted equality and diversity within their daily work. The service had an EDI policy and included a gender statement for all new and updated guidance from June 2024.

Staff told us they completed personalised care plans for women and birthing people based on their individual needs and preferences. We saw care plans reflected this and were discussed during staff handovers.

We attended the ward round on the labour ward and saw the consultant and team always considered the wellbeing of women and birthing people, encouraged them to ask questions and share their views. Staff checked they understood information and gave them time to consider options for care and birth.

We reviewed 11 care records for postnatal mothers and saw notes were comprehensive and showed that individualised care was provided. Maternity passports were held by women and birthing people with learning disabilities and autism (or other individuals who would like an accessible maternity care plan). This included the relevant information needed by the professionals who supported them, and personalised care plan booklets were rolled out in April 2024 and available in easy read and different languages.

High risk women and birthing people who needed closer monitoring on either the antenatal or postnatal ward could be transferred to the labour ward for closer monitoring or cared for in rooms closer to the midwives’ station. Staff referred to the mental health team if there were severe concerns about mental health and we were told a mental health nurse would be allocated to provide support.

Leaders used a nationally recognised acuity tool to calculate the required number of midwives needed in the service, including the number needed to maintain 1-to-1 care in labour, and continuity of care during the antenatal and postnatal periods. Leaders told us that this had been calculated based on the specific needs and acuity of the local population.

People could mostly access care, treatment, and support when they needed it, including out of hours and in an emergency. The service provided a triage telephone line 24-hours, 7 days a week for women and birthing people to speak with a midwife about any concerns. Specialist bereavement midwives worked Monday-Friday and provided cover over weekends. In addition, 16 midwives had been trained to offer bereavement support to women and birthing people outside of these times.

We saw evidence that women and birthing people had requested a debrief and were told the service was not available. The Debrief Clinic had to be paused due to the high volume of referrals. However, as part of the factual accuracy process the Provider shared their quality improvement project. This aimed to create a new, sustainable and clearly defined service to address this gap for women and birthing people who had given birth within the trust. Leaders hoped to achieve this by October 2025, although as of June 2025 no actions had been identified.

Appointments with an Obstetrician or a Senior Midwife were available for those who experienced a traumatic birth or requested a discussion

Leaders gave us examples of complex cases where they provided personalised care plans. For example, a transgender person who chose a home birth following a previous caesarean section and they supported a family that were out-of-area because they had a complex history and were known to the service.

Partners who we spoke with did not provide any feedback regarding this quality statement.

The service maintained a database to ensure oversight of all complex cases and highlighted those with protected characteristics. This enabled them to monitor the impact of interventions and personalised care.

The Phoenix Team provided antenatal, intrapartum and postnatal care for pregnant people who were 21 years and younger. The team had been established for 3 years and included 8 midwives, 1 consultant and 1 maternity support worker who provided continuity of care and offered a full range of midwifery services and support.

They used social media platforms to engage with their caseload and had a very responsive Instagram page. This included many accounts of positive feedback about the care and service the team provided. We read feedback from young people that were included in the Phoenix caseload and feedback was extremely positive. Some comments included ‘’I had outstanding care’’, ‘’cannot thank Phoenix Team enough for their care and support’’ and ‘’the team supported me with all 3 of my babies, feel so sad that this will be the last time.’’

We visited in October 2024, and the team had not received any complaints or adverse incidents for that year. They used feedback and data to tailor the service to meet the needs of their young families. For example, they set up a chlamydia screening pathway that was available from booking.

We saw a range of maternity related antenatal and postnatal classes advertised on the trust maternity website. This included a variety of face to face and virtual classes, free and paid options.

We reviewed feedback from the CQC maternity survey (2024). We received feedback from 196 women who given birth at the trust and 8.7/10 felt they had the opportunity to ask questions about the labour and birth. This was similar to the national average for other trusts, and we saw evidence in care notes to reflect that women and birthing people were given information to support their health and wellbeing and make informed decisions.

Leaders told us they shared feedback from women and birthing people with staff and the trust board.

The service had a comprehensive website with access to a wide array of useful information and resources. This included information leaflets, available in different languages, links to evidenced bases resources, support groups and mobile phone apps. There were checklists, guides, and infographics to help support women and birthing people through pregnancy, birth and their parenting journey. Staff encouraged them to print information out, display on their fridge, save to their phone or share online with family and friends. There were also some virtual tours of the service to help prepare and support decisions for place and type of birth.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Information was clearly displayed in clinical areas, the trust maternity website and social media platforms of how to do this and who to contact. This included access to QR codes to support the process.

Leaders told us they aimed to resolve any complaints immediately, and in the most informal way. Information on how to make a complaint was available in all clinical areas including the trust website.

Leaders told us they invited complainants to meet to discuss their concerns in person. Leaders placed importance on listening to the perspective of the complainant and any staff member. They worked in partnership with complainants to achieve a solution to their concerns and involved them in any investigations.

We were told the service provided a maternity and neonatal independent senior advocate who helped to ensure the voices of women, birthing people and families were listened to. They ensured their voices were acted on by their maternity and neonatal teams when they experienced an adverse outcome in their care.

The service had a comprehensive website with access to a wide array of useful information and resources. This included information leaflets, available in different languages, links to evidenced bases resources, support groups and mobile phone apps. There were checklists, guides, and infographics to help support women and birthing people through pregnancy, birth and their parenting journey. Staff encouraged them to print information out, display on their fridge, save to their phone or share online with family and friends. There were also some virtual tours of the service to help prepare and support decisions for place and type of birth.

However, although maternity services made it easy for women, birthing people and families to give feedback there was a consistently poor response rate. For example, only 12% in August 2024 and only 8% in September 2024 and although we could see changes were made in response to feedback, we could not see how they were used to design services to meet their needs and expectations. Leaders had recruited a patient experience midwife 3 months prior to our visit and told us this would be a focus for them.

The head of nursing for safe staffing and the temporary staffing team oversaw complaints related to temporary staff. This provided a clinical perspective and a process. Staff involved in complaints were asked to complete a reflection on the complaint and use it to improve their practice.

There were 10 formal complaints regarding the maternity service in the 3 months prior to our visit. We saw they were being managed in line with local policy and there was no related theme. However, we saw evidence that poor communication was often a theme highlighted in feedback and complaints and a quality improvement project had been set up to address this in September 2024.

Leaders completed regular surveys for families to give feedback about their care and expectations. They advertised these on social media platforms, the trust maternity website, and clinical areas. Leaders made changes in response to feedback. For example, a baby changing facility had been implemented in the triage area in response to feedback.

Women and birthing people could access care, treatment, and support when they needed it, including out- of-hours and in an emergency.

Leaders told us they were a key stakeholder at the Local Maternity and Neonatal System Equity and Equalities steering group. They worked closely with external organisations such as the maternity and neonatal voices partnership and charities. For example, they worked with a charity called Maternity Digital Hubs and received a digital grant for 25 SIM cards a month which they offered to the most vulnerable women and birthing people.

Staff told us of actions they took to ensure all women and birthing people were able to receive the care and treatment they needed. For example, they ensured women and birthing people who could not attend community clinics were able to visit the hospital for their appointments, and staff made alternative arrangements if needed. The service also offered a variety of clinics to meet all needs. For example, a healthy weight clinic, multiple birth clinic, a birth choices clinic and more.

Staff also told us they used a telephone translation service for women and birthing people whose primary language was not English. We received mixed feedback about the translation-line with some feeling that it worked well, and others that it was impersonal. We also received mixed feedback about the guarantee of female translators and the policy to not use family and friends to translate too.

There was a clear policy for using the translation service, but the process was not embedded. Policy included an option to book a face-to-face interpreter for limited situations which included breaking bad news. However, staff did not mention this option to us and some staff told us they used relatives to interpret (which was outside policy). This indicated that the process was not embedded.

We also saw that there was a recent delay with an emergency caesarean section because of issues accessing an interpreter for consenting. Staff had recorded difficulty getting through to language-line and a 25-minute delay getting an interpreter to complete consent.

We read examples of feedback that showed women and birthing people felt they were treated as individuals. For example, 1 mother’s feedback: “As a woman of colour, there’s an anxiety that comes with pregnancy childbirth that is heightened. All midwives made me feel heard, listened to understood. I felt every care person was rooting for me and on my side. These midwives went above and beyond. They did beyond their job!”

Leaders gave us examples of complex cases where they provided personalised care plans. For example, a transgender person who chose a home birth following a previous caesarean section and they supported a family that were out-of-area because they had a complex history and were known to the service.

Leaders told us they shared feedback from women and birthing people with staff and the trust board. They also presented a mothers’ story at the clinical governance meetings and the maternity and neonatal care oversight group. They told us listening to the stories of women and birthing people were very powerful. A mother with protected characteristics including a learning difficulty had recently presented their birth story which had raised awareness of the diversity of the maternity population and the importance of building staff capacity into the system to provide personalised care.

The service maintained a database to ensure oversight of all complex cases and highlighted those with protected characteristics. This enabled them to monitor the impact of interventions and personalised care.

The service was in the process of working with business intelligence colleagues to develop a dashboard/power BI tool, which included a range of EDI characteristics against key metrics and outcomes.

Women and birthing people that we spoke with told us they were informed of their planned care and treatment. Families were clear about discharge plans and who to contact with any concerns. Discharge summaries were shared electronically with health visitors and GPs and follow up arrangements were made prior to discharge.

Leaders understood the impact that grief and mental illness could have on bonding and attachment and family relationships. Maternity services had started a new project alongside the perinatal mental health team on breastfeeding, grief and trauma and workshops had commenced at the time of our visit.

Staff helped women and birthing people plan for their future. They discussed contraception, sexual and mental health with people prior to discharge. They reinforced key information (such as the importance of cervical screening) with written information and links to accredited websites with evidenced based information and support. In addition, staff shared details of support groups such and encouraged parents to join the maternity and neonatal voice partnership to help design and continually improve their maternity services.