Queen's Medical Centre

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• 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 looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last inspection we rated this key question good. At this assessment, the rating remained good. This meant the service worked together to meet the needs of women.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Women were either referred to maternity services by their GP or could refer themselves to the hospital. Women who requested to give birth at home whether they were low or high risk were supported in their choice.

All women could choose where they could birth, this included home, birth centre or hospital labour ward, which met women’s needs responsively.

There was a homebirth team, which included a team of midwives based in the community, and a consultant obstetrician and consultant neonatologist who both visited women in their own homes antenatally. Individualised and personal plans of care were developed to enable women to give fully informed consent. The risks to both the woman and her baby were explained and documented, and a mutually agreed plan of care was added to the woman’s pregnancy record. However, we spoke with staff who shared that plans for babies born at home were not always achievable considering the care was taking place in the community. For example, it was not always possible to ensure a baby had passed urine and obtain a sample.

The service triage telephone line was 24 hours was available, 7 days a week for women to call and speak with an appropriately trained midwife about any concerns they may have and be signposted to the most appropriate service.

However, the transitional care pathway was not fully aligned with the British Association of Perinatal Medicine (BAPM) transitional care framework for practice (2017) which formed part of the maternity incentive scheme safety action 3. The service had made some progress, and an overarching action plan had been developed and signed off by the trust board and the Local Maternity and Neonatal System (LMNS).

On this inspection, we found the midwifery led unit labour rooms had been refurbished to make them less clinical in appearance and included features such as murals and mood lighting. Staff told us this helped to contribute to a more relaxing birthing environment.

There was support for women with mental health concerns from a perinatal team. In all 10 records we reviewed, we saw completed mental health assessments and support when the woman was discharged back to the community.

Women and their partners we spoke with told us the staff provided enough information in a format they could understand. They could access the service by telephone day and night and had a prompt hospital-based review as needed.

The trust had invested in a new Fetal Medicine Unit at Queens Medical Centre which provided an excellent environment for interventional procedures and supportive care for women.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, the signs in the unit were poor and did not support easy navigation between services.

Information in various formats and languages ensured all people using the service had up to date and accurate information to help them to make informed choices and play an active part in their care, treatment and birth planning.

Spoken language interpreters were accessible around the clock, provided through a regularly utilised external translation service. Interpreting services were available face to face, and through telephone interpretation either on demand or pre-booked. It was also made available through video or audio interpreting. The service was also exploring different ways of using interpretation services. This included using an electronic handheld device which was originally designed for commercial use during travel. The supplier contacted the trust, and the service was piloting the device in several areas including inpatient and community. It was also carrying out quality assurance checks to ensure the device was translating effectively. Initial feedback from both women and staff was positive.

The service had processes to support women who were deaf or blind. They could access face to face British Sign Language (BSL) interpreting and video relay BSL interpreting. BSL users also had support to telephone the hospital when needed.

There was access to ‘easy read’ leaflets, which could be found on the trust’s website. The trust had signed up to a national service to support women and families with protected characteristics including learning disabilities and autism.

There were effective discharge processes for women who were discharged out of area. However, we also saw occasions when this had not worked well as staff had reported these on LFPSE. For example, out of area discharges were not received by the other NHS trust, which resulted in women not receiving postnatal visits. Staff were working to ensure a more effective process for out of area discharge.

However, the signage in the maternity unit did not enable women and their families to navigate their way through the service with ease. The service provided appropriate, accurate and up-to-date information in formats that tailored to individual needs.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service made sure that people could access the care, support, and treatment they needed when they needed it.

The maternity unit had used a nationally recognised electronic tool to record the acuity, midwifery staffing levels, and number of women. The total activity was reported at points throughout the day. Additional information recorded was in relation to those requiring enhanced care, and inductions of labour including starting, continuing and delays. Mutual aid was offered and agreed between the trust’s Nottingham City Hospital and Queens Medical Centre sites. This process provided a comprehensive overview of the entirety of the service. This process also supported the recording of maternity red flag data in accordance with the National Institute for Health and Care Excellence (NICE).

People told us they could access care, treatment, and support when they needed to and in a way that worked for them. There were many examples given of reasonable adjustments being provided for women when needed. This was timely and in line with evidence-based practice. Staff were able to talk us through examples and we heard about individual experiences for women where adjustments had been made.

The service worked hard to understand the community’s needs to ensure all women had access to care, support and treatment in the way they required and when they required it. Women confirmed this during the inspection when we spent time with the community MW team.

The community midwife team worked across a large area and worked flexibly to meet the needs of the service. However, we had feedback that there appeared to be 2 tiers of provision between the homebirth team and the community team. We were told by multiple sources that women were choosing to transfer care to the homebirth team although continued to birth in the hospital. This was because there was a greater continuity of care, appointments were longer and, in the woman’s own home.

The chaplaincy services provided support 24 hours a day for situations such as the event of a loss, to provide a naming ceremony, or emergency baptism. It provided support to all faiths.

Triage processes were monitored, and we saw the service consistently since January 2023 assessed women within 15 minutes of their arrival. We saw on average 95% of women were assessed within 15 minutes and this was better than the trust target of 90%.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.