Blackpool Victoria 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 assessed 6 quality statements. The service did not always routinely monitor women's care and treatment to continuously improve it. The service did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of women themselves.

The service mostly planned and delivered women's care and treatment with them, including what was important and mattered to them. Although, staff did not always do this in line with legislation and current evidence-based good practice and standards. The service mostly worked well across teams and services to support women. The service supported women to live healthier lives, or where possible, reduce their future needs for care and support.

At our last assessment we rated this key question requires improvement. At this assessment the rating remained the same.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Clinical pathways we saw in women’s records were completed comprehensively.

We saw there were appropriate care pathways in place and a team of complex social needs (CSN) midwives ensured pregnant children and young women aged under 18 were supported throughout pregnancy and the post-natal period both in community and hospital.

For residents of Blackpool Local Authority, referrals were made to the family hub triage for additional support, including the allocation of an early parenthood service nurse.

The care of young persons under the age of 16, was led by one of the named midwives in the CSN team and antenatal care was adapted to their individual needs including their school timetable.

There were systems and pathways which ensured support for vulnerable women or women who lacked capacity. Anyone identified at antenatal appointments were immediately referred to the complex social needs team, for screening by a specialist midwife. Referrals that met a threshold for complex needs team were caseheld by the team and continuity by a named specialist was ensured.

Any strengths, needs or potential risks were identified, and an individualised management plan was devised. Referrals were made as required to partner agencies such as children’s social care, adult social care, and learning disability team.

If a woman’s first language was not English, they were also referred to the complex social needs team to assess any additional support required. Additional communication aids were identified and a consideration made for a more specialist assessment when needed.

Best interests documents we saw included women’s views, beliefs, values (including religious, cultural, moral or political) and how they would likely influence decisions.

Women with vulnerabilities and who lacked capacity were supported postnatally with accessing contraception.

Staff accessed policies and best practice guidance on the trust electronic system. However, guidelines and policies were still not always reviewed regularly. We found two hard copies of out of date policies on emergency equipment trolleys and displayed in staff areas on the MDU. We escalated this at the time of our assessment and the policies were removed and replaced. In addition, staff we spoke with told us they were aware of 31 guidelines that were out of date. This meant there was a risk staff did not always have access to the most up to date best practice guidance and may not always practice in accordance with it.

We discussed this with leaders who acknowledged guideline review and ratification was not timely. This was due to guideline authors not having sufficient time. The trust told us it was working to make changes to improve the process as a matter of urgency. Leaders clarified that 5 out of 31 guidelines had been reviewed and were awaiting approval, 14 had been reviewed and awaiting ratification and 11 guidelines were awaiting review.

Staff did not always follow legislation and current evidence-based good practice and standards. For example, in theatre, whilst we saw that all stages of World Health Organisation (WHO) safer surgery checklist were completed with no gaps. The checklist was recorded on the whiteboard only and not in the women's electronic record. We checked eight women's electronic records and found only one had a WHO checklist recorded. This meant there was not always a formal record that could be audited to provide assurance that staff always delivered evidence based care and treatment in accordance with best practice guidance.

Trust audit data for the period 1 December 2024 to 31 March 2025 confirmed poor compliance. Of 306 caesarean sections, 118 (38%) WHO checklists had been recorded on the electronic system. Of the 118 completed, `sign in'' compliance was 99%, `time out' (84 of 118) 71% and `sign out' (37 out of 118) 31%.

The service was compliant with all elements of the saving babies lives care bundle (version 3). This was based on national guidance such as NICE and Royal College of Obstetrics and Gynaecology (RCOG) to target a reduction in perinatal mortality. The service was fully compliant with all six elements. The elements with the highest compliance score of 100% and fully implemented were `reduced fetal movements' and `diabetes'. All other elements had compliance scores between 80% and 95% such as `smoking in pregnancy' and `preterm birth'. The service had an overall score of 91% compliance across all six elements which exceeded the requirement of 70%.

The trust provided data from October to December 2024 for the NHS screening programme key performance indicators (KPIs). The acceptable threshold was met for almost all KPI metrics. Timeliness of antenatal screening was 78.4% which met the threshold of 75% and antenatal screening coverage was 99%.

The service had action plans for the triage unit that were based on RCOG best practice recommendations and CQC maternity national review findings. We observed the action plans and saw that they were compliant with most of the actions.

We received feedback from external partner services that worked collaboratively with the trust. They told us that obstetricians and midwives mostly worked well together with the neonatal teams and spoke positively about the personalised care for women with complex needs.

For example, staff we spoke with told us about the multidisciplinary perineal health service that was recently established. They described a comprehensive policy, appropriate training for all midwives, and in depth investigations of severe perineal trauma were completed. They facilitated postnatal and antenatal scanning and clinics which linked into additional hospital services.

We saw examples in the last 12 months of how mutual aid was shared effectively between this maternity service and other NHS trusts. There was an escalation policy which staff followed when urgent transfers to another service were required.

Work was ongoing to manage the complexity of the women and support service demand. Joint clinics occurred with specialist expertise such as cardiac and renal specialities.

The complex medical needs team provided specialised care for pregnant women with pre-existing medical conditions. The team included consultants with specialist interests, specialty trainees and midwives. They offered a multidisciplinary approach to help women with complex medical needs have a safe pregnancy with the best possible outcomes. For example, women with uncontrolled diabetes were offered a continuous blood glucose monitor, and this resulted in women being empowered to manage their blood glucose levels more effectively.

However, some partners and staff we spoke with described a lack of communication and understanding between teams and services to support women. Some staff felt frustration when the MDU day unit was full, and women were sent to the delivery unit. This impacted on flow and resulted in a backlog of women on ward D waiting to be transferred.

The service had relevant information promoting healthy lifestyles and support on wards/units. There were plenty of leaflets and posters with electronic codes that could be scanned using a mobile phone to gain health information. For example, infant feeding, skin to skin contact, smoking cessation, post pregnancy physiotherapy and sudden infant death syndrome (SIDS). In addition, we saw an information board promoting safer sleep. Although we did not see many information leaflets in public areas in different languages these were available at request.

Breastfeeding women could access ward based support groups and a new online support program. Staff told us that women were signposted to community breastfeeding groups on discharge.

However, the infant feeding service was not yet accredited by UNICEF UK Baby Friendly Initiative (BFI). There were three stages of accreditation and the service had not passed all of the standards for stage two when they were assessed in December 2024. Stage two is to ensure that all staff have the knowledge and skills they need to implement the standards. Staff we spoke with told us that infant feeding had been removed from the annual maternity update day and more protected time was needed for training with the infant feeding midwife. There was an action plan in place to embed knowledge and strengthen the progress to achieve the final stages.

The trust confirmed that infant feeding was completed every three years in line with guidance and additional training sessions were available outside of the annual maternity update day.

The service had a public health midwife and midwifery health trainers who focused on smoking cessation, gestational diabetes, vaccinations, health promotion and parent education. A vaccination nurse was visible on site in the reception area which offered walk-in appointments for women. We saw posters to raise awareness of vaccinations. The service had supported the NHS roll-out of the respiratory syncytial virus (RSV) vaccine for pregnant women. Other vaccines included whooping cough and flu. Data showed that 365 RSV vaccines had been given between Sept 2024 and March 2025.

The service worked in partnership with local services to promote healthier lifestyles, together with social and emotional development. Staff had set up events that were face to face rather than online to encourage families to meet up. This included coffee mornings with free tea and coffee as an incentive. Staff told us that this had been successful.

Staff were proactive in finding ways to engage with women who might be at risk of experiencing healthcare inequalities. For example, they attended community hubs in the local area to invite prospective parents to join classes or programmes.

The service had a perinatal educational programme to support expectant parents to manage the emotional and physical transition into parenthood. This was facilitated by family engagement workers, midwives and health visitors. Education sessions included infant feeding, baby care and safe sleep.

The trust was consistently above the national average since October 2023 for the indicators ‘women who were smokers at booking appointment’ and ‘women who were smokers at delivery’. However, the service undertook targeted work to facilitate and promote smoke free pregnancies. Data showed an improvement since September 2024 with a reduction from 15% to 7% in January 2025 which was closer to the national average of 6%.

Managers used annual schedules for planning, monitoring and oversight of audit activities. However, these were not always comprehensive. For example, (including but not limited to) pain audits, newborn early warning trigger and track, maternity early warning score tools, documentation audits and consultant ward round compliance audits were not on the schedule. Leaders told us that additional audit activities would be added to the schedule, but no dates were provided.

There were separate schedules and audit leads for maternity and obstetrics. These included audits that monitored Saving Babies’ Lives Care Bundle’ (SBLCB) and recommendations of the Ockenden review.

However, the maternity schedule recorded 26 of 59 audits as not registered, with no start dates. One was duplicated on the obstetric schedule and had two different audit leads. Ten audits had start dates recorded which ranged from June 2024 and all were recorded as ‘’in progress’’ and RAG rated amber.

This meant we were unclear how the trust was assured the audit process was effective to ensure audits were completed and registered timely. The schedules did not demonstrate that action plans could be shared promptly or how managers maintained effective oversight of all audit activities. In addition, we were unclear how the trust was assured staff managed care and treatment in accordance with trust policy and that outcomes always met expectations, given the lack of audit outcomes.

Although we found some improvement, the trust was still not always compliant with placental histological investigations. For example, incidents referred to Maternity and Newborn Safety Investigations (MNSI) in the previous 12 months showed that of 4 that met MNSI criteria, 2 involved placentas not being sent for histological investigation.

However, the service acted in response to MNSI recommendations. They reviewed and updated associated policies and processes. Staff we spoke with told us this helped with tracking, monitoring and accessing placental histology reports. It also supported future management plans for women who had previously experienced pregnancy loss.

The trust submitted NHS screening programme key performance indicator data to NHS England. The most recent submission showed that for almost all metrics, the acceptable thresholds were met.

Trust data showed that 75% of mothers had skin-to-skin contact with their baby within one hour of birth in February 2025. This had improved from 67% in December 2024 and was slightly higher than the national average 74.7%.

There had been no direct maternal deaths from the start of the reporting period which was February 2022. Trust data from February 2024 to February 2025 showed that the stillbirth rate for the service was 3.6 per 1000 live births. The national average was 4 per 1,000.

Between February 2024 and February 2025, the rate of women who had a 3rd or 4th degree tear at delivery was mostly worse than the national average. For this time period, rates for the trust ranged from 23 to 42 per 1000 deliveries compared to the national average range of 27 to 30 per 1000 deliveries. Trust data showed that in March 2025 the percentage of 3rd/4th degree tears in assisted vaginal births was 0.8% and for unassisted vaginal birth it was 2.3%. For the previous 12 months the percentage was mostly 1% and under for both these metrics.

The trust was mostly worse than the national average since October 2023 for ‘babies who were born preterm’. This was an area that had been monitored by LMNS following an external review in May 2023. The service had an action plan in place to support recommendations from the external review. Leaders we spoke with told us that no concerns had been raised by LMNS for this metric. In relation to this data, leaders considered the demographics of the local area to be a factor. For example, 33% of mothers were in the most deprived decile compared to the national average of 14%.

Between March 2024 and February 2025 the trust was worse than the national average for the indicator ‘women who had a PPH of 1,500ml or more’. However, in March 2025 at the time of our assessment the trust was in line with the national average. Staff and leaders told us that the service was not an outlier for ‘women who had a PPH of 1,500ml or more’ and had found issues with how the PPH proforma was being completed on the electronic system. Leaders were working with LMNS to provide assurances and staff told us that learning had been shared on how to fill in the proforma’s correctly.

The trust was consistently worse than the national average since October 2023 for ‘babies with a first feed of breast milk’. In March 2025 the service had reported a breastfeeding initiation rate of 64%, this had declined from 74% in October 2024.

Staff understood how and when to assess whether a woman had the capacity to make decisions about their care. They gained consent from women for their care and treatment in line with legislation and guidance. Staff could access relevant policies including Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Although the consent policy was overdue review, it referenced current relevant best practice guidance, such as making best interests decisions and Gillick competency.

Staff made sure women consented to treatment based on all the information available and clearly recorded consent in the woman's records. We observed staff gain consent before obstetric surgery and consent was recorded in all of the maternity records we reviewed where applicable.

The service had developed post-mortem consent boxes in line with national guidance to obtain informed consent. The boxes provided information on post-mortem examinations and gave support and guidance for women and families.

We specifically requested audit data for the consent process. We received consent audit data for 79 surgical cases between 1st January 2024 and 31st December 2024. The evidence provided was from a randomised sample of surgical cases from the FICC division that includes children, gynaecology and maternity services. The data did not state how many of the sampled cases were specifically for maternity. The associated action plan was a blank template. This meant we were unclear how the service was assured the consent policy was always followed consistently well.