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Inspection Summary


Overall summary & rating

Good

Updated 9 July 2014

Blackburn Birthing Centre is one of seven hospitals and care centres that form East Lancashire Hospitals NHS Trust. This location provides maternity services only. It is a free-standing birth centre where women for whom problems are not anticipated can give birth to their babies in a relaxed ‘home-from-home’ atmosphere. Although registered with CQC with the name Blackburn Birthing Centre it is known locally as Blackburn Birth Centre, so will be referred to in this way in the rest of the report.

The unit comprises four delivery rooms and a four-bed post-natal bay to allow mothers and babies to remain for a period after delivery. There are approximately 950 babies born here each year.

We carried out a comprehensive inspection because East Lancashire Hospitals NHS Trust had been flagged as high risk on the Care Quality Commission (CQC) ‘intelligent monitoring’ system (which looks at a wide range of data, including patient and staff surveys, hospital performance information, and the views of the public and local partner organisations). The inspection took place on 30 April 2014.

Overall, this birth centre was providing a good service. We rated it as ‘good’ for providing effective care, caring for patients, being responsive to patients’ needs and being well-led. However, we found that improvements were required in providing safe care.

Our key findings were as follows:

  • Care was delivered with kindness and compassion. Women were treated with dignity and respect.
  • Incidents were reported and there was evidence of learning as a result of these.
  • Ward, birthing and communal areas were clean and infection control practices were in place.
  • Birthing mats were worn with ragged edges in places and were stained.
  • Midwifery staffing levels within the birth centre were sufficient to provide a safe service.
  • Women were provided with food and drink, although the provision was limited.
  • Transfers of women from the birth centre to hospital were low.

We saw several areas of outstanding practice, including:

  • East Lancashire Hospitals NHS Trust’s maternity services, of which the Blackburn Birth Centre forms part, were awarded the Royal College of Midwives’ Mothercare Maternity Service of the Year Award (along with Downpatrick Community Maternity Services, Northern Ireland and NHS Forth Valley, Scotland) for their ‘innovative work to improve maternity services, promote normal births and facilitate staff engagement activities’. They received the award for improving normal birth rates, reducing caesarean section rates and increasing birth choice for women.

However, there were also areas of poor practice where the trust needs to make improvements:

Importantly, the trust must:

  • Birthing mats must be cleaned and regularly checked for any damage, replacing them as necessary.

In addition the trust should:

  • Personal development reviews should be recorded correctly so an accurate figure for those completed is available.
  • There should be support available and used for women and partners whose first language is not English.  

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 9 July 2014

Effective

Good

Updated 9 July 2014

Caring

Good

Updated 9 July 2014

Responsive

Good

Updated 9 July 2014

Well-led

Good

Updated 9 July 2014

Checks on specific services

Maternity and gynaecology

Good

Updated 9 July 2014

In order for the services to be safe, improvement is required. Incidents were reported and there was evidence of learning as a result. We found ward, birthing and communal areas were clean with good infection control practices in place, meaning women and babies were protected from the risks of infection. However, birth mats were warn and showed signs of wear around the edges. There was also evidence of staining.

There were three birthing pools used for labour and delivery. Women reported being fully informed of the risks of delivery in a standalone unit, including the length of time emergency transfer by ambulance would take.

Staff were aware of their responsibilities with regards to safeguarding. They had undergone training at the appropriate level, along with trust mandatory training, adult and neonatal basic life support and management of an obstetric emergency, such as the management of a shoulder dystocia or post-partum haemorrhage.

Women were screened appropriately to ensure they were low risk, and where they did not meet the low-risk admission criteria, received appropriate management plans were made. 

Midwives reported their staffing levels to be satisfactory and we saw that staffing levels were sufficient to provide a consistently safe service, giving one-to-one care in labour. However, as a service overall, East Lancashire Hospitals NHS Trust maternity service had a midwife-to-birth ratio of 1:31.2, against the recommended rate of 1:28. Following recruitment across the rest of the trust, midwives reported being called to work in other areas far less frequently. Midwifery sickness rates were low. Systems existed to call for further support at times of peaks activity.

Maternity and family planning services were effective. Policies and procedures followed national guidelines. Women were offered a range of pain relief, with three out of four birthing rooms being equipped with a birthing pool. Women were supplied with food and drink, although the provision was limited. This may pose a problem for women wishing for a little longer stay to establish breastfeeding. Transfer rate was monitored and was lower than the national average. The service was provided seven days a week and had not had to close since opening in 2010. Staff received appraisals, but these were not always recorded on the trust database. Staff reported good working relationships with GPs and obstetricians.

The services were caring. Care was delivered with kindness and compassion. Patients and their partners were involved and emotional support was good. Staff worked with women to support them with their choice for place of birth. Debrief sessions were provided to women who needed to be transferred to the obstetric unit.

The services provided were responsive to the needs of the local people, however, there was little support for women and partners whose first language was not English.

The maternity and family planning services were well-led. Staff reported good support, both locally and from the wider maternity service. There was a culture of openness and staff reported enjoying working at the centre. There was an up-to-date risk register that had been reviewed, and performance, activity and incidents were fed into the wider trust. The model of care provided was promoted across the wider NHS.