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Ludlow Community Hospital Requires improvement

Reports


Inspection carried out on 3 January 2017

During an inspection to make sure that the improvements required had been made

Ludlow Midwife Led Unit (MLU) is based within Ludlow Community Hospital which is run by Shropshire Community Healthcare NHS Trust. Maternity services are provided by Shrewsbury and Telford Hospital NHS Trust. The MLU provided a midwifery service for low risk women 24 hours a day. The MLU team also provided community midwifery services to women in the Ludlow and surrounding area.

This unannounced inspection on 3 January 2017 was part of the focused, follow-up inspection of the trust which, included all maternity services.

Ludlow MLU closed on 13 October 2016, due to the poor and unsafe condition of the premises. Alternative accommodation within Ludlow Community Hospital was identified and the MLU relocated and reopened on 7 November 2016.

We rated Ludlow Midwife Led unit as requires improvement overall.

  • Ludlow MLU did not fully reflect a “home from home” environment to provide a service focused on the needs of low risk woman. The environment was in poor condition, some equipment was not clean or dust free. The lack of an immersion bath meant that women could not receive low-level pain relief.

  • Midwifery staffing arrangements meant that continuity of care during the women’s pregnancy by their named midwife was not possible.

  • Patient records did not include all required information such as all medicines administered during labour and all patients’ observations.

  • Not all records of medicine administration were up to date and accurate and the temperature of the room where medicines were stored was not monitored.

  • There was a lack of challenge by staff to ensure that the environment and equipment promoted the home from home of a midwife led unit.

  • The review of maternity services and the future of Ludlow MLU was of concern to staff.

However:

  • Ludlow Midwife Led unit provided opportunities for low risk women in Ludlow and the surrounding areas who wanted to have their baby in a midwife led unit.

  • Staff were caring and compassionate.

  • The Supporting Women with Additional Needs team provided support to both patients and midwives for the care and support of vulnerable women.

  • No serious incidents had been reported between 01 November 2015 and 31 October 2016.

  • Care and treatment is delivered in line the current evidence based guidelines. Staff adhered to the trust Intrapartum Care on a MLU or Homebirth policy (June 2016), all trust wide policies and procedures were available to staff on the intranet.

  • Effective systems of communication were established between the consultant led unit and the MLU, GPs and other health professionals ensuring that effective care and treatment was delivered.

  • A full review of the maternity service was ongoing across all maternity services including Ludlow MLU, looking at different ways to improve the service with different models of care.

We saw several areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure patient records include all required information about the patient.

  • Ensure there is an appropriate record of all medicines administered.

  • The trust must review the risks relating to the environment of the MLU to ensure it is fit for the purpose of providing a homely environment for low risk women to give birth.

In addition the trust should:

  • The trust should ensure there is an effective system in place to keep Ludlow MLU clean and dust free.

  • The trust should ensure a record of the temperature where medicines are stored is maintained.

  • The trust should ensure the unit safety dashboard is available and shared with staff.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 14 October 2014

During a routine inspection

The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital service for nearly half a million people in Shropshire, Telford and Wrekin and mid Wales. Ninety per cent of the area covered by the trust is rural. There are two main locations, the Royal Shrewsbury Hospital (RSH) in Shrewsbury and the Princess Royal Hospital (PRH) in Telford. . The trust also provides a number of services at Ludlow, Bridgnorth and Oswestry Community Hospitals.

The midwifery led unit (MLU) at Ludlow had 62 deliveries in 2013/14 and anticipates a similar number for 2014/15. The unit has one labour room and a three bedded bay for antenatal and postnatal care. The unit has one labour room and a three bedded bay for antenatal and postnatal care. There is a shared toilet for women during their stay. The MLU accepts women who have been assessed as low risk and suitable to deliver their baby there. Some women who book and attend to deliver their baby at the MLU are transferred during labour if complications arise.

We carried out this comprehensive inspection because the trust had been flagged as a potential risk on CQC’s Intelligent Monitoring system. The inspection took place between 14 and 16 October 2014 and an unannounced inspection visit on 27 October.

This maternity unit was rated as good although improvements in leadership were required.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • The unit was visibly clean and well maintained. Infection control rates in the hospital were lower than those of other trusts.
  • Patient’s experiences of care were good.
  • The trust had recently opened the new Shropshire Women’s and Children’s Centre at the Princess Royal site. This had seen all consultant-led maternity services and in-patient paediatrics move across from the Royal Shrewsbury site. We found that this had had a positive impact on those services.
  • The service provided at the unit was well defined and escalation processes were in place.

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

Importantly, the trust must:

  • Develop a clear strategy and vision for this service which aligns its current structure.

There were also areas of practice where the trust should take action which include:

  • The trust should ensure that the quality dashboard reports accurately reflect performance against targets and that the thresholds are clear.
  • The trust must ensure that all staff are consistently reporting incidents and that they receive feedback on all incidents raised so that service development and learning can take place.
  • The trust must ensure that staff are able to access mandatory training in all areas

Professor Sir Mike Richards

Chief Inspector of Hospitals