The Care Quality Commission (CQC) has rated neonatal services at John Radcliffe Hospital, run by Oxford University Hospitals NHS Foundation trust, as good, following an inspection in January.
The neonatal unit at John Radcliffe Hospital, Oxford, is an acute service providing care for babies across Oxfordshire and surrounding areas.
This inspection was carried out to ensure full oversight of maternity and neonatal services at the trust and was the first time neonatal services had been inspected independently of maternity or children and young people’s services.
Following the inspection, CQC has rated safe, caring, effective, responsive and well led as good.
However, the inspection did find some aspects of care in need of improvement and CQC has told the trust to submit a plan showing what action it is taking in response to these concerns.
Amanda Williams, CQC deputy director of hospitals, secondary and specialist care in the South East, said:
“At this inspection, we found a neonatal unit where staff were providing safe and compassionate care to families during a vulnerable and stressful time for them.
“It was encouraging to see the trust taking a family-centred approach, ensuring families were actively involved in care planning and decision-making for their babies. Staff routinely included families in ward rounds to help improve their understanding of their baby’s condition and proposed treatments.
“This compassion from staff was particularly evident where a baby was identified as having life-limiting conditions. We saw staff involve families in sensitive discussions about treatment decisions and demonstrated kindness and respect in these situations, ensuring care was individualised and aligned with family wishes.
“Staff were confident identifying and escalating sepsis and perinatal infections, and they had a good understanding of safeguarding responsibilities and how to support women disclosing situations such as domestic abuse.
“However, there were some areas for development. Inspectors found the environment didn’t always meet the needs of babies and families. The neonatal unit was located in what was initially a temporary location but it had been there since 2016 and the layout presented challenges for staff and families. For example, the high dependency unit was very cramped, which made it difficult for staff to move around during emergencies and reduced privacy for families.
“Leaders are aware of these concerns and it’s crucial they make faster progress to address them, so the physical environment of the unit supports the compassionate and supportive care staff are providing to babies and their families.”
Inspectors found:
- Feedback from families was overwhelmingly positive. One woman said the eight weeks her son spent in the unit were really tough but knowing staff were taking such good care of him helped her get through it.
- The unit arranged regular training simulations to ensure staff were confident responding to complex situations such as multiple births and baby abduction. This meant staff could respond appropriately during such incidents and had a strong understanding of escalation processes.
- The service had made clear progress in strengthening its culture. Staff said senior leaders and matrons were increasingly visible and approachable, which supported a more open culture where concerns could be raised.
- The unit had significantly improved how quickly mothers received support to provide breast milk, from 57% within expected timeframes in 2022 to 92% at the time of inspection.
- The service had a discharge outreach team that supported families when babies were transitioning home. The team provided parents with training to ensure they felt confident managing their baby’s ongoing care at home, including oxygen therapy and tube feeding.
Inspectors also found:
- The unit was using three separate record systems and leaders weren’t fully aware of the risks this posed. Although baby records were generally well maintained, neonatal staff couldn’t, for example, access antenatal records.
- When the bereavement suite was occupied, discussions had to take place in a nurses’ office, which wasn’t always an appropriate environment for sensitive conversations.
The inspection identified two breaches of regulations in the neonatal service relating to the environment in the high dependency unit and to management of the records systems.
CQC refers to women, but recognises and respects that some transgender men, non-binary people and people with variations in sex characteristics or who are intersex may also use maternity services and experience some of the same issues.