Lancashire & South Cumbria NHS Foundation Trust

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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

This means we looked for evidence that the service met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care. Person-centred care

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Quality Statement Score: 3

3. We scored the service as 3. The evidence showed a good standard. 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. The inpatient unit provided groups both for mum and baby to take part in together and separate groups just for mums that addressed baby bonding and parenting skills.

Patients and their carers told us they felt their care was well coordinated and staff worked well with them. They were encouraged to be involved in their care and treatment plan and knew who they could approach to request information from if needed. Staff had a very good understanding of patient’s individual needs, and these were respected. The family and carers we spoke with said they had specific support for their own needs, and the care was not just about the patient but the whole family. They also said they were involved in the care planning process through multi-disciplinary meetings.

We observed staff engaging with patients in a person-centred way and adjusting their approach according to the patient’s needs. Information was displayed informing patients of different treatment, care, and therapeutic options along with how to give feedback on care. All care and treatment plans we reviewed showed patient involvement.

There were a wide range of activities taking place on the inpatient ward. We found these to be both meaningful and touched on the strengths and interests of the patients taking part. There were options for both group and 1-1 activities dependent on patient preference and need. This included baby specific groups such as baby massage and story time, as well as groups just for mum around developing self-confidence and parenting skills. This ensured that mums were given support to work on their own mental health as well as to engage with their baby and if required given support with parenting skills and bonding.

Patients were involved in creating and reviewing their care plans in collaboration with staff. We saw records that showed patients had access to regular one to one time with a named nurse or key worker.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Patients on the ward told us they were shown round when first admitted. All relatives told us they built strong and supportive relationships with the staff caring for their loved one. Patients confirmed they were supported in relation to discharge planning and knew the steps leading to discharge.

Staff supported patients on the inpatient ward to maintain contact with their families and carers. Visiting on the ward was welcomed and there was a big emphasis on encouraging the family unit to be together and develop, both on the ward and in the community.

Patients had access to a patient information booklet and there were pathways in place with other services, for example, community mental health teams. We looked at previous discharge summaries which contained a discharge plan covering, plan of care, early warning signs of relapse or triggers for patients.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information governance systems included confidentiality of patient records through an electronic records system which was password protected to maintain confidentiality of patient records.

The service complied with the Accessible Information Standard.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. Patients were able to attend ward round meetings in the inpatient setting, and meetings regarding individual patient care in the community. They could also speak to staff during regular 1 to 1 meetings where they could discuss their treatment plans and preferences in detail.

The information provided was in a form accessible to the particular patient group.

Staff made information leaflets available in languages spoken by patients.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress

Quality Statement Score: 4

4. We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result. Learning from complaints, despite the low number, was a key focus of the service. They met with patients following concerns or complaints, in order to gain feedback and ensure similar complaints were not raised again in the future. Feedback from patients was not only valued, but used to shape the future of the service.

There were 6 complaints across the 4 teams in the 12 months preceding our on-site assessment. Of these, 1 complaint was partially upheld, the rest were not upheld. In comparison to the 374 compliments the teams had received in the same time period, this was a very small amount. There were no clear themes to pull out from these complaints and all related to different issues, such as beliefs held whilst mentally unwell that resolved once the patient was well, patients not consenting to partner visits and a couple around medication and clinical decision making. However, the teams still worked with the complainants to work through the issues raised and resolve them in a timely manner. In order to try and reduce similar complaints re occurring, the service met with groups of patients to discuss themes from recent complaints, to gain their views on how things could have been improved for them and what things they felt might have helped imrpovde their experience. This involvement, allowed the service to learn and improve, even from the small number of complaints they had received. Patients and carers all told us they would feel comfortable in raising concerns and reported that there was lots of information available to them about raising concerns as well as in welcome packs to the services and on the Trust website. There was also information and posters about the trust’s patient advice and liaison service.

Patients knew how to complain or raise concerns. When patients complained or raised concerns, they received feedback. On the ward, we observed specific information about how to complain and how to contact CQC. Patients also had access to regular community meetings, and we saw a ‘you said we did’ board on most wards. Patients and their loved ones could give feedback about their care and were listened to when they voiced their preferences and asked questions about their treatment or medicines. They also had access to an independent advocate. The service as whole had a very proactive approach to collecting and using feedback from patients and their families who had used the service. We were able to see how feedback was collected from lots of different sources, including questionnaires, friends and family test and discharge questionnaires for specific services such as parent infant practitioners, so that feedback could be drilled down to a specific service and made more meaningful. We saw the use of peer support workers in all of the services, people with live experience of using perinatal services being utilised to help and support current patients. The peer support workers were also involved in recruitment of staff and in focus groups about changes within the service. The peer support worker team were well utilised to develop and shape the future of the service. An example of this was a recent meeting with patients who had recently been on the inpatient ward who were autistic, staff met with them to gain their views on the autism pathway that was being developed.

Staff protected patients who raised concerns or complaints from discrimination and harassment. Staff knew how to handle complaints appropriately. Staff received feedback on the outcome of investigation of complaints and acted on the findings.

The trust had a detailed incident reporting policy. Staff were aware of the trust’s incident reporting procedures and felt safe to report concerns. Safety events were usually reported promptly and in line with trust policy and were thoroughly investigated.

Quality Statement Score: 4

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

Patients had access to a range of professionals including a doctor, nurses, psychologists, occupational therapists, social workers, nursery nurses, parent infant practitioners, pharmacists, and support workers. They were able to work with patients individually to help deliver holistic treatment. Partners we spoke with, of patients on the ward, told us about the accommodation on the hospital site that was there for them to use to enable them to stay over when visiting their partners from further afield. This accommodation could also be used to allow new mums to be on their own off the ward, when they were nearing discharge so staff could observe them prior to discharging them home.

The introduction of the clinics for women with moderate perinatal issues meant that more women across Lancashire had access to services at a place that suited them. The clinics were based out in the community in the family hubs, which meant that women were able to easily get to appointments. Women attending appointments had access to a range of perinatal services, which also included, health visitors and 3rd sector perinatal organisations. Women we spoke to reflected that this was invaluable and meant they were able to get care and treatment quickly, in their own community.

Staff ensured the needs of patients with mobility issues were met – for example, the ward was on ground level and had an accessible bathroom. As mentioned earlier, the ward had a room that had been adapted to support women post caesarean section/surgery. This contained an adjustable hospital bed so women could be kept comfortable and maintain some level of independence in doing so. The community teams ensured rooms where they met with patients were accessible for people with mobility issues or wheelchair users.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was on the same site as the local acute hospital.

Staff ensured patients had access to post-discharge care, for example, S117 aftercare, community mental health services and crisis services. For patients being discharged from the ward, the service had developed the outreach team since January 2024. Their focus was on early support for women who were admission vulnerable in the community and continuing support for women for up to 3 months post discharge. The outreach service was contracted to deliver 18 contacts per month, on average the service delivered over double those contacts each month, The team worked alongside the specialist community mental health teams, supporting patients with evidence-based interventions including dialectical behavioural therapy type skills to reduce distress, manage risk and support parent-infant relationships.

Quality Statement Score: 4

4. We scored the service as 4. The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

The service provided on site accommodation separate to the inpatient unit that could be used for both patients and their families. This could be used for families who did not live in the local area, in order for partners to remain in contact with the patient and the baby during their stay. It was also used for patients who were nearing discharge, in order for staff to be able to test out leave for patients who lived a considerable distance from the hospital, where shorter periods of leave would have been difficult to facilitate. This was supported by the outreach team and supported patients to gain some independence whilst still being closely monitored by the service, supporting a safer discharge and ongoing support.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Patients could easily access the care and treatment they needed. Support for patients who spoke a different language was available. Patients told us they were supported and did not raise any concerns about their experiences in respect of equality or discrimination.

Managers gave examples of where adjustments had been made or were already in place to support patients who may have accessibility or mobility needs. Staff and managers described how patients would be supported with any spiritual or cultural needs that they may have, which included visits from religious leaders (on the inpatient ward), having access to spiritual materials or being supported to attend places of worship. Staff also described how any dietary needs would be supported for any patients that had specific requirements for cultural or religious reasons.

Patients reported that they accessed advocacy services and described that they knew how to raise any concerns that they may have and that they would feel confident in being able to do this.

Staff were trained in equality, diversity, inclusion and human rights.

Quality Statement Score: 4

We scored the service as 4. The evidence showed an exceptional standard. People were given exceptional support to plan for important life changes, so they could make informed decisions about their future.

Staff support patients to make decisions about their care and treatment and their future.

Staff create personalised care plans to account for the patient’s needs, wishes and feelings.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. The services all had good links with local services, such as the perinatal midwives, health visitors and the other mental health teams such as CMHTs and crisis teams. They had also ensured they were visible within local communities by holding their moderate clinics in family hubs. This meant they sat in the same space as other professionals for families such as midwives and health visitors, so it made it easier for women and families visiting to access other services where needed. This was a conscious decision from the service when setting up the moderate clinics, to ensure ease of access for local communities.

During our on-site visits, we saw lots of thank you cards from patients who had been discharged from the service. After discharge from the ward there was follow up calls and staff told us that patients often kept in touch giving updates on how they and their baby were getting on. We saw that the ward always sent a first birthday card to all babies that had been with them, and often families would respond with photos and updates of the baby.

There had been 112 discharges from Ribblemere Ward between April 2023 and March 2025. Of those patients, none had been readmitted to the inpatient service. Joint working between ward staff, the outreach team and the specialist perinatal community mental health teams meant that the service was able to ensure women and their family had been supported at home, with an enhanced package of care within the first 3 months of discharge resulting in no readmissions to the inpatient ward. Data provided to us by the Trust showed that the service had a higher number of admissions than other similar services across the country per 10 beds, alongside this the service had the lowest length of stay which was below the lower quartile for England The mean length of Stay for England during 2023/24 was 36.71 and for Ribblemere ward was around 20.