Berwick Infirmary

We inspected the maternity service at Berwick Infirmary.

Our rating of services stayed the same. We rated it them as good because:

• We inspected maternity services at Northumbria Healthcare NHS Foundation Trust in May 2019. Our inspection included Berwick midwifery led unit (MLU). Several areas for improvement had been identified at our previous inspection in 2015 and at this inspection we found each of these had been addressed.
• There were systems for reporting, investigating, acting and learning from adverse events and there were clear safeguarding processes in place. Records and risk assessments were completed at each stage of pregnancy. There was consistent communication between teams.
• The risk of child abduction had been mitigated across all maternity services by security arrangements including staff challenging all visitors and staff stationed at ward entrances, monthly drills, a CCTV system and routine security guard attendance on the ward. The same mitigations had been implemented at Berwick MLU.
• Infection control procedures and practices were in line with guidance and equipment checks were completed consistently. Drugs, including emergency medicines were prescribed, stored securely and administered appropriately.
• The service provided care and treatment based on national guidance and best practice. Outcomes were good and harm free care at Berwick MLU was 100%. There were sufficient midwifery staff, competent for their roles. Staff met most trust mandatory training and safeguarding training compliance targets. Staff supported women to make informed decisions about their care and treatment, assessed and monitored pain and gave pain relief in an appropriate and timely way. Staff gave women enough food and drink to meet their needs and improve their health.
• Staff treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from women and families was positive with good patient survey results. Staff provided emotional support to women, families and carers to minimise distress. Staff supported women to understand their condition and make decisions about their care and treatment. Staff gave women practical support and advice to lead healthier lives.
• Key services were available seven days a week to support timely care. The service had considered its staffing and the care it provided and amended its provision to provide safe care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. There were clear and robust policies in place to ensure that patients were seen at the right place at the right time. The service was inclusive and took account of women’s individual needs. They treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had a clear strategy and plans for the future of the service and supported staff to achieve the service priorities. Staff at all levels were committed to embedding the changes and improvements in maternity services. Managers and staff worked together to identify and manage risks, information, and to share lessons learned.
• Staff supported each other and felt very positive about leadership within the service. The senior team were visible and approachable and staff valued the vision, support and leadership of matrons and the clinical lead. Line managers worked as role models and were part of the team. Staff were offered opportunities for training and progression.
• There was a clear governance framework and quality performance and risks were recognised and managed. Staff followed duty of candour appropriately.
• Staff felt very engaged and involved in the development of the service and its aims to provide good quality care for women. We saw encouragement and recognition were given to staff for fostering innovation or improvements to the service across different levels within the teams.
• There was evidence of innovative practice throughout the service and by staff at all levels including:
  • A health psychology team which supported women who had experienced a previous traumatic birth.
  • A continuity of care model in MLUs
  • Sharing of information regarding safeguarding including partners (SIRS)
  • A monthly skill drill for all staff in all clinical areas
  • A ‘Listening Buddies’ system
  • Quarterly staff away days for multidisciplinary team (MDT) development.

However:

• Review dates for Patient Group Directions (PGDs) used by midwives had been exceeded. This meant that medicines were being administered or supplied without an appropriately reviewed authority document. This is not in line with regulation or NICE guidance. Following feedback to the trust after the inspection the pharmacy reviewed PGDs and expedited their approval.