Bradford Royal Infirmary

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated this question as good. Staff provided evidence based care and treatment. Leaders monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefits of babies, immediate and wider family members. Families were supported to be involved in the care of their baby.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service was committed to involving families in a holistic needs assessment through a multidisciplinary approach. All members of the multidisciplinary team made themselves available to families to support maximum involvement. Neonatal consultants and leaders also based themselves on the neonatal unit for ease of access by families who had questions.

Staff and leaders were able to explain clear processes for ensuring needs were assessed in a timely and holistic way taking into account the complex needs of the baby and also the babies families and caregivers. Leaders and consultants explained that they had purposefully based themselves within the unit for ease of access by staff when concerns arose. This supported timely assessment when risks changed.

The team used a range of nationally recognised clinical tools and checklists to ensure holistic assessment of baby's needs. Babies were formally reviewed daily through embedded ward round processes. Ongoing review continued throughout each day on the neonatal unit and at each community visit by the outreach team. There was also a multi-disciplinary approach to outpatient follow up care. The service had a comprehensive range of clinical guidelines that were in place to support assessment of need.

We saw that families had opportunities to learn about and understand a range of evidenced based care and treatment options provided by the service. This included active participation in care, provision of leaflets, QR codes and attendance at ward rounds along with easy access to multi-disciplinary team members. During our assessment we observed staff dressed as a kangaroo speaking to families to raise awareness of the kangaroo care concept of skin to skin contact during a promotional day. This supported alternative and innovative ways of sharing evidence based practice with families.

Staff and leaders maximised the effectiveness of care and treatment by routinely sharing areas of good practice. Staff spoke with confidence about evidence based practices and national guidelines. Ward rounds were used as learning opportunities for all staff and families to understand evidence based practices reflected in individual care plans. We observed good evidence of active participation in research alongside sharing of evidence based practice as part of day to day routines through ward rounds, weekly learning sessions, notice boards and tea rounds.

The team had a range of opportunities available to support ongoing learning and up to date knowledge of evidence based practices and national guidelines. Process and protocols surrounding specific interventions were supported by relevant evidence based practice. All members of the multi-disciplinary teams took responsibility for sharing specific practices and supported colleagues to learn new approaches to improving care delivery. The team followed relevant feeding guidelines for neonates. There was a specific Bradford neonatal unit pain guideline in place for prevention and management of pain. This included evidenced based practices for non pharmacological methods of pain management.

Feedback received from people using the service demonstrated that families were able to feel like part of the team working to look after their baby. Families said 'it was good to feel like I am part of my baby's care', 'we were able to listen and ask questions'. Families felt informed and assured as a result of being able to participate in the ward rounds.

Staff and leaders told us about a range of multi-disciplinary team (MDT) meetings that provided essential communication opportunities. These MDT meetings were highly effective in supporting babies and families as they moved between services and when they had involvement from a range of care providers. Staff told us that teams worked together from the earliest opportunity, for example, joined up working with cardiology and fetal medicine teams. Perinatal palliative care and external services offering specialist support would be contacted at the earliest opportunity and referrals made in a sensitive way to meet individuals needs. Staff shared consistently positive examples of working across boundaries using initiative, knowledge and expertise of services appropriately to ensure individual needs were consistently met to a high level. We heard examples where complex care needs of babies and families had been managed by staff co-coordinating care to ensure the right services were involved at the right time. Staff working both internally and externally to the neonatal services were able to access detailed information they needed to appropriately assess, plan and deliver care.

One local hospice organisation told us they felt they were seen as part of the neonatal team and had good working relationships that supported high quality joined up working and transitions of care.

We observed highly efficient processes within ward rounds that ensured family engagement as part of the team was a priority consideration. All members of the MDT were actively encouraged to participate along with family members as an equally accepted part of the team. We observed knowledgeable staff effectively sharing thorough information regarding risk and we saw that risk information was proactively sought.

The neonatal service had highly effective processes in place to ensure that care was coordinated across a range of services. Processes ensured that teams worked effectively across a range of boundaries, for example with the social care sector, voluntary organisations, hospices and the wider health system across Yorkshire and Humber. The team had recently identified the need for designated staff with protected time to be responsible for coordinating care. Specific posts had been created, trialled and their were plans to expand this team to include a further staff member to ensure continuity. System working allowed for holistic needs of babies and families to be met, including for example, specialist palliative and bereavement care, complex health conditions, smoking cessation, housing and financial support.

The unit had relevant information promoting healthy lifestyles and support. For example, there were posters displayed introducing the clinical psychologist. There was a matrons clinic running twice per calendar month. We saw posters promoting this in the unit foyer as well in the parent sitting room. The clinics purpose was to talk about babies care and what was on families and carers minds. The aim was that through these discussions, there can be improvements made for families and a widened understanding of the challenges faced. There were many options for signposting to other services for healthier lifestyle support and well-being support. Baby massage classes were held as follow up for high risk babies at Bradford. The feedback received directly from people's experiences of this was positive and includes parents sharing it was 'Beyond expectations - additional professional input at the end is a great idea.' Parents shared they had more confidence with their baby overall, they felt comfortable and it brought them closer to their baby.

Staff told us there was interpreting services available including face to face, telephone or video call to support individuals in understanding information. There was also a recognised translation application available for people to use. There was a psychology service within the unit that was accessible by both staff, parents and siblings as and when required. The service supported nutritional health and wellbeing through distribution of food parcels to families who were struggling. This was a collaborative with the local foodbank.

Bradford Butterfly Pathway was launched in 2017 and provided care and support to families. This was through a multidisciplinary team, Neonatal Consultant, Perinatal Palliative Care-Coordinator, midwifery, foetal medicine, cardiology, allied health professionals and the local hospice teams. This allowed families to make informed choices during their pregnancy and labour, and provide the right care for their baby immediately after birth and further into the postnatal period. This included parallel planning symptom management, and anticipatory bereavement support as appropriate. There was a psychology support service for families and a clinical psychologist in the team on the unit.

The unit had a matron's clinic which ran twice per calendar month, there were posters displayed with details of dates and times for attending. The purpose of the matron's clinic was to provide feedback, talk about baby's care and discuss what is on parent/ carer minds. We read the commissioning quality assurance review on the neonatal unit from December 2023. This report was written by National Health Service England (NHSE) with contributions from NHS West Yorkshire Integrated Care Board, Yorkshire and Humber Neonatal Delivery Network and Service Specialist Commissioning NHSE. One of the areas that they found was that multi-disciplinary team working was highly evident, staff were able to articulate previous issues, the journey and actions taken to achieve the results. The Bradford Neonatal Service Workbook designed in-house, that was used for staff induction, was taken away by the visiting team as an example of best practice

Staff were able to share that they routinely monitor people’s care and treatment to aim to continuously improve it. Staff explained they looked at clinical outcomes to inform where change was needed most as well as through feedback received.

Looking at the provider audits as part of the 'safer procedure audits' for 2022-2023 showed clear monitoring of each procedure, areas of good practice, improvement, comments/ recommendations and actions taken as a result. Babies receiving care form the neonatal outreach team were able to have home tube feeding. This had saved 35 bed days in hospital on the unit over the previous 12 months review. The ventilator audit showed 100% compliance when checked between August 2023 - January 2024.

We did not speak specifically to families about consent. However, we observed and heard about positive practices when working with families and babies to ensure sufficient information was shared to support decision making by the most appropriate individual.

Staff explained that they act as advocates for the babies in their care. Plans of care were discussed as an ongoing routine practice by all members of the MDT with families where possible. Staff told us that they ensured all families and individual parents had all available information provided to them in a range of different ways to ensure they fully understood and were able to make informed decisions. For example, staff understood some cultural expectations and practices for babies who had passed. Staff where clear not to make assumptions based on a families known religious practices and would always ensure that individual parents had enough information to make their own decisions based on their own individual wishes.

The service had processes in place to ensure consent was gained from parents or those with parental responsibility when required. A review of records and an audit demonstrated that gaining and recording of consent was a routine practice within the service. The service placed high importance upon consent and identified any discrepancies in practice effectively, following up with actions. The team had a clear understanding of the do not attempt cardiopulmonary resuscitation (DNACPR) process. We understood that this would be discussed with families where appropriate, documented in notes and ReSpect forms completed accordingly.