Bradford Royal Infirmary

On this page

• 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

We rated this question as good. The service actively worked to meet the needs of local people and families travelling from outside of the area. The service actively engaged with families to understand the changing needs of those using the service. They took account of individual needs and made it easy for people to give feedback.

This service scored 79 (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 inclusive and took account of babies and their families individual needs and preferences. Staff provided individualised care to babies and their families to meet specific individual needs and families we spoke with said they had been given personalised care and treatment.

Staff made reasonable adjustments to help babies and their families access services and coordinated care with other services and providers. Leaders and staff made sure families could get help from interpreters or signers when needed. Staff gave multiple examples when they had accessed the interpreting services when children, young people or their families did not speak English as their first language.

The neonatal unit had a dedicated private room with space for up to two mothers at a time to support privacy according to individual choice when expressing milk or breastfeeding. We received lots of positive feedback for this space from women using it on the unit. Women and their families had access to a kitchen and facilities to make hot drinks. Staff also provided the option for them to have snacks such as sandwiches, crisps or fruit.

People told us that they received care and treatment that met their own needs.

Staff and leaders across the multi-disciplinary team including allied health professionals, nursing, healthcare assistant, medical and palliative care staff were able to clearly articulate their understanding of the diverse range of needs within the population they served. Wider family context was consistently taken into account with individualised adjustments and support options offered to ensure babies had equal opportunities for consistent family involvement.

We heard positive feedback from partners and multi-disciplinary team members evidencing seamless continuity of care. Members of the multi-disciplinary team were knowledgeable about community resources and able to share details of referral routes for a range of pathways including for example down's syndrome, neonatal feeding support in the community, mental health and well-being support.

We saw clear processes in place to ensure continuity and joined up care that met the needs of individual babies and families. There was a well-established multi-disciplinary team in place that worked well together. Cultural differences were consistently taken into account when planning care through MDT working processes.

People told us they could get information and advice that was accurate, up-to-date and provided to them in a way that they understood, and which met their communication needs. People who use the service, their family, friends, and carers were provided with information that it is accessible, safe and secure and supports their rights and choices. We heard about examples from women who had interpreting and translation services arranged where they didn't speak English as their first language. We also were told about an example where a women had been supported with using the digital service for virtual ward round access from home when she needed it. People knew how to access their health and care records and decide which personal information could be shared with other people, including their family and care staff. The unit took part in a study between Bradford Royal Infirmary and another hospital in which parents were recruited whose first language was either Urdu or Mirpuri. The research looked at interpreted conversations between doctors and parents in prenatal and neonatal care and was ran by a local University. The Trust used this study to look to make improvements in any areas they could for families and their babies.

Staff told us that patients received information in a timely way that met best practice standards, legal requirements and was tailored to individual needs. Staff felt they were clear and transparent with information. Staff talked about making reasonable adjustments for people to meet individual needs, this included examples for disabled people, interpreting and translation services for those who don't speak English as their first language and for deaf people who use British Sign Language (BSL).

There were clear processes in place for accessing interpreters when required in a timely way. This ensured clear communication during updates, consultations and decision making processes. We saw evidence of good processes in place for language line and strong links with the midwifery colleagues in the roll out of language line carts, which further improved communication. There was a variety of multilingual staff in post. The Trust actively recruited a workforce of colleagues who represented the diversity of the local population. Situation, Background, Assessment, Recommendation (SBAR) training was available to all staff in the neonatal service. Whilst this was primarily used as a communication tool for healthcare worker to healthcare worker, it was well utilised to communicate with families when decisions were required. Information about people that was collected and shared met data protection legislation requirements.

People told us it was easy to give feedback and raise concerns about care received. The services booklets included information on how to raise concerns, provide comments or make suggestions for any improvements relating to their experience in a range of accessible ways. QR codes were easily accessible and supported people to access the information in a range of different languages.

Managers investigated complaints and concerns thoroughly and made appropriate recommended actions. Managers regularly shared feedback from complaints with staff at various meetings such as the daily safety brief. Learning was shared as part of staff education within the division and also across the trust to all staff. Reflective practice offered opportunities for change within multidisciplinary teams. The service used the learning from complaints and concerns as an opportunity for improvement to local practice and procedures.

The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included families in the investigation of their complaint where relevant.

People told us they could access care, treatment and support when they needed to and in a way that worked for them. There were many examples given of reasonable adjustments being provided when needed, and this was timely and in line with best practice. The language line cart which was a device on wheels aided 24/7 interpreting availability. The cart could be brought to the bed or cot side to help with interpreting healthcare conversations and decision making. The service offered 40+ languages and British Sign Language (BSL).

Staff told us that when they are making any changes to services in the unit that equity of access is considered. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support, whether this is from wider society, within organisational processes and culture or from individuals. Staff told us they use people’s feedback and other evidence to actively seek to improve access for people more likely to experience barriers or delays in accessing their care.

Peoples care records and clinical records reflected individual needs being met and assessed at all times. Services are designed to make them accessible and timely for people who are most likely to have difficulty accessing care. When there are barriers, they are removed. Physical premises and equipment are accessible. People are given support to overcome barriers to ensure equal access. The neonatal unit prioritises, allocates resources and opportunities as needed to tackle inequalities and achieve equity of access.

People told us they felt that their care, treatment and support promoted equality, and they did not feel there were any barriers to their care. People felt empowered by staff on the unit and they felt they understood their rights. People told us the benefits that the virtual ward rounds had on them and that this had recently launched. It meant all families could be involved if they chose to be. Families were delighted to be able to dial into their babies ward round when they could not be present in person. This ensured first hand communication was received by them.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals. Staff were proactive to address these barriers to improve people’s experience, act on information about people's experiences and outcomes and allocate resources and opportunities to achieve equity.

The neonatal unit complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes.

We saw positive feedback following a range of multi-disciplinary interventions demonstrating families were supported to make choices about future support needs. Families were empowered to hear babies voices and think about what might be best for their baby as an individual. We reviewed feedback from families who had received support on the perinatal pathway. This demonstrated 'involving parents helps you look past the guidelines and statistics and just see the real feelings we have'.

Dedicated staff gave examples of decision making with families when considering end of life care for babies. Personalised care plans were developed based on individual needs and wishes. We heard that families were supported to make decisions at a time that was right for the family.

We saw processes in place that were led by dedicated staff to support families through times when significant decisions needed to be made, for example, advanced decision making and planning for babies born with life shortening conditions. This also included parallel planning to allow planning for different possible outcomes. We heard about the Bradford Butterfly Pathway, an initiative for perinatal palliative care. This pathway provided consistent support in future planning with continuity of care throughout from a designated member of staff. Support was provided to facilitate choices for families and incorporate emotional, social and cultural needs for mothers and extended families. We heard that support also allowed for the focus on implications for future pregnancy and genetic screening for extended family members.