Archived: Penrith Hospital

Updated 22 November 2018

We only inspected the midwifery-led birthing centre at Penrith Community Hospital. This was part of the unannounced inspection of North Cumbria University Hospitals NHS Trust. The midwifery-led birthing centre is part of the Trust maternity service. It is a midwife-led unit and base for community midwives. The birthing centre aims to provide an alternative place to give birth to local mothers deemed as low risk pregnancies. The centre can accommodate one mother in labour and provides a birthing pool and bed room.

The birthing centre was open daily between 08.30 and 17.00 and outside of these hours there was an on call rota for women who chose to deliver at the centre. In the 12 months between May 2017 and June 2018 there were 18 births at the centre. Women were able to have antenatal and postnatal appointments at the centre.

Updated 22 November 2018

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

• There was new senior leadership was in place with a new clinical director and associate director of midwifery both recruited in early 2018.
• Cross site working has improved from our previous inspection. Managers worked across all sites. However, staff continued to work at separate sites with shared processes and functions. Some staff from Penrith Birthing Centre were required to work at one of the main sites as part of the escalation policy when those units required additional staff.
• Governance processes with risk and governance leads for clinicians and midwives had improved in the service. There had been improvements in identification of risks, action plans and follow up of actions from audits.
• Nursing and midwifery staffing levels were better than the national recommendations for the number of babies delivered on the unit each year.
• Staff understood their responsibilities to raise concerns, to record safety incidents and near misses.
• Women were positive about their treatment by clinical staff and the standard of care they had received. They were treated with dignity and respect.
• Policies, systems and processes were in place to protect children and adults from neglect or abuse. There was a clear referral pathway via the community midwives if there were any identified safeguarding issues with expectant mothers.
• Staff followed best practice with infection control and prevention principles, in relation to the management of clinical waste.
• There was a robust midwifery led care policy, which identified the criteria for women being able to deliver within the unit and at home. Midwives completed risk assessments at booking to identify women with any risk factors. High risk women were referred to consultant led antenatal clinics. Women referred by their GP attended the birthing centre for assessment.
• There was a clear protocol to follow should any woman needed to be transferred to hospital. Staff called for an emergency response ambulance immediately.
• The centre was midwifery led and consisted of a lead midwife, community midwives, healthcare assistants and administration staff.
• Community midwife caseloads were managed appropriately. The management team were planning a review of the community midwifery caseloads following our inspection.
• Two further midwives who worked in West Cumbria would attend the centre if a patient needed to access the centre.
• Community midwifery staff were included within the maternity staffing escalation plan. This meant that should the consultant led units in either the Cumberland Infirmary or the West Cumberland Hospital require additional staff to provide safe care; community midwives were required to attend. This meant that the service at the birthing centre could be suspended for that period of time.
• There were no medical staff based at the maternity unit. However, staff were able to contact consultants at the Cumberland Infirmary for advice.
• The trust had a clear policy for the reporting of incidents, near misses and adverse events. Staff reported incidents using the trusts electronic reporting system. There were no serious incidents reported at Penrith Community Hospital. Staff were informed of incidents and learning that had occurred in the acute maternity units.
• Medicines, including those for pain relief, were safely administered. However, we found some medicines were not stored appropriately at the unit and each community midwifery team had a different process for the management and carrying of emergency medicines.

However:

• Managers discussed all transfers from the centre to the Cumberland Infirmary at Carlisle, however there was no formal audit undertaken to identify themes and trends, additionally there was no record of this discussion.
• The birthing centre was under used. Staff had begun some marketing work to raise the profile of the centre and had seen an increase in bookings in the month prior to our inspection.
• The service was not compliant with the Health and Safety Executive guidance to reduce the risk of legionella in the birthing pool. There was no checklist for cleaning of the birthing pool so staff were not aware of what was expected of them.
• There was a lack of evidence of regular audit within the birthing centre.
• We found some medicines were not stored appropriately at the unit and each community midwifery team had a different process for the management and carrying of emergency medicines.

Updated 22 November 2018

At our previous inspection we told the trust it should:

• Ensure the quality of information to improve the support for women who wish to complain. We found that although some complaint leaflets were available, information on both the role and contact details of the Care Quality Commission was out of date and inaccurate, and the leaflets did not clearly direct people to the Public Health Service Ombudsman.
• Ensure there is a service level agreement with the host trust to identify expectations about servicing and access to emergency continuity plans.
• Develop a local risk register for the centre to underpin the service risk register and ensure local risks are recorded, mitigated and escalated appropriately.
• Clarify the governance structure, as the Maternity Services Liaison Committee had not met for two years.
• Clarify a leadership role with a clear remit to promote ‘normality’ in child birth as supported by the Royal College of Midwives Campaign for Normal Birth and the National Childbirth Trust Birth Policy.
• Consider using information technology to improve the effectiveness of data flows. We were informed that the centre had recently received approval to introduce the IT data systems needed to help develop innovation and improvements.

Our rating of this service stayed the same. We rated it as good because:

• New leadership was in place with a new clinical director and associate director of midwifery both recruited in early 2018. Leaders were respected by staff at all levels but had not yet been able to fully embed changes in practice.
• There had been some significant improvement in cross site working between medical staff and senior midwife managers. Managers worked across all sites. However, staff continued to work at separate sites with shared processes and functions. Some staff from Penrith Birthing Centre were required to work at one of the main sites as part of the escalation policy when those units required additional staff.
• There was improvement in governance processes with risk and governance leads for clinicians and midwives. There had been improvements in identification of risks, action plans and follow up of actions from audits.
• Managers continued to review all transfers from the centre to the Cumberland Infirmary at Carlisle to identify indicators and trends for the reasons why women could not deliver at the centre. Two women required transfer to the Cumberland Infirmary between May 2017 and June 2018. We were told each transfer was discussed, however, there was no formal audit of themes or record of the discussion.
• Nursing and midwifery staffing levels were lower than the national recommendations for the number of babies delivered on the unit each year. The service continued to be under used. However, staff had begun some marketing work to raise the profile of the centre and had seen an increase in bookings in the month prior to our inspection.
• Staff understood their responsibilities to raise concerns, to record safety incidents and near misses.
• Women were positive about their treatment by clinical staff and the standard of care they had received. They were treated with dignity and respect.
• Services were planned, delivered and co-ordinated to take account of women with complex needs, there was access to specialist support and expertise. Midwives worked with medical staff and specialist midwives at the main sites to ensure women received care which met their needs.
• The trust had policies, systems and processes in place to protect children and adults from neglect or abuse. There was a clear referral pathway via the community midwives if there were any identified safeguarding issues with expectant mothers.
• Staff followed best practice with infection control and prevention principles, in relation to the management of clinical waste. However, the service was not compliant with the Health and Safety Executive guidance to reduce the risk of legionella in the birthing pool. There was no checklist for cleaning of the birthing pool so staff were not aware of what was expected of them.
• The premises and facilities at the birth centre were appropriate for the services provided there. The environment was spacious.
• There was a robust midwifery led care policy, which identified the criteria for women being able to deliver within the unit and at home. Midwives completed risk assessments at booking to identify women with any risk factors. High risk women were referred to consultant led antenatal clinics. Women referred by their GP or the emergency department attended the ward for assessment.
• If any woman needed to be transferred to hospital staff called for an emergency response ambulance immediately.
• The centre was midwifery led and consisted of a lead midwife, community midwives, healthcare assistants and administration staff.
• Community midwife caseloads were managed appropriately.
• Two further midwives who worked in West Cumbria would attend the centre if a patient needed to access the centre.
• Community midwifery staff were included within the maternity staffing escalation plan. This meant that should the consultant led units in either the Cumberland Infirmary or the West Cumberland Hospital require additional staff to provide safe care; community midwives were required to attend. This meant that the service at the birthing centre would be suspended for that period of time.
• There were no medical staff based at the maternity unit. However, staff were able to contact consultants at the Cumberland Infirmary for advice.
• Patient records were completed appropriately and stored securely.
• The trust had a clear policy for the reporting of incidents, near misses and adverse events. Staff reported incidents using the trusts electronic reporting system. There were no serious incidents reported at Penrith Community Hospital. Staff were informed of incidents and learning that had occurred in the acute maternity units.
• Medicines, including those for pain relief, were safely administered. However, we found some medicines were not stored appropriately at the unit and each community midwifery team had a different process for the management and carrying of emergency medicines.