Nottingham City Hospital

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 effective as good. We assessed 6 quality statements. Staff assessed people, so the care and treatment provided mostly met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered. Staff worked in a culture of evidence-based practice. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff discussed people’s needs with them, and they were involved in how their care and treatment was planned. People we spoke with were confident they had been listened to and understood. Staff asked them for any updates, such as whether pain was being controlled, or if they had any additional needs. People said staff considered their wellbeing to give the best possible outcomes.

Staff used effective tools to support clinical practice with people who had difficulties with communication. This included tools for people who did not speak English as their first language. Staff assessed people and acted on risk to reduce incidents of avoidable harm. Staff worked with other specially trained professionals to support people with additional needs when required.

Records were up to date and included comprehensive assessments undertaken leading to effective ongoing care.

People we spoke with felt they had good, evidenced based care whilst at Nottingham City Hospital. We were told by people using services, that they felt appropriate tests were carried out in order to support families. Some people we spoke with told us they had been in hospital for several days to ensure that test results were returned so new babies could safely be taken home.

Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. All staff had access to National Institute for Health and Care Excellence (NICE) guidance on their mobile phones through an app. This enabled quick access to updated guidance. When guidance was updated managers

produced posters and sent emails to alert staff.

Staff spoke passionately when speaking about delivering evidence based care. Staff told us that they would work with other departments to provide an holistic approach to care.

We reviewed a sample of maternity policies and found these were in date and referenced appropriate guidance.

Staff had access to guidelines to support care provision. However, when staff printed these documents hard copies were noted to be out of date. This could lead to accessing incorrect information.

People told us that they were satisfied with the care they received, birth plans were being adhered to where possible. People also told us the helpline was particularly useful, as they were able to voice concerns, and staff could advise people to come into the induction or labour suite when appropriate.

People told us they were mostly happy with their care. However, all people we spoke with felt there was limited continuity of care throughout their pregnancy. For example, people told us they rarely saw the same midwife twice. This often led to having to repeat information to different staff. However, one positive experience of care was described when Lawrence ward staff supported a family with tutorials and leaflets specific to their child's condition.

Most staff told us that they worked well as a team and there was good culture and a positive atmosphere amongst the midwives. However, some staff reported teamwork was not always present and that there was a disconnect between staff and management.

Staff reported that they believed that the ward (Lawrence) would work better if there was better collaboration and communication with the antenatal team. For example, we were told patients were sometimes placed on the ward unannounced.

Staff told us that there had been work on reducing the rotation of staff, which had helped to improve relationships and that 'communication throughout the department was improving'. However, we were also told that sometimes there was difficulty communicating between the services. This led to disagreements and confusion regarding patient criteria and placement. We were told of ongoing work to bridge the gaps between the different areas within the department. This work however was not embedded.

We received mixed feedback from partners some positive regarding improvements in teamwork. However, a number of negative concerns were shared with us regarding embedding of change across maternity. We were told that improvement was often slow to progress.

We observed handover which was led by the bed coordinator. Staff members from various teams within maternity were present. The handover was very structured and supportive.

We observed two caesarean sections. Staff demonstrated good team working within the theatre environment.

We observed the use of an electronic maternity notes system. This ensured communications were recorded, in order to reduce any loss of information in subsequent pregnancies. This information was also then available to community midwives. However, medical discharge summaries were created and dispatched from a different system. This could lead to potential information being missed and result in poor postnatal follow up care. This was already on the trust risk register. However, a solution had not been identified at the time of our assessment.

People were supported to initiate breast feeding postnatally in hospital and when discharged home. We saw a large amount of information and literature which could be accessed in order to promote a healthier lifestyle. For example, information on eating a healthy balanced diet, drinking plenty of fluids and getting enough rest post childbirth.

Staff assessed people's health when admitted and provided support for any individual needs to live a healthier lifestyle. For example, people were asked about their smoking status at their booking appointment and had carbon monoxide monitoring if they smoked. Women were offered smoking cessation support and could be referred to a smoking cessation service. The trust website contained information about breast feeding, weight loss, and the importance of a healthy diet.

The trust had clear procedures in place for advising women and birthing people with practical support and advice on how to lead healthier lives before and after childbirth.

People we spoke with told us they did not always feel they were communicated with regularly, particularly about delays with induction of labour.

Leaders told us they routinely monitored people’s care and treatment to continuously improve it. 'We ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves'.

However, the trust maternity dashboard, which was shared with us, identified that outcomes were not always positive and consistent. For example, the service had a higher percentage of 3-4 degree tears in assisted vaginal deliveries. They had been above the national target in 10 out of 12 months at the time of our assessment.

The service had a specific maternity improvement programme which included quality improvement processes. For example, induction of labour and caesarean section pathways. Leaders told us they were outcome focused and the dashboard helped provide direction. The service were compliant with Saving Babies Lives 3. ( A programme that aims to improve safety for mothers and babies by improving the knowledge, skills and confidence of midwives and obstetricians).

The service measured outcomes. However, they were not always positive and consistent, and that they did not always meet both clinical expectations and the expectations of people. For example, outcomes were above trust expectations for vaginal tears, haemorrhage and caesarean deliveries. However, there were marked improvements in breast feeding and reduced readmission.

All women and birthing people we spoke with felt they had been given enough information, including risks and benefits, to make an informed decision about their care and treatment and that they were able to give informed consent. Birthing people were able to give us examples of information they had been given and how they were asked for their views and preferences before consent to treatment. One woman told us that English was not her first language and that before staff advised her of the consent process, they made sure she fully understood the explanation and offered to provide her with an interpreter. The women said, “I was offered an interpreter, but I did not think I needed one so refused.”

All staff we spoke to explained how they obtained consent from people to carry out care and manage information. Staff gained consent and documented in records. Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act 1983, Mental Capacity Act 2005 and the Children Acts 1989 and 2004 and they knew who to contact for advice.

The trust operated a two stage consent process, where birthing people were approached to consent to a procedure that had been proposed. They were first provided with information regarding the procedure and treatment alternatives, before a second appointment to discuss any related questions or concerns.

There were up-to-date policies and procedures, which were accessible to staff through the trust’s intranet site.