Bradford Royal Infirmary

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We rated this question as outstanding. Staff were committed to treating patients and those close to them with compassion and kindness, respected their privacy and dignity and found ways to meet individual needs. Staff worked in partnership with babies and families.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were positive results in the friends and family survey data showing that 100% of people had given 5 stars based on them and their families feeling comfortable on the unit. Virtual ward rounds had also ensured they gathered feedback. Families were spoken to and asked for their feedback as users of this service. Feedback for the ward rounds was very positive and the only barrier that had been highlighted by a parent was that their other children needed caring for at the same time as ward rounds. Families said staff treated them well and with kindness. Family members of patients were very complimentary with the care they had received from staff.

There was excellent personalised care delivered by staff to promote privacy. For example, staff closed the curtains around cot and bed areas to enable conversations with parents / carers so that they remained confidential and private. Staff completed and met the trust target for equality and diversity mandatory training which covered equality, diversity, and human rights. They followed policy to keep patient care confidential. Staff supported babies and their families who became distressed in an open environment and helped them maintain their privacy and dignity. Throughout the unit there were multiple rooms which were used as quiet rooms or for private and sensitive conversations. Staff understood the emotional and social impact that a babies care, treatment or condition had on their relatives well-being. They offered continuity of care, as far as possible, from the same member of staff. The service provided appropriate emotional support to families following a bereavement. We also heard from new staff and students that they had been treat with equal kindness, compassion and dignity. These behaviours were modelled throughout care and with staff.

Staff who worked within the bereavement service provided a full range of services to support families. For example, they could facilitate transfers of patients to a local hospice; arrange bereavement counselling; provide palliative support for patients who were at end of life; visit families in their own homes; arrange for the chaplain to visit to provide spiritual, pastoral, and emotional support.

Staff were discreet and responsive when caring for babies, children, young people, and their families. We observed staff taking the time to interact with them in a respectful and considerate way. They were welcoming, introduced themselves and demonstrated compassionate care. Staff provided exceptional dedicated and personalised emotional support and advice to families when they needed it to help to minimise their distress in difficult situations. They understood personal, cultural, and religious needs. On all areas visited there were positive examples of emotional care. Staff were conscious of the needs of families, especially if the babies had been an inpatient for a significant length of time. We saw multiple thank you cards from families of babies who had used the service.

Women shared with us that they felt the care, support and treatment for themselves and their babies met their individual needs.

Staff told us they took into account individual needs when care planning, this included being aware of cultural backgrounds and protected characteristics. Staff gave us a few examples of this, including ensuring interpreter services were provided as soon as they were identified as being required.

We saw that the Trust had recently gained access to an award winning digital communication tool which was designed to enable communication across barriers in healthcare settings including visual, hearing, cognitive impairment and languages. They had launched their own family communication Padlet tool/app. This was an interactive notice board that the unit used to update families with information regularly and could be accessed online, by smartphone or by tablet. It allowed the unit to add signposting links to other services and agencies that families could reach quickly. The Trust utilised a wide amount of visual aids and culturally sensitive materials across the neonatal service. This included posters and leaflets, pictures, and translated written materials to supplement verbal communication. They also had a TV screen in reception that played a loop of important information, posters and videos for families that enabled them to be adaptive and maximise the information shared. We observed the unit's educational materials were culturally sensitive, and respected diverse family backgrounds and beliefs.

All external leaflets displayed in the neonatal unit were assessed by the Trust Clinical Priorities Advisory Group (CPAG) committee for accuracy before approval. We saw and were told it was standard process to record individual needs in patient care records and we saw this meant the patients were receiving the most appropriate care as a result of this.

We spoke to families during inspection and reviewed feedback received by the provider and through social media. We heard that families felt valued and had good opportunities to be able to input into the care of their baby. Families were supported to have choice and control over the care and treatment for their baby by being supported to put themselves 'in the shoes of their baby'.

The neonatal service promoted the importance of babies voices and supported staff and families to view babies as individuals with their own experiences and feelings. Families were routinely offered education around topics including for example, feeding, holding, bathing and activities such as reading to or singing to babies. Personal circumstances of families were consistently taken into account to ensure that appropriate support options were considered in supporting early bonding between babies, parents and wider families.

Systems and processes in place were highly effective in supporting babies and families to have their voices heard. The team worked consistently to ensure that families and babies had choice and control over their care and treatment. This included consistent education for staff around hearing the voice of the baby and taking behavioural cues that might be much more subtle within the neonate speciality. This education and support was extended through staff to families using embedded ward round and multi-disciplinary ways of working. Daily processes included regular prompts to consider how families could be supported to be primary caregivers.

The service provided a wide range of information on the website and within welcome booklets on topics such as infant feeding and maternal bonding. Women, and families, were encouraged to participate in ward rounds to enable them to be fully involved in their babies care. Staff talked with families in a way they could understand. We spoke with a women who confirmed she had felt involved in every step of her babies care and reported that the information given by staff was comprehensive and understandable.

Staff supported and involved families to understand their babies condition and make decisions about their care and treatment. They ensured a family centred approach.

On all areas in the neonatal unit there were positive examples of emotional care. Staff were conscious of the needs of babies and their families, especially if the patients had been an inpatient for a significant length of time. We saw multiple thank you cards from families of babies who had used the service. There were staff working as neonatal unit volunteers, and this role was there to increase parental satisfaction as well as decreasing anxiety and stress. Key tasks of the volunteer were clear and included family centred care support and support for activities on the unit. They also provided practical information for families, helped with siblings and organised as well as helped in events.

We heard and saw the service had a strong culture of supporting positive wellbeing for all staff in order to ensure the maintenance of an effective service for babies and families. Staff support was seen as vital in equipping staff to support families and was prioritised from the beginning of a staff members journey within the service. Staff told us about a range of effective well-being support mechanisms available to them and found leaders were consistently available to listen to staff views or provide support. Leaders demonstrated that they listened to staff and recognised the importance of maintaining a healthy and strong workforce. Leaders had normalised positive well-being through being inclusive, active listening and open conversations.

There were clear processes in place that supported the open, supportive listening culture. Processes had been created specifically for the staff working within the neonatal services in recognition of the nature of the specific challenges staff might face. These processes were supported by evidence based practice. There were clear pathways for staff to also access the wider organisations support mechanisms.