Archived: Bridgewater CHCFT Bevan House

Updated 17 December 2018

Bridgewater community midwifery services provides 24-hour maternity services for people that reside in the Halton area of Cheshire that includes Widnes and Runcorn.

For the twelve months prior to inspection, the service booked 1,488 women and there were nine home deliveries.

The service was divided into two teams; one for women in Widnes and the other for Runcorn. Each included base rooms for the midwives.

The antenatal clinics, for Widnes were in the same building as the urgent care centre. For Runcorn clinics were located within GP surgeries. There were also clinics held at Halton hospital for women needing to see a consultant obstetrician for the hospital that they were booked for their delivery.

We visited the Widnes and Runcorn sites, Halton hospital and St Pauls GP surgery.

We plan our inspections based on everything we know about services including whether they appear to be getting better or worse.

We inspected the hospital as part of an unannounced inspection between 17 and 19 July 2018. As part of the inspection we reviewed information provided by the trust about staffing, training and monitoring of performance.

We reviewed six electronic patient records. We spoke with three women as well as observing three patients during antenatal appointments and a visit.

We spoke with 25 members of staff including midwives band six and seven (including specialist roles), consultant, midwifery support workers and the head of midwifery.

Updated 17 December 2018

Our rating of this service improved. We rated it as good because:

• Following the last inspection, emergency equipment was available in both locations where midwifery was provided.
• Staff had completed mandatory training and specific skills and drills for this service. Since the last inspection, midwives spent 22.5 hours annually in the maternity unit of the neighbouring NHS trust.
• Since the last inspection, a safeguarding midwife has been employed. Staff had received safeguarding training updates and understood how to keep patients safe.
• Areas we visited were visibly clean.
• There were sufficient numbers of midwifery staff to meet the needs of the service.
• Patient records were completed appropriately by all staff. Since the last inspection, Digi pens were no longer used.
• Staff understood how to report incidents and received feedback. Since the last inspection, trends were identified and lessons learned and shared.
• Staff followed national guidance and monitored the service.
• Staff were appraised and supported by senior staff. Following the last inspection, Professional Midwifery Advocates had been trained and were awaiting direction form the regional network re implementation.
• Patients were supported by staff with individualised care. Since the last inspection, there were processes to refer women, to neighbouring trusts for support with a mental health need.
• Since the last inspection, the clinic at Halton hospital had been reorganised so that consultations were mainly in a room rather than in bays with privacy curtains.
• There was an open and transparent culture with clear supportive leadership.
• The service followed the wider regional network strategy.
• Following the last inspection, the service worked with a neighbouring hospital trust being part of the maternity voices programme where meetings were held with staff and women who used the service.

However:

• In both areas emergency bags included some equipment that was overdue for servicing, as recorded on the sticker attached and there was extra birthing, rather than emergency items not on the checklist. This was addressed during the inspection.
• Medicines which required to be kept at a certain temperature were stored in emergency bags but there was no date when the medicine was removed from the fridge. This was addressed during the inspection.
• Fridge temperature checks, at Widnes had been recording as exceeding the maximum range for at least four months.

Updated 17 April 2014

We found that patients and their needs were placed at the centre of their care. There was a high regard for safety and we could see that lessons had been learned following incidents. The trust shared learning with staff using among other things intranet updates and a trust-wide newsletter. 

The services were effective and led by the needs of the patient. There was a real attempt to be 'joined-up' in the teams’ approaches to care. The trust had a clear vision for the organisation, and a commitment to sharing best practice across its wide geographical area. 

Patient were overwhelmingly positive about the services received. Patients were complimentary about the staff and told us they had received good standards of care that met their needs.

Community matrons and reablement teams showed great pride, vision and expertise. They showed a great appreciation for reducing unnecessary admissions to hospital and speeding up patients’ discharge back into the community. We saw evidence of close integrated partnership working and proactive monitoring of the quality of services.

Staff were generally proud of working for the trust. They said it offered an open and listening culture with senior executives visiting teams and regular communication via the trusts intranet. 

The recent reconfiguration and lack of clarity of changes to management within teams had raised some anxieties among staff, although most staff on the frontline felt they just got on with the job regardless of managerial changes. The management of change was unclear to some managers taking over new services, with no clear direction of the services strengths and weaknesses.

Updated 17 April 2014

We found that the children’s and families’ service was safe, effective, caring and in the main responsive to the needs of the local population.

There were systems in place for reporting incidents and near misses and staff were using these appropriately. The safeguarding arrangements were well embedded in practice and staff felt well supported by the specialist safeguarding team. Staff were provided with supervision although in some cases due to management changes there had been gaps in management supervision. There was access to mandatory training and a system to remind staff when they needed to refresh their training. There were safe systems for the management of medicines and the removal of clinical waste. Risk assessments were generally clear and mitigating actions were in place, although some of these were not regularly reviewed. There were some staff shortages but these were being resolved.

Staff were supported using nationally recognised guidelines. There was evidence that audit was used to measure patient outcomes and patients were encouraged to provide feedback on their experience of care. There was a policy to support staff  working alone but the strategies in place to protect staff were not consistent across the trust. It was clear that all professional staff were committed to multi-agency working and the delivery of care as close to home as possible. There were assessments of young people’s competence for consent using the Fraser guidelines where this was necessary.

All the people we spoke with agreed that the professionals were caring, and they were committed to putting the child and family at the centre of all that they did. We did see some records that were not fully completed and this had not been picked up by the trust’s audit. However the interactions we saw between professionals, children and their families were respectful. We saw records that showed emotional support was given to children and families in a variety of situations and there was evidence of services working around the needs of the families.

There was evidence that the trust was aware of the needs of the local population and that it had led or been involved in projects to improve public health. There was evidence of good multi-agency as well as multi-disciplinary working across the trust. There were some areas of therapy and nursing where there were long waiting times. These had come about during the reorganisation and action was being taken to address them. Staff had actively pursued effective planning for discharge with the local acute trusts and this was mostly effective. There was evidence that staff supported and encouraged feedback from parents and children but the trust’s feedback form was not child friendly.

There was a trust vision that all staff were aware of. There had recently been changes to the management structure bringing all the teams providing the same service across the trust under one manager. The trust promoted innovation and learning but this innovation was in pockets and not trust-wide. The managers we spoke with were passionate about their role and about developing services to meet local needs. All the staff we spoke with said that the trust’s board were open, responsive and visible to the workforce.

Updated 17 April 2014

The community dental service had systems and processes in place to keep people safe. The service had learned from incidents and mechanisms were in place to identify and control risks to patients.

The dental service was effective and focussed on the needs of patients and best practice. There were systems in place to audit both clinical practice and the overall service.

Patients and their representative’s spoke highly of the care provided. They confirmed they had been given privacy and were treated with dignity and respect whilst receiving treatment.

The community dental service was responsive to the needs of patients. The maintenance of clear, concise and detailed clinical records confirmed that care and treatment was provided in a way that met the diverse needs of patients.

The community dental service was well-led. Initiatives had been established to improve services, and there were quality assurance processes in place. Staff spoken with confirmed that they felt valued and supported in their roles and that managers within the dental service and overall trust were approachable and visible.

Updated 17 April 2014

There were systems and processes in the end of life care services to provide safe care and support for patients and these were working effectively. Patient safety was being monitored and incidents were investigated to learn and improve care.

The end of life care services followed national guidelines and staff used care pathways effectively. The trust took part in national and local clinical audits. The processes for collecting patient safety data and complying with end of life care indicators could be further improved. There were enough staff with the right skills to meet patients’ needs. Patients were supported with the right equipment. Patient records and clinical notes were completed appropriately.

Patients spoke positively about their care and treatment. There were systems in place to support vulnerable patients. The end of life care services engaged with other care providers and professionals to make sure that coordinated care took place. There was enough capacity to ensure patients referred to the services could be seen promptly and receive the right level of care.

Staff were appropriately supported with training and supervision and encouraged to learn from mistakes. The end of life care services did not have clear leadership roles. Individual teams were effective but worked in isolation of each other and there was no shared learning across teams.

Updated 17 December 2018

Our rating of this service improved. We rated it as good because:

• Following the last inspection, emergency equipment was available in both locations where midwifery was provided.
• Staff had completed mandatory training and specific skills and drills for this service. Since the last inspection, midwives spent 22.5 hours annually in the maternity unit of the neighbouring NHS trust.
• Since the last inspection, a safeguarding midwife has been employed. Staff had received safeguarding training updates and understood how to keep patients safe.
• Areas we visited were visibly clean.
• There were sufficient numbers of midwifery staff to meet the needs of the service.
• Patient records were completed appropriately by all staff. Since the last inspection, Digi pens were no longer used.
• Staff understood how to report incidents and received feedback. Since the last inspection, trends were identified and lessons learned and shared.
• Staff followed national guidance and monitored the service.
• Staff were appraised and supported by senior staff. Following the last inspection, Professional Midwifery Advocates had been trained and were awaiting direction form the regional network re implementation.
• Patients were supported by staff with individualised care. Since the last inspection, there were processes to refer women, to neighbouring trusts for support with a mental health need.
• Since the last inspection, the clinic at Halton hospital had been reorganised so that consultations were mainly in a room rather than in bays with privacy curtains.
• There was an open and transparent culture with clear supportive leadership.
• The service followed the wider regional network strategy.
• Following the last inspection, the service worked with a neighbouring hospital trust being part of the maternity voices programme where meetings were held with staff and women who used the service.

However:

• In both areas emergency bags included some equipment that was overdue for servicing, as recorded on the sticker attached and there was extra birthing, rather than emergency items not on the checklist. This was addressed during the inspection.
• Medicines which required to be kept at a certain temperature were stored in emergency bags but there was no date when the medicine was removed from the fridge. This was addressed during the inspection.

Fridge temperature checks, at Widnes had been recording as exceeding the maximum range for at least four months.