Archived: Bidston and St James Children's Centre

Updated 7 April 2017

One to One (North West) Ltd was set up in May 2010. One to One provides a community based caseloading midwifery led service with the main ethos based on the concept of continuity of carer. One to One is an independent provider of maternity services commissioned by the NHS, which specialises in large-scale community caseloading midwifery. This includes providing antenatal and postnatal care in the community setting as well as offering private scanning, homebirths and pool births at home.

Currently One to One employs 100 staff, of which 70 are clinical staff across all provider locations. The provider had a registered manager in the North West.

Previous CQC inspections were undertaken in April 2015 and November 2015

Updated 7 April 2017

Bidston and St James Children’s Centre is operated by One to One (North West) Limited. The North West registered location is situated in the Bidston and St James Children’s Centre, Birkenhead.

There are also three-satellite community Hubs or Patient Advisory Centre’s (PAC), situated in Crewe, Warrington and Ellesmere Port.

The service provides maternity care.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 16 and 17 January 2017. We interviewed 25 members of staff and four service users.

To get to the heart of women’s’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Strategy for the service was underpinned by the service five core values: excellence, safety, women centred, integrity and professionalism. These also underpinned midwifery practice and organisational systems.

An established leadership team, were both visible and accessible in the North West service. Staff, we interviewed as part of the inspection, were positive about the visibility and support from senior team. In addition, there were regular opportunities for midwives to meet with their line managers to discuss cases related to risks and suitable plans of care.

For long-term sustainability of the service, One to One envisaged the ongoing provision of the midwifery caseloading continuity of carer model. Caseload midwifery offers continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods.

We regulate and inspected this service but we do not currently rate single service providers. We highlighted good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There was risk assessment guidance in place and an escalation policy to ensure women received safe care. Risk assessments were reviewed regularly, and when there were any concerns about the health of the woman or her baby, referrals were made to other providers.

• The service had internal and one external supervisor of midwives (SoM) to support staff and women.

• Ninety eight percent of staff had completed safeguarding training in line with best practice guidance. Staff had an awareness of issues relating to domestic violence and female genital mutilation.

• Caseloads were planned based on midwife availability, staff experience and women’s complex care needs. The service monitored the number of women on its caseload to ensure there was sufficient staff to provide the level of care required.

• Care and treatment was provided in line with One to One policies and Practice Points (similar to standard operating procedures), which reflected guidance from the National Institute of Health and Care Excellence (NICE) and Royal Colleges.

• Women received education about choices for feeding their babies and they were supported by staff to feed their baby by their chosen method.

• Some staff had completed the NHS New born and Infant Physical Examination Programme (NIPE).

• Twenty-one of the 47 midwives were trained in hypnobirthing.

• One to One (North West) Limited worked closely with a number of external agencies and third party providers and were working towards improvements in communication to increase shared working pathways with other providers in an effective way.

• Staff were kind, caring and sensitive in the way they communicated. They spent time speaking with women, addressing any worries or concerns. Care was individualised and women valued the close relationships they built with the midwives.

• Staff took time to discuss previous birth experiences, worries, and fears about the current pregnancy. Women spoke very positively about the high level of emotional support provided and told us they felt confident and reassured by the support they were given.

• Staff spoke with women about their mental and physical well-being. They had access to formal assessment tools to use where there were concerns about depression or anxiety.

• Appointments were tailored around the needs of the women. Midwives provided care in the PACs and women’s homes.

• Staff had access to a telephone translation service if required.

• There was access to advice from a midwife 24 hours a day. Appointments could be arranged at mutually convenient times with women. Midwives were able to visit women on the same day if requested and considered necessary.

• Complaints were managed in a timely manner and communication with families were undertaken by telephone or a home visit and followed up with a letter addressing concerns with an action plan. We saw evidence of lessons learnt from complaints displayed.

• Quality of care, incidents, risks and lessons learnt were reviewed and discussed at regular meetings.

• There was a risk management policy in place that set out how risks should be monitored and mitigated and we saw examples of completed risk assessments.

• There was a positive, open and enthusiastic culture within the service. Staff were committed to provide the best service possible to their women.

• There was a vision and strategy for the service that had been developed by the registered manager.

• However, we also found the following issues that the service provider needs to improve:

• The service did not follow best practice guidance in relation to infection prevention and control.

• The environment was not always visibly clean.

• Clinical risk assessments were completed for women. These were documented well on the electronic records system but not always clearly or concisely in women’s handheld maternity notes.

• Electronic records were maintained to a high standard, however, these were not contemporaneous with the women’s handheld notes, which were difficult to follow, information was not clearly or concisely recorded and copies of screening results and hospital discharge letters were not filed in a timely manner.

• Staff supported women to make decisions and choices about their care and treatment. However, this was not always fully and concisely documented in the women’s handheld records.

• Seventy nine per cent of staff had received an annual appraisal. However, specific personal development objectives were set and discussed as part of the “consolidation” passport.

• Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with five requirement notices that affected maternity and midwifery services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals North Region

Updated 7 April 2017

We regulate this service but we do not currently rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

Clinical risk assessments were completed but documentation was not always accurate, complete or contemporaneous. There were policies and procedures in place to ensure staff escalated care to other providers if required. Electronic records were completed to a high standard; however, maternity handheld notes were not clear or concise.

The majority of care was provided by staff that followed evidence-based guidelines and policies. However, some national guidelines were not adhered to fully.

Ninety eight percent of midwives had completed safeguarding level three training. Not all staff had completed their mandatory training or received specific complex obstetric needs training, pool birth or suturing training. Not all had had received an annual appraisal review.

Staff provided advice and support in feeding their babies.

Staff provided care in an individualised way, supported women to make informed choices and respected their decisions. However, this was not always documented in full. Women told us staff provided a high level of emotional support and feedback was consistently positive.

Women were able to access advice 24 hours a day. There were no restrictions to the number of appointments they could receive to ensure they were fully supported throughout their pregnancy and for up to six weeks following the birth. Staff understood that some women might have additional needs and there were facilities in place to support this for example, access to translation services.

There had been 18 complaints about the service in 2016 and staff were able to give examples of learning from previous complaints.

The vision for the service was to grow the service into a company that was seen as the preferred choice for women and their families for their maternity care and to deliver this care to the safest and highest standards.

The culture in the service was positive and enthusiastic and staff were dedicated to providing the best care possible. Staff met monthly and discussed key information such as clinical quality, care outcomes and key incidents or risks. A risk management policy was in place and we saw this had been implemented appropriately.