Archived: Penrith Hospital

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.