Chief Inspector of Hospitals rates Liverpool Women’s NHS Foundation Trust as Good

England’s Chief Inspector of Hospitals has rated the services provided by Liverpool Women’s NHS Foundation Trust as Good following an inspection by the Care Quality Commission in February 2015.

A team of inspectors found that the trust provided services which were effective, caring, responsive and well led. But the trust required improvement for providing safe care.

The inspection team, which included a variety of specialists and experts by experience, visited Liverpool Women’s Hospital, community midwife services, and outpatient services provided at Liverpool Women’s at Aintree Hospital. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/REP.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Liverpool Women’s NHS Foundation Trust has a lot of to be proud of. Apart from providing essential specialist services to women and babies from Liverpool and the surrounding areas, it is a major centre for research.

“We found maternity inpatient services, gynaecology, neonatal services, end of life care, outpatients and termination of pregnancy services to be good. Staff at every level were committed and passionate about their work and the quality of care they provided.

“Since our previous inspections in April and September 2014, the trust has clearly worked hard to make significant improvements to its governance and risk management systems. We found the senior team was visible and accessible to staff, and managers were seen by staff as supportive and approachable.

“While there were clearly many areas of good practice, there were also some areas for improvement particularly within the trust’s community midwifery services and we have told the trust where it needs to make changes. Our inspectors will return to check on those improvements.”

CQC found that the trust had a strong senior leadership team, and that staff felt engaged and were keen to learn and continually improve the services they offered to women and their babies. The trust’s vision - ‘to be the recognised leader in healthcare for women, babies and their families’ - underpinned all the trust’s strategies and plans and was well known to staff throughout the organisation.

All areas of the trust were clean and robust infection control practices were adhered to by staff. Staff communicated with and supported people in a compassionate way, and patients spoke positively of the care they had received.

Care and treatment was delivered in line with national guidelines and outcomes for patients were comparable or better than average for similar services. The systems for safeguarding babies were robust, well understood and supported by staff training. However, the trust had identified that adult safeguarding was less well developed and in response, a comprehensive staff training programme for the safeguarding of vulnerable adults had recently been introduced.

The neonatal service had introduced the Advanced Neonatal Nurse Practitioner (ANNP) role. The ANNPs were having a positive effect in supporting high-quality care for babies needing specialist neonatal support. However, it was acknowledged that more work was required to fully embed and integrate this key role within the service.

Inspectors noted a significant increase in nurses and midwives employed since their previous visit. In addition, there were sufficient numbers of consultants and middle grade doctors to provide good quality care and treatment for patients; however, in maternity inpatient services, the consultant cover was lower than the 98 hours a week minimum recommended by the Royal College of Obstetrics and Gynaecology for a unit this size.

Medicines management and storage required improvement in a number of areas; in the inpatient maternity services, medicines were not always stored at the correct temperatures and community midwives were found to be carrying out-of-date medicines.

The reports highlight several areas of outstanding practice including:

• The neonatal unit was the first unit in the country to put the HeRo System in practice. This was a system that monitors the variability in babies heartbeats in order to assist with the early diagnosis of infections and other complications.
• The neonatal unit employed an effective system to benchmark practice and outcomes against other similar units in the UK and the USA. There was also benchmarking against similar units for mortality and morbidity rates.

The trust has been told that it must take action to improve in the following areas:

• The trust must improve the way in which medicines are managed and stored, ensuring that the medication data sheets in each room within the neonatal unit are checked at more regular intervals.
• The trust must ensure that the risks regarding the storage of formula milk are appropriately assessed, and effective controls implemented to manage those risks.
• The trust must be able to provide operating department practitioners or suitably qualified midwives in theatre recovery outside normal working hours.
• The trust must ensure that the telephone triage line must be staffed at all times.
• The trust must ensure that all staff are able to safeguard adults appropriately.

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch Liverpool.

On 19 May the Care Quality Commission presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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