Updated
15 March 2024
Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at North Devon District Hospital.
We inspected the maternity service at North Devon District Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.
North Devon District Hospital provides maternity services to a population of 165,000.
Maternity services include an outpatient department, antenatal and postnatal ward (Bassett), labour ward, and one maternity theatre. Between April 2022 and March 2023, 1,240 babies were born at North Devon District Hospital.
We will publish a report of our overall findings when we have completed the national inspection programme.
We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well led key questions.
Our rating of this hospital stayed the same. We rated it as Requires Improvement.
- Our rating of Requires Improvement for maternity services did not change ratings for the hospital overall. We rated safe as Requires Improvement and well led as Requires Improvement.
We also inspected one other maternity service run by Royal Devon University Healthcare NHS Foundation Trust. Our report is here:
Royal Devon & Exeter Hospital (Wonford) – https://www.cqc.org.uk/location/RH801
How we carried out the inspection
We provided the service with 2 working days’ notice of our inspection.
We visited the Labour ward / Delivery Suite, and the antenatal and postnatal ward.
We spoke with 9 midwives, 2 support workers and 1 woman who was using the service.
We reviewed 12 patient care records, 5 observation and escalation charts and 7 medicines records.
Following our onsite inspection, we spoke with senior leaders within the service. We also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
Services for children & young people
Updated
9 November 2014
We found children’s services to be safe. Parents told us that staff were caring and we saw that children and their parents and carers were treated with dignity, respect and compassion. Ward areas and equipment were clean.
There were contingency plans in place if there were staff shortages and/or the wards were full. Patients requiring intensive mental health support were cared for by agency staff with mental health training. There was a multidisciplinary proposal for an urgent assessment protocol.
There were thorough nursing and medical handovers that took place between shifts to ensure continuity of care and knowledge of patient needs. We saw evidence of outstanding collaborative working, both within the units and with the community paediatric nurses.
We found that the environment within the ward made it challenging to accommodate the differing needs of patients, of infants, including those whose mothers were breastfeeding, and of children and young people requiring care and treatment.
We saw evidence of planning for future sustainable children’s services and learning from incidents. We also saw how the service made good use of the skills and resources it had.
Updated
9 November 2014
Care provided by the critical care team was safe and treatment delivered was effective. Staff were caring and patients were treated as individuals. Their needs were met by considerate and compassionate staff. The service was well-led at both department, nurse and medical staff level. The team worked well together and this was commented upon by staff, patients and visitors.
Patients were happy with their care and all the discussions we had with patients were overwhelmingly positive. There was good multidisciplinary input into patient care to enhance recovery and discharge from the unit.
There were some instances of the discharge of patients not being at an optimal time. The majority of patients were not discharged at night, but some left the unit earlier than was ideal, to make room for unplanned emergency admissions. In busy times, some patients were discharged back to the wards to free bed space for more acutely-unwell patients. There was no step-down facility to a high dependency unit (HDU), as the hospital did not have a dedicated HDU.
The unit was small and there had been no renovation to bring the unit up to modern standards of facilities and equipment since it was built in the 1970s. It was, therefore, not able to respond to all treatment, or integrated care pathways.
Updated
12 September 2019
Our rating of this service went up one rating. We rated it as good because:
The service used national standards of good practice to provide safe services for patients. This included practices around hygiene, infection prevention and control, safeguarding procedures and management of changes in patients’ conditions.
End of life care was delivered in line with national guidance. There were effective systems to monitor performance.
Care for patients approaching the end of their life was provided with compassion and respect. Staff made sure patients and those close to them understood their care and treatment. Relatives and carers were involved in discussions about the plan of care.
The end of life and specialist palliative care team met the needs of patients in a timely way .
The end of life and specialist palliative care services were now fully integrated. The leadership had continued to improve since our last inspection in 2018. It was an integrated and strong team with an emphasis on providing consistent and high quality care.
Governance processes had strengthened since our last inspection and there was an end of life strategy to support the vision for the service.
It was apparent during our inspection that all the staff had the patient and their families at the centre of everything they did. They were passionate about end of life care and were dedicated to their roles and approached their work with flexibility.
Updated
12 September 2019
Our rating of this service improved. We rated it as good because:
- The service used national standards of good practice to provide services for patients. This included practices around hygiene, infection prevention and control, safeguarding procedures and management of patient risks.
- Staff were conversant with managing people who may be suffering with sepsis and ensuring they received appropriate treatment.
- Most facilities were suitable for their purpose and were well maintained.
- Staff kept records of patient consultations and shared the information with GPs.
- We saw staff treating patients with kindness and respect and ensuring appropriate consent was gained from patients about sharing information.
- Staff kept the patient experience at the heart of their practice. Changes made to practice and services took into account how patients would be affected. Patients were given choices and urgent needs were prioritised.
- The service had improved some referral to treatment times.
- Managers and leaders of the service worked together and engaged staff to make improvements to the service. They used their skills to encourage staff to contribute ideas and felt empowered to make improvements. Staff felt supported by their managers.
- Governance structures had been improved and staff were clear about reporting procedures.
- Development of staff was a priority for the service. Staff were competent in their roles, attended mandatory and specialist training to enhance their skills.
However:
- Some of the premises were cramped for the number of clinics being held. This had led to a lack of privacy for some patients.
- Some records were not stored securely.
- Medicines management did not always follow current guidelines.
- Referral to treatment times did not always meet national standards and ophthalmology treatment times had worsened.
- Not all staff had received up to date appraisals, although the service was working to improve this.
Urgent and emergency services
Updated
12 September 2019
Our rating of this service stayed the same. We rated it as requires improvement because:
We rated safe, responsive and well-led as requires improvement but effective and caring were rated as good.
- There were some concerns about the completion of patient care records and medicines were not always managed safely. Reviews of safe levels of nursing staff were not carried out as often as they should be. Daily checking of emergency equipment was not always carried out. However, the cleanliness of the department had improved greatly, and patient risks were assessed and managed safely. Staff were largely compliant with mandatory training and regular updates including safeguarding training.
- The service did not always meet national targets around waiting times. However, service leaders worked to plan and deliver the service to meet the needs of the population and staff made reasonable adjustments to meet the needs of individuals. Complaints were investigated and managed in a timely manner.
- There were processes to improve the quality of care and patient outcomes, but these were not fully embedded. Processes and the recording of mortality and morbidity were not always sufficiently detailed to give evidence of an effective process. There was a lack of audit oversight and identified risks were not always documented, assessed and mitigated. However, the culture amongst staff was positive and most staff felt engaged with service improvements.
- The service provided care and treatment in line with national guidance and participated in national patient outcome audits. Staff were supported to access further professional training and developed. Staff supported patients to make decisions about their care and took appropriate actions when patients lacked mental capacity.
- Staff treated patients with kindness and compassion. Staff ensured patients were involved in decisions about their care. Patients were positive about the care they received in the department.