New Forest Birth Centre

Updated 17 April 2019

We carried out an unannounced inspection on 4, 5 and 6 December 2018.

This report relates to the service provided at the New Forest Birth Centre which is a standalone service in the New Forest. They worked collaboratively with Princess Anne Hospital which is the main maternity centre for University Hospital Southampton NHS Foundation Trust.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities at the service.

The New Forest Birth Centre (NFBC) is a stand-alone unit on the edge of the new forest.

During the inspection we visited the New Forest Birth Centre. This is a midwife-led unit which consisted of two birthing rooms and seven postnatal beds. The unit looked after low risk pregnant women and had facilities to transfer women to Princess Anne Hospital which is the main maternity centre. Women requiring epidural or medical help were transferred to the Princess Anne Hospital.

The Princess Anne Hospital is a tertiary provider of complex maternity and neonatal services including high risk maternal and fetal medicine and infants with complex medical and surgical needs. The trust has 80 maternity beds.

We previously inspected maternity jointly with gynaecology, therefore we cannot compare our new ratings directly with previous ratings.

Updated 17 April 2019

• The hospital always had enough staff with the right qualifications, skills, experience and training to keep women safe from avoidable harm and abuse, and to provide them with the care and treatment they needed.

• Staff had clear understanding about their safeguarding responsibilities and were confident about actions they would take if they had any concern about a woman’s well-being. Staff followed internal procedures for safeguarding women and children.

• Women had access to maternity services when they needed it, with access to telephone guidance twenty- four hours a day and prompt responses. The trust provided maternity services seven days a week.

• The service provided care and treatment that was based on national guidance and monitored its application in practice.

• Actions were taken to improve service provision in response to feedback, incidents investigations and complaints received.

• Staff told us there was good working relationship with Princess Anne Hospital and they felt well supported in delivering care to women and babies.

• The trust vision and strategy was understood by staff and staff said they were supported by their managers.

However:

• There was only one midwife on site and staff relied on support from the main hospital which may impact on care of women.

• The service treated concerns and complaints seriously, investigated them, learned lessons from the results and shared with staff. These were not completed in a timely way; detailed responses had resulted in delays for the complainants which the trust was working to improve.

• Not all staff had received annual appraisals to provide support and monitor their practice. This was below the compliance rate set by the trust.

• All staff had not completed additional training for management of women in the birthing pool.

Updated 17 April 2019

We rated it as good because:

This was the first inspection of the core service of maternity at the New Forest Birthing Centre as a separate service. Therefore, we cannot compare our new ratings directly with previous maternity and gynaecology ratings.

We rated this service as good because:

• Midwives and obstetric staff had completed additional training for the management of emergency including the Practical Obstetric Multi Professional Training (PROMPT) for obstetric emergencies such as shoulder dystocia, ante-partum and post-partum haemorrhage and maternal sepsis.
• Staff had clear understanding about their safeguarding responsibilities and were confident about actions they would take if they had any concern about a woman’s well-being. Staff followed their internal procedures for safeguarding women and children.
• Staff carried out detailed assessments of women including the most vulnerable groups and ensured that safeguards were in place.
• Actions were taken to improve service provision in response to feedback, incidents investigations and complaints received.
• Ante-natal risk assessments and screening for safeguarding and mental health were recorded and actions instigated as needed.
• Women had access to maternity services when they needed it, with access to telephone guidance 24- four hours a day and prompt responses. The Trust provided maternity services seven days a week.
• The service had developed a needing extra support team who managed the care of women with complex needs and providing continuity in their care.
• The service provided care and treatment that was based on national guidance and monitored its application in practice.
• Incidents were managed well and staff were supported to report incidents. Learning from incidents were shared regularly with staff group which encouraged openness.
• Services were planned and delivered to meet the needs of the local population and reflected some aspects of the National Maternity Review.
• Staff told us there was a good working relationship with Princess Anne Hospital and they felt well supported in delivering care to women and babies.
• There were effective multi- agency working to meet the needs of women and children.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Managers at local levels in the Trust had the skills to manage the service providing quality and sustainable care.
• The Trust vision and strategy was understood by staff and staff said they were supported by their managers.

However:

• There was only one midwife allocated per shift and staff relied on support from the main hospital or staff in the community which may impact on care of women and babies.
• The service treated concerns and complaints seriously, investigated them, learned lessons from the results and shared with staff. These were not completed in a timely way; detailed responses had resulted in delays for the complainants which the Trust was working to improve.
• Not all staff had received annual appraisals to provide support and monitor their practice. This was below the compliance rate set by the Trust. The trust told us they had taken steps following the inspection to improve appraisal rates, such as allocating protected times on the duty roster for appraisals.
• All staff had not completed additional training for management of women in the birthing pool.