Berwick Infirmary

Updated 16 October 2019

Berwick Infirmary is a small community hospital located within the town centre of Berwick upon Tweed. Geographically there are 57 miles between the Infirmary and the Northumbria Specialist Emergency Care Hospital (NSECH) and 52 miles between the Infirmary and the Wansbeck General Hospital.

Berwick Infirmary is one of the hospitals providing care as part of Northumbria Healthcare NHS Foundation Trust. This hospital provides community inpatient beds; an urgent care centre and midwifery led maternity service. We inspected maternity services at this hospital.

Northumbria Healthcare NHS Foundation trust provides services for around 500,000 across Northumberland and North Tyneside with 999 beds. The trust has operated as a foundation trust since 1 August 2006.

We inspected Berwick Infirmary as part of the comprehensive inspection of Northumbria Healthcare NHS Foundation Trust, which included this hospital, Northumbria Specialist Emergency Care Hospital, North Tyneside General Hospital, and community services. We inspected maternity services at Berwick Infirmary on 21 May 2019.

Services provided at this hospital include; inpatient services for elderly medicine, stoke and orthopaedic rehabilitation and palliative care; a minor injuries unit which is open 24 hours and supported by GPs.

For women expecting to have an uncomplicated delivery, there is a midwifery-led service at Hillcrest Maternity Unit which provides a single delivery room and birthing pool.

Obstetric services at Northumbria Healthcare NHS Trust are provided at The Northumbria Specialist Emergency Care Hospital (NSECH) for high and low risk women. There are three midwifery led units (MLUs) at Alnwick Infirmary, Berwick Infirmary and Hexham General Hospital which provide care for low risk women.

Antenatal services are provided on the base sites at Wansbeck and North Tyneside hospitals with outreach antenatal clinics to Hexham and Alnwick. Community midwifery is provided across the whole geographical area of the trust catchment area. There are five teams within North Tyneside and central Northumberland with community midwives working an integrated model of care in the three MLUs.

The maternity service provides antenatal and postnatal care to mothers who live locally but choose to deliver elsewhere, including over the Scottish border. Further to this some mothers may choose to give birth in Northumberland but are residents of neighbouring CCGs and have their community midwifery care at other trusts.

There is provision for antenatal education on preparation for labour, birth and infant feeding.

From January 2018 to December 2018 there were 3,050 deliveries at the trust with an average of eight deliveries a year at Berwick MLU.

The unit was open from 8.30am to 6pm Monday to Friday and 9am to 2.30pm on Saturdays and Sundays. There was one delivery room which had a birthing pool and active birth equipment. There was one home from home room and an antenatal clinic.

During our inspection we reviewed all services based at the Berwick site. We spoke with two women and one partner, as well as five staff which included midwives, a domestic and a health care assistant. We observed care and treatment and looked at the storage of care records. We also reviewed the trust’s performance data.

Updated 16 October 2019

We inspected the maternity service at Berwick Infirmary.

Our rating of services stayed the same. We rated it them as good because:

• We inspected maternity services at Northumbria Healthcare NHS Foundation Trust in May 2019. Our inspection included Berwick midwifery led unit (MLU). Several areas for improvement had been identified at our previous inspection in 2015 and at this inspection we found each of these had been addressed.
• There were systems for reporting, investigating, acting and learning from adverse events and there were clear safeguarding processes in place. Records and risk assessments were completed at each stage of pregnancy. There was consistent communication between teams.
• The risk of child abduction had been mitigated across all maternity services by security arrangements including staff challenging all visitors and staff stationed at ward entrances, monthly drills, a CCTV system and routine security guard attendance on the ward. The same mitigations had been implemented at Berwick MLU.
• Infection control procedures and practices were in line with guidance and equipment checks were completed consistently. Drugs, including emergency medicines were prescribed, stored securely and administered appropriately.
• The service provided care and treatment based on national guidance and best practice. Outcomes were good and harm free care at Berwick MLU was 100%. There were sufficient midwifery staff, competent for their roles. Staff met most trust mandatory training and safeguarding training compliance targets. Staff supported women to make informed decisions about their care and treatment, assessed and monitored pain and gave pain relief in an appropriate and timely way. Staff gave women enough food and drink to meet their needs and improve their health.
• Staff treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from women and families was positive with good patient survey results. Staff provided emotional support to women, families and carers to minimise distress. Staff supported women to understand their condition and make decisions about their care and treatment. Staff gave women practical support and advice to lead healthier lives.
• Key services were available seven days a week to support timely care. The service had considered its staffing and the care it provided and amended its provision to provide safe care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. There were clear and robust policies in place to ensure that patients were seen at the right place at the right time. The service was inclusive and took account of women’s individual needs. They treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had a clear strategy and plans for the future of the service and supported staff to achieve the service priorities. Staff at all levels were committed to embedding the changes and improvements in maternity services. Managers and staff worked together to identify and manage risks, information, and to share lessons learned.
• Staff supported each other and felt very positive about leadership within the service. The senior team were visible and approachable and staff valued the vision, support and leadership of matrons and the clinical lead. Line managers worked as role models and were part of the team. Staff were offered opportunities for training and progression.
• There was a clear governance framework and quality performance and risks were recognised and managed. Staff followed duty of candour appropriately.
• Staff felt very engaged and involved in the development of the service and its aims to provide good quality care for women. We saw encouragement and recognition were given to staff for fostering innovation or improvements to the service across different levels within the teams.
• There was evidence of innovative practice throughout the service and by staff at all levels including:
  • A health psychology team which supported women who had experienced a previous traumatic birth.
  • A continuity of care model in MLUs
  • Sharing of information regarding safeguarding including partners (SIRS)
  • A monthly skill drill for all staff in all clinical areas
  • A ‘Listening Buddies’ system
  • Quarterly staff away days for multidisciplinary team (MDT) development.

However:

• Review dates for Patient Group Directions (PGDs) used by midwives had been exceeded. This meant that medicines were being administered or supplied without an appropriately reviewed authority document. This is not in line with regulation or NICE guidance. Following feedback to the trust after the inspection the pharmacy reviewed PGDs and expedited their approval.

Updated 16 October 2019

• We inspected maternity services at Northumbria Healthcare NHS Foundation Trust in May 2019. Our inspection included Berwick midwifery led unit (MLU).
• Several areas for improvement had been identified at our previous inspection in 2015. At this inspection we found each of these had been addressed.
• There were systems for reporting, investigating, acting and learning from adverse events and there were clear safeguarding processes in place. Records showed pregnancy pathways were clear and risk assessments were completed at each stage of pregnancy. There was consistent communication and handover between teams.
• The risk of child abduction had been mitigated across all maternity services by security arrangements including staff challenging all visitors and staff stationed at ward entrances, monthly drills, a CCTV system and routine security guard attendance on the ward. The same mitigations had been implemented at Berwick MLU.
• Infection control procedures and practices were in line with guidance and equipment checks were completed consistently.
• Drugs, including emergency medicines were prescribed, stored securely and administered appropriately.
• We found patient records were made up of a mix of paper and electronic records which staff mostly completed accurately and completely.
• The service provided care and treatment based on national guidance and best practice. Staff monitored the effectiveness of care and treatment using an electronic maternity dashboard. The service also used the maternity safety thermometer. Outcomes were good and harm free care at Berwick MLU was 100%.
• Equipment including the adult emergency resuscitation trolley and resuscitaire had been checked regularly with no dates missing from checklists.
• There were sufficient midwifery staff for the number of babies delivered on the unit. Midwives and other healthcare professionals worked together as a team to benefit women. They supported each other to provide good care. Staff were competent for their roles. Managers appraised staff and held supervision meetings to provide support and development.
• MLU staff used a ‘Rotation Toolkit’ to demonstrate and document maintenance of community midwives’ competency in line with recommendations of the Kirkup report.
• Midwifery staff met trust mandatory training and safeguarding training compliance targets of 95% for the majority of modules.
• Staff supported women to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They supported women experiencing mental ill health and used measures that limit women's liberty appropriately. Staff assessed and monitored pain and gave pain relief in an appropriate and timely way. Staff gave women enough food and drink to meet their needs and improve their health.
• Staff treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from women and families was positive with good patient survey results. Staff provided emotional support to women, families and carers to minimise distress. They understood patient's personal, cultural and religious needs. Staff supported women, families and carers to understand their condition and make decisions about their care and treatment. Staff gave women practical support and advice to lead healthier lives.
• Key services were available seven days a week to support timely care. The service had considered its staffing and the care it provided and amended its provision to provide safe care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. There were clear and robust policies in place to ensure that patients were seen at the right place at the right time.
• Women could access the service during opening times or the on-call service and received the right care promptly. The service was inclusive and took account of women’s individual needs and preferences and coordinated care with other services and providers.
• Women and their families provided feedback and raised concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had a clear strategy and plans for the future of the service. Leaders supported staff to achieve the service priorities. Staff were aware of the trust’s vision and were committed to embedding the changes and improvements in maternity services and as part of the trust as a whole. Senior managers and operational team worked together to identify and manage risks, information, and to share lessons learned.
• Staff worked together, supported each other and felt very positive about leadership within the service. The senior team were visible and approachable and staff valued the vision, support and leadership of matrons and the clinical lead. Line managers worked as role models and were part of the team. Staff were offered opportunities for training and progression.
• There was a clear governance framework and quality performance and risks were recognised and managed. The service used the maternity dashboard as a clinical performance and governance scorecard and helped to identify patient safety issues in advance. Staff followed duty of candour appropriately.
• Women and staff had access to information and informative literature. Copies of the delivery summary were sent to the GP and health visitor.
• Staff sought opinions of those who used the service and feedback was positive. There was a maternity services user forum to gather experiences from women and improve standards of maternity care.
• Staff felt very engaged and involved in the development of the service and its aims to provide good quality care for women. Staff took part in fundraising initiatives. We saw encouragement and recognition were given to staff for fostering innovation or improvements to the service across different levels within the teams.
• There was evidence of innovative practice throughout the service and by staff at all levels including:
  • A health psychology team which supported women who had experienced a previous traumatic birth.
  • A continuity of care model in MLUs
  • Sharing of information regarding safeguarding including partners (SIRS)
  • A monthly skill drill for all staff in all clinical areas
  • A ‘Listening Buddies’ system
  • Quarterly staff away days for multidisciplinary team (MDT) development.

However:

• Review dates for Patient Group Directions (PGDs) used by midwives had been exceeded. This meant that medicines were being administered or supplied without an appropriately reviewed authority document. This is not in line with regulation or NICE guidance. Following feedback to the trust after the inspection the pharmacy reviewed PGDs and expedited their approval.