Nottingham City Hospital

Updated 13 September 2023

Nottingham City Hospital is operated by Nottingham University Hospitals NHS Trust. The maternity service sits within the division of family health and provides a range of services from pregnancy, birth and postnatal care. There are inpatient antenatal, intrapartum and postnatal beds available for women. Bonington ward is a 27 bedded mixed antenatal and postnatal ward which also has allocated beds for neonatal transitional care. Lawrence ward is a 27 bedded mixed antenatal and postnatal ward which has a dedicated 4 bedded bay for induction of labour. At the time of our inspection, Bonington ward was closed for refurbishment.

The Labour Suite has 13 beds with a separate 4 bedded midwife led unit called the Sanctuary birth centre. There are also 2 obstetric theatres within labour suite with 24-hour anaesthetic cover, a bereavement suite and direct access to the neonatal unit.

There is a 5 bedded combined maternal and fetal surveillance (ABC) triage unit located on the ground floor where women requiring urgent care outside their routine clinical appointments were seen.

Data from the trust reported there were 4,174 births in the 2021/22 financial year.

Community maternity services are provided by teams of midwives predominantly commissioned by NHS Nottingham and Nottinghamshire Integrated Care Board.

We inspected the service on the 25 and 26 April 2023. The inspection team comprised 2 inspectors and 1 midwife specialist advisor. An operations manager oversaw the inspection.

During our inspection, we visited Lawrence ward, Bonington ward, Labour suite, Sanctuary birth centre, Triage assessment unit, Day assessment unit and the obstetric theatres. We spoke with 11 patients and relatives and 50 members of staff. These included service leads, matrons, midwives, consultant obstetricians and anaesthetists, junior doctors and healthcare assistants. We observed care and treatment and looked at 24 complete patient records.

Updated 14 March 2019

Our rating of this service stayed the same. We rated it as good because:

• Patients were protected from avoidable harm and abuse.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect, and were involved as partners in their care.
• Patients’ needs were met through the way services were organised and delivered.
• The leadership, governance and culture promoted the delivery of high quality person centred care.

However:

• Patients medicines were not always stored in a locked cupboard.
• Potassium infusions were not stored separately from other infusions.
• Some drug fridges had two thermometers and staff were not clear what the purpose of the second thermometer was.
• Mental Capacity assessments were not always reviewed as required.

Updated 8 March 2016

We found the adult critical care services were good for safe, effective, and responsive, and outstanding for caring and well led.

There was a genuinely open and honest culture in which incidents and concerns were shared across the services and changes implemented to improve patient safety. National, trust, and local audit data was used to support service improvements.

Internal training and support for staff development was of a good standard and well established, however we did have concerns about limited access to the critical care module for registered nurses in CCD.

Care was patient centred and continually assessed on an individual basis. Emphasis was placed on the safeguarding of patients who were unable to communicate due to their clinical condition.

Patients and visitors consistently expressed satisfaction with the care and treatment they received stating that staff were very kind, caring and nothing was too much trouble.

There was a collective enthusiasm across all staff groups with a clear knowledge of the vision, values and strategic goals for the adult critical care and cardiac critical care services.

Staff told us they were proud to work in the department, felt very supported in their work and their opinions were valued.

Updated 14 March 2019

Our rating of this service improved. We rated it as good because:

• Staff had a good understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer alerts.

• Staff were aware of the trusts whistleblowing procedures and what action to take if they had concerns.

• There were comprehensive risk assessments completed in the medical and nursing notes. These were commenced on admission and there was evidence that risk assessments continued throughout the patients stay in hospital.

• We saw good examples of good multi-disciplinary working and involvement of other agencies and support services.

• All patients and their relatives we spoke with, told us they were fully included in discussions around their plan of care.
• The chaplaincy service had a key performance indicator of for referral to treatment times for emergency and urgent calls. Data showed that from January 2018 to October 2018, the chaplaincy service had achieved 98% against the trust target of 95%.
• There were systems in place to ensure that staff affected by the experience of caring for patient at end of life were supported. For example, staff had access to counselling, and alternative therapies through a self-referral system.
• Staffing ratios at Hayward house had improved since our last inspection and were now meeting the needs of the patients
• The Trust had implemented the SWAN model of care across the organisation in November 2017, enabling staff to prioritise the patients and families’ priorities and recognise the future bereavement of the families going forward, thereby providing person centred care

However:

• There were no audits to identify the ratio of cancer to no-cancer patients treated by the service
• The CQC had previously identified that the service did not monitor if end of life patients died in their preferred place of death. This was still not being undertaken
• The trust did not separately monitor delayed transfers of care for end of life care patients.
• The CQC had previously identified that the service did not provide a seven day a week service from the hospital palliative care team. This was still not being undertaken
• There were significant difficulties with the removal of the deceased patients from Hayward House

Updated 14 March 2019

• Babies received high quality care from dedicated and caring staff who had received appropriate training and education to enable them to provide safe care and treatment. The service had nursing staff with additional training in a variety of quality roles such as research, tissue viability, feeding, infection prevention and control and safeguarding.
• The NICU 2017/18 annual infection control report stated the Nottingham service were one of the units completing 100% data input of blood cultures in the data system for 2017 allowing them to be part of the NNAP report. Data demonstrated that for units delivering >500 central line days in infants <32w the service were ranked 3rd best overall in terms of infections per 1000 central line days. The rate of 5.6/1000 line days was below the UK average of 8.2. The unit was well maintained and decorated with appropriate equipment and facilities to care for patients and provide a caring, supportive environment for parents and families.
• Staff completed and updated risk assessments for each baby. They kept clear records and asked for support when necessary. Senior staff had identified a risk of pressure damage to babies’ nasal septum so had introduced a new style of ventilator cap. Staff were being trained in the use of the new cap during our inspection to reduce the risk of pressure ulceration.
• Specialist staff supported mothers to improve breast feeding rates. There were facilities to help mothers express and store breast milk.
• Feedback from parents and families was without exception positive about the care their babies had received. We saw many examples of the care and support offered to parents and siblings. The bereavement team offered comprehensive, caring support to bereaved families including siblings.
• The service used technology to support mothers who could not visit the unit and minimise mother and baby separation.
• Staff we spoke with were proud to work for the service. There was a positive open culture in which staff felt able to ask for help and report concerns. Staff were encouraged to develop themselves and services for patients and families.

Updated 13 September 2023

Updated 8 March 2016

We rated the outpatients and diagnostic imaging service as good overall.

Staff reported incidents appropriately and we saw evidence of incident investigation, actions and shared learning. Clinical areas were visibly clean with effective systems to ensure cleanliness was maintained. Medicines were stored appropriately and fridges and stock were checked regularly. Records were stored securely and were available on time for clinics. There were safeguarding policies and procedures in place and staff were aware of safeguarding leads. Staff were up to date with their mandatory training. Equipment was not always checked or maintained in line with trust policies and manufacturers guidance.

Outpatient and diagnostic imaging services worked to National Institute for Health and Care Excellence (NICE) and other national guidance. There were good examples of multi-disciplinary working. All staff we spoke with had received an annual appraisal, although outpatient and diagnostic imaging services fell just below the trust target of 90%. Radiology services offered a seven day service to hospital departments. Staff understood their role concerning the Mental Capacity Act 2005 and knew what to do when patients were unable to give consent for treatment.

Staff respected and maintained patients’ privacy and dignity. Patients were positive about staff and the way they were cared for. Staff gave examples of when they had gone the extra mile to help patients. Staff involved patients in their care and treatment.

In some areas, the environment had an adverse impact on the planning and implementation of outpatient and diagnostic imaging services.

The trust had not met cancer waiting time targets, which meant some patients did not have timely access to treatment. There were targeted clinics for communities or groups of people who were at risk of particular conditions. Interpreters and chaperones were available for patients who required them. There was limited information available in different languages. Staff were aware of the trust’s complaints policy and were able to describe what they would do in the event of a patient making a complaint.

There was a well-defined strategy for outpatient and diagnostic imaging services with clear links to the overall trust strategy. Risks were discussed at directorate meetings with clear actions and accountability to respond to them. Leaders were approachable and visible and were aware of the issues and risks affecting their service. Staff were well motivated and felt supported by their leaders. There was a patient centred and supportive staff culture. There were examples of where services sought continuous improvement and innovation.

Updated 15 September 2021