Alnwick 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 community in patient and urgent care services as part of our comprehensive inspection of community services at this trust; these services are reported within separate inspection reports. This report specifically relates to 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 Alnwick 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, Wansbeck General Hospital, Hexham General Hospital, and community services. We inspected maternity services at Alnwick Infirmary on 11 November 2015.

Overall, we rated maternity and gynaecology services as good, with well-led rated as requires improvement.

Our key findings were as follows:

• There were no cases of hospital-acquired Methicillin-Resistant Staphylococcus Aureus (MRSA) or Clostridium difficile (C. difficile) in 2014/15 at this hospital.
• The hospital had infection prevention and control policies in place, which were accessible, understood and used by staff.
• Patients received care in a clean, hygienic and suitably maintained environment.
• There were cleaning schedules in place across all wards and departments which were fully completed in line with cleaning requirements and the trust’s policy.
• There was adequate personal protective equipment (PPE) such as aprons and masks available to staff. We routinely saw staff using this equipment during our inspection.
• There were sufficient staffing levels to meet the needs of women. There was a ratio of midwives to births of 1:3, this was better than the ROCG guideline of 1:28.
• There was no medical staff based at this maternity unit, however a consultant led clinic was held fortnightly for women with a high risk pregnancy.
• There was a robust midwifery led care policy, which identified the criteria for women being able to deliver within the unit and at home.
• Women were provided with tea and toast following delivery. There was no formal food service due to the nature of the unit and small number of births.
• Staff interacted with women in a respectful way. Women were involved in their birth plans and had a named midwife.
• Women received an assessment of their needs at their first appointment with a midwife. The midwifery package included all antenatal appointments with midwives, ultrasound scans and all routine blood tests as necessary. The midwives were available, on call, 24 hours a day for births as needed.

There were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Complete a comprehensive gap analysis against the recommendation made for the University Hospitals of Morecambe Bay NHS Foundation Trust.
• Ensure that the maternity and gynaecology dashboard is fit for purpose, robust and open to scrutiny.

In addition the trust should:

• The trust should ensure that the clinical strategy for maternity and gynaecology services which is embedded within the Emergency Surgery and Elective Care Annual Plan, sets out the priorities for the service with full details about how the service is to achieve its priorities, so that staff understand their role in achieving those priorities.

• Ensure that delivery rooms are fully inspected following delivery and ensure that homeopathic remedies are removed and destroyed or returned to the patient.

• Ensure that record keeping is consistent across and within maternity services at this hospital.
• Consider a formal programme of staff rotation to provide assurance of clinical competence.

• Ensure that the storage and collection of placentas at this hospital is consistent with other hospitals within the trust.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We spoke with 13 patients about the care and treatment they received. Comments about the care included, “I’m being looked after well. I’ve got sugar diabetes so they’re keeping a close eye on me," “They look after me properly, it’s like a hotel” and “I’ve always thought it’s marvellous. They look after me very well.”

In addition we talked with three relatives and a visitor to find out their thoughts. The visitor commented, “They look after her very well” and the relatives all agreed that the care was “very good.”

However on the day of our visit, 5 patients from the 13 we spoke with considered that they were not fully included in discussions about their care and treatment. One said, “They don’t involve me with what’s going on. It would be nice to have more information. There were negative comments too about the staffing levels. Five patients commented that there weren’t enough staff to attend to their immediate needs. However we did not see evidence of this. We noticed that call bells were answered promptly and that patients were supported with their care needs.

Patients told us that they felt safe on the ward. Staff knew about the different types of abuse and were able to explain the processes for following up any safeguarding issues.

A number of patients said they did not know how to make a complaint. Although the complaints procedure was not clearly displayed on the ward, we did notice it was beside each patient’s bedside.