We inspected Bridgnorth Midwife Led Unit (MLU) as part of a focussed inspection of Shrewsbury and Telford Hospital NHS Trust in November and December 2016. We visited the MLU unannounced on 1 November 2016.

We rated Bridgnorth Midwife Led Unit as good overall.

• There were systems in place to ensure the service was meeting the individual needs for women using the service. We found the service to be very responsive to the requirements of women using the service at all stages of the patient journey.
• The service provided a range of choices for women during labour, which included pain relief and hypnobirthing. Women told us they felt involved with decisions in their care and we saw women were supported emotionally throughout their pregnancy, birth and postnatally.
• We saw that staff were following good practice with infection prevention and control, the unit was clean and there had been no incidents of infections such as MRSA or CDiff during the reporting period.
• Staff were all aware of how to report incidents and were encouraged to do so. We saw that staff had opportunities to learn from incidents across the trust and that incidents were investigated appropriately.
• We saw that robust clinical governance and risk management arrangements were in place.
• Women and the family members we spoke with described positive care experiences. The results of the friends and family tests showed that over 97% of women who participated would recommend the service to their friends and family.
• Staff had access to and followed policies and procedures that were based on national guidance.
• The MLU was accredited with the UNICEF Baby Friendly Initiative (BFI). We saw that the unit promoted breastfeeding and the important health benefits of this for mother and baby.
• We saw that there were good systems in place to ensure good working relationships with other teams within the trust and with external organisations.
• We saw a positive culture within the MLU with strong leadership. Staff and women using the service were encouraged to provide feedback into how improvements could be made.

However:

• The MLU had experienced closure due to staff being required to support the consultant unit.

We saw areas of outstanding practice including:

• Staff at the MLU had participated in hypnobirthing training to provide women with further choice during their labour. However, there were also areas of poor practice where the trust needs to make improvements.

Professor Sir Mike Richards

Chief Inspector of Hospitals

The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital service for nearly half a million people in Shropshire, Telford & Wrekin and mid Wales. 90% of the area covered by the trust is rural. There are two main locations, the Royal Shrewsbury Hospital (RSH) in Shrewsbury and the Princess Royal Hospital (PRH) in Telford. . The trust also provides a number of services at Ludlow, Bridgnorth and Oswestry Community Hospitals.

The midwifery led unit (MLU) at Bridgnorth had 75 deliveries in 2013/14 and 26 delivers for the year to date as at the end of August. The unit has two labour rooms, one with a pool and a five bedded bay for antenatal and postnatal care. There was a shared toilet for women during their stay. The MLU accepted women who had been assessed as low risk and suitable to deliver their baby there.

We carried out this comprehensive inspection because the trust had been flagged as a potential risk on CQC’s Intelligent Monitoring system. The inspection took place between 14 and 16 October 2014 and an unannounced inspection on 27 October.

This maternity unit was rated as good although improvements in leadership were required.

Our key findings were as follows:

• Staff were caring and compassionate and treated patients with dignity and respect.
• The unit was visibly clean and well maintained. Infection control rates in the hospital were lower than those of other trusts.
• Patient’s experiences of care were good.
• The trust had recently opened the new Shropshire Women’s and Children’s Centre at the Princess Royal site. This had seen all consultant-led maternity services and in-patient paediatrics move across from the Royal Shrewsbury site. We found that this had had a positive impact on those services.
• The service provided at the unit was well defined and escalation processes were in place.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Develop a clear strategy and vision for this service which aligns its current structure.

There were also areas of practice where the trust should take action which include:

• The trust should ensure that the quality dashboard reports accurately reflect performance against targets and that the thresholds are clear.
• The trust must ensure that all staff are consistently reporting incidents and that they receive feedback on all incidents raised so that service development and learning can take place.
• The trust must ensure that staff are able to access mandatory training in all areas

Professor Sir Mike Richards

Chief Inspector of Hospitals