North Bristol NHS Trust is an acute trust located in Bristol that provides hospital and community services to a population of about 900,000 people in Bristol, South Gloucestershire and North Somerset. It also provides specialist services such as neurosciences, renal, trauma and plastics/burns to people from across the South West and in some instances nationally or internationally. The trust has five main locations that are registered with the Care Quality Commission. It provides healthcare from Southmead Hospital, Cossham Hospital, the Frenchay Hospital site, the  Riverside Unit and Eastgate House. The main hospital at Frenchay closed in May 2014 when the new hospital at Southmead opened. The trust also provides community healthcare for children and young people across Bristol and South Gloucestershire. Cossham Hospital consists of a midwife-led birth centre, which had 556 deliveries between January 2013 and March 2014, and an outpatients department, which provided 19,603 appointments in 2013/14.   Overall we have rated Cossham Hospital as good. Services in all the areas we inspected were good, and caring and responsiveness in the maternity service was outstanding.  Our key findings were as follows:

• Staff were clear about the processes for reporting incidents, received feedback and learning was shared.
• The hospital was clean, tidy and well maintained. Staff were seen to be bare below the elbow in line with trust policy and washed their hands before and after carrying out patient care.
• Access and uptake of both mandatory training and further training was good. In addition, training in obstetrics and neonatal emergencies was extended to the wider team, including paramedics and community midwives.
• Staffing in outpatients and diagnostic imaging was good. Although staffing in the maternity service was clearly meeting patients’ needs, the ratio of midwives to births was only recorded at overall trust level. This showed a midwife-to-birth ratio of 1:33.9, which was below the England average of 1:29.
• Staff provided care and treatment based on national guidelines such as those produced by the National Institute for Health and Care Excellence.
• In the maternity service, patient outcome data was recorded and fed back to staff on a monthly basis, enabling staff to review and if necessary take action to improve practice.  
• Staff were caring and provided kind and compassionate care. In the maternity service this extended to the whole family and women with complex needs were embraced into the service.
• In outpatients, referral to treatment times were consistently met.
• In the maternity services were tailored to meet the needs of the individual woman and her family, and were delivered in a way to ensure flexibility, choice and continuity of care.
• Services were well led. Staff were positive about the leadership and management of the maternity service. Governance systems were embedded.

  We saw several areas of outstanding practice including:

• Half-day training sessions were run for all trust staff (midwifery and medical) as well as paramedics from the local ambulance service. These were in addition to the annual updates provided.
• Facilities for women in labour were outstanding, and promoted the use of water for both pain relief and delivery and care, in a calming and relaxing environment for normal births.
• The kindness, compassion and holistic approach to care at the birth centre was found to be outstanding, with strong person-centred care and support clear to see.
• There was very clear evidence of learning from incidents, complaints and concerns. Actions were taken and learning was shared both internally and across the wider maternity service.
• Efforts to engage hard-to-reach members of the community and overall public engagement were outstanding. Strong networks existed and staff used a wide variety of methods to encourage and promote public engagement.

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

 The trust should:

• undertake a staffing review and report on staffing at the Cossham Birth Centre separately from the main unit at Southmead to ensure that the midwife-to-births ratio is within the limits set by the Royal College of Obstetricians and Gynaecologists and that one-to-one care in labour is provided 100% of the time
• review the number of supervisors of midwives to ensure a supervisor-to-midwives ratio of 1:15 is met
• ensure that the availability of a chaperone is displayed for patients in the outpatients and diagnostic and imaging departments.

Professor Sir Mike Richards

 Chief Inspector of Hospitals

We visited the birth centre, the satellite renal dialysis unit, the X-ray, outpatients and physiotherapy departments. We spoke with new mothers, patients and staff in all departments. We were able to speak with approximately 30 patients and 25 staff members.

The overwhelming response we received from both of the new mothers, patients and their families that we spoke with, was that they were satisfied with the care treatment and support provided. “Fantastic experience (birth centre)”, “Being able to come here rather than go to Southmead for dialysis is easier as I live nearby”, “The facilities in the outpatients department are so much more pleasant here, light, airy and modern” and “I have received excellent care. I always see the same physiotherapist so have received a consistent service”.

We checked to see that patients were treated respectfully and were involved in making decisions about their care and received the care and treatment they expected. We also looked at how the Trust communicated with other healthcare professionals involved in a patients care, and how they ensured that patients were safeguarded from infections. We checked that the staffing levels in each of the departments were appropriate.