We inspected Oswestry Midwife Led Unit as part of a focused inspection of Shrewsbury and Telford Hospital NHS Trust in November and December 2016. We visited the unit unannounced on 1 November 2016.

We rated Oswestry Midwife Led Unit as good overall.

• Staff fully understood their professional responsibility to report incidents and concerns. No serious incidents had been reported between 01 November 2015 and 31 October 2016

• Patient records were stored securely and we saw they were up to date and legible.

• Care and treatment is delivered in line the current evidence based guidelines. Staff adhered to the trust Intrapartum Care on a MLU or Homebirth policy (June 2016), all trust wide policies and procedures were available to staff on the intranet.

• Effective systems of communication were established between the consultant led unit and the MLU, ensuring that effective care and treatment could be delivered.

• Women told us that they felt very well cared for and the staff were caring, thoughtful and compassionate

• A full review of the maternity service was ongoing, looking at different ways to improve the service with models of care being scoped by the trust

• Midwives were clear about their role and levels of accountability

Professor Sir Mike Richards

Chief Inspector of Hospitals

The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford and Wrekin, and mid Wales. Ninety per cent 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 Oswestry had 74 deliveries in 2013/14 and anticipated a slightly higher number for 2014/15 because of the new birthing pool. The unit has two labour rooms, one with a pool, and a five-bed bay for antenatal and postnatal care. There is a shared toilet for women during their stay. The MLU accepts women who have 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 visit 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.
• Patients’ 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 inpatient 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 to 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