Stroud Maternity Hospital is one of the hospitals run by Gloucestershire Hospitals NHS Foundation Trust. It provides maternity services to the local community of Stroud and the surrounding areas. Maternity services are also provided at Gloucestershire Royal Hospital and Cheltenham General Hospital. The service is run by the same management team (within the women’s and children’s division) across the whole of Gloucestershire Hospital NHS Foundation Trust. and, as such, is largely regarded within the trust as one service. For this reason, some duplication within the three reports is inevitable.

Stroud Maternity Hospital is a stand-alone midwife-led unit with 10 beds and is located 11.5 miles from the main obstetric unit at the Gloucestershire Royal Hospital.

We inspected Gloucestershire Hospitals NHS Foundation Trust as part of our in-depth hospital inspection programme. The trust was selected as it was an example of a low-risk trust according to our new intelligent monitoring model. The inspection took place on 10–13 and 20 March 2015, and we visited this hospital on 12 March 2015.

Overall, this hospital was rated as good.

The trust’s services are managed through a divisional structure that covers all the hospitals within the trust, with some staff rotating between the three sites; therefore, there are significant similarities between the content of the three location reports.

Our key findings were as follows:

• There was a good culture of incident reporting, openness and learning.

• Whilst trust-wide staffing levels were worse than the England average, there were sufficient staff to meet patients’ needs, with one-to-one care provided to all women in labour at Stroud Maternity Hospital.

• Risks were managed well, including those around access to the maternity unit, and staff were trained to manage care in the event of an obstetric emergency.

• Infection control risks were not fully addressed, with no process in place to identify whether equipment had been cleaned and was ready for use.

• Medicines were not securely stored nor held within tamper-proof containers, and staff did not follow the trust’s policy on safe administration of medicines.

• Staff received training in safeguarding vulnerable adults and children and recognising abuse.

Systems were in place to identify women and babies at risk, including at risk of domestic violence.

The maternity unit employed a lead midwife in safeguarding as well as midwives specialising in substance misuse and teenage pregnancy. These were available for support and advice to midwives working in Stroud and the surrounding community.

• Care and treatment delivered was evidence based, with policies and guidelines developed in line with national guidance.

• A wide range of pain relief was available, including massage, essential oils and water.

• Family of origin questionnaires were completed to identify women at higher risk of sickle cell disease and thalassemia. The percentage of these women being screened at under 10 weeks’ gestation was not reported on the dashboard. However, two audits had identified only 33% of high risk women were completing the family of origin questionnaire, and therefore opportunities for early screening undertaken before 10 weeks’ gestation were missed.

• The transfer rates to the main obstetric-led unit were reported as marginally below the national average, at 24.6% compared with the national rate of 26.4% as reported in the Birthplace study.

• Care was seen to be delivered with kindness and compassion. Women were involved in decision making. Patients and their relatives had a good understanding of and described feeling involved in the care.

• Women were supported to make choices on where to have their babies. The service ran home births as well as births in the maternity unit.

• Translation services were provided by a telephone translation service. Leaflets were available in alternative languages, although these were not immediately available for midwives to give women but had to be ordered in.

• The service had a well-defined governance structure with a good connection to the board. Activity, quality and risk were monitored and reported on; however, actions to address risks were not recorded on the risk register. Specialist midwives were employed to support the governance function.

• Staff actively promoted the Mums Up and Mobile (MUM) project to promote normalityin labour and through supervision women were supported with their birth choices.

We saw several areas of outstanding practice including:

• Staff actively promoted the Mums Up and Mobile (MUM) project, which had also been presented nationally at midwifery conferences. Through supervision, women were supported with their birth choices.

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

Importantly, the trust should:

• Review the storage of emergency drugs to ensure they are accessible but safely stored, checked and tamper evident.

• Ensure all staff are trained in the safe storage, handling and administration of medicines.

• Ensure systems are in place so staff know when equipment has been cleaned and is ready for use.

• Review the processes to ensure early screening (pre 10 weeks’ gestation) can occur where the need is indicated.

• Review the timeliness of access to patient information in alternative languages.

Professor Sir Mike Richards, Chief Inspector of Hospitals