Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service provided safe care for mothers and babies. The service had embedded a learning culture and showed how things had changed following feedback and incidents. The service had a full multi-disciplinary team in place that worked together to ensure patients had holistic treatment plans and risk assessments in place. The environment was safe, welcoming, and clean. Medicines were stored, administered, and audited well.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients attended regular community meetings, where patient feedback was collected. The service had a “you said, we did” notice board.

We saw evidence of embedded learning culture. Staff we spoke with described a variety of ways in which they stayed informed and looked at learning following feedback from patients and incidents. The inpatient and community perinatal team had regular professional development sessions where specific issues and experience were shared.

The team identified lead roles to ensure sharing of good practice. Staff had developed a process for debriefs for patients discharged from the unit to examine their potentially negative experiences. Managers completed a weekly notes audit to ensure all documentation was completed.

We spoke with 2 patients. One said, she “dreaded the thought of having to explain her situation over and over when being admitted to the ward”. However, she said “it didn’t happen, and that staff talk to one another, and they all care enough to check in to see how I am doing”. Patients were given comprehensive admission packs for both mothers and fathers.

We saw staff from other specialities regularly attended the ward and the community team, including mental health midwives and health visitors. We were told there was a dedicated fathers’ representative who wherever possible contacted fathers before their partners admission and maintained regular contact and supported them to be involved in ward rounds.

We spoke to partners including a health visitor, social worker and midwives who attended the service to support patients. They told us communication from the service was excellent. The service involved partners from the acute services, police and health visiting team where appropriate. Partners told us care was integrated between teams.

The service had processes set up to allow partnership working, for example with the acute hospital, police, safeguarding, inpatient, and adult social services. The service also sees women who are at serious risk of a mental illness and who are planning pregnancy to ensure appropriate support is in place. The community service had a waiting list in place which clearly showed how long patients were waiting for treatment and recorded regular waiting well call dates. Each patient on this waiting list received a call to ensure they were safe and determine if they required urgent treatment.

We spoke with 2 patients, both said they felt very safe on the ward. They were fully involved to develop their care plan and discussed any risks.

We spoke with 9 members of staff on the inpatient ward and in the community team; all were able to demonstrate how they would identify and raise a safeguarding issue. They also told us how they would support the patient throughout the process.

We saw one example where a patient had been referred to safeguarding. All aspects of the patient and the wider family were considered, and the patient was supported throughout the process.

The trust had a safeguarding policy in place, we saw a notice board which was dedicated to safeguarding and the teams had identified safeguarding leads.

We spoke with 2 patients they said there were plentiful and varied meaningful activities on the ward which kept them busy and reduced the likelihood of risky behaviour. They told us the activities were all baby and mum focused, for example baby hand and footprints and self-soothing boxes. One patient told us staff had supported them to complete the risk assessment form however the patient found this distressing, so staff now go through risks with the patient and fill the form in without them being present.

Staff we spoke with said patients are nursed in the least restrictive way possible to enable them to recreate home life as much as is safely possible. Examples of this were 24-hour access to the ward kitchen, open access to the laundry and garden following a comprehensive risk assessment completed with the patient.

We looked at 5 care records across both areas, all were fully comprehensive and had updated risk assessments in place. The records showed patient involvement. We saw use of video interaction guidance which is endorsed by The National Institute for Health and Care Excellence (NICE) and aims to help enhance the patient’s relationship with their baby and focuses on tuning in, empathising and considering overall wellbeing. The service held daily multidisciplinary meetings where risks and safeguarding incidents were discussed.

We spoke with 2 patients who both said the environment was lovely and homely and they felt safe on the ward. They told us that the choice of rooms was excellent and said they could access them whenever they needed to. The spaces available, were a quiet room, a sensory room, nursery, garden, large kitchen, ensuite bedrooms and a large communal living and dining area where activities were undertaken.

Staff we spoke with said they ate with patients in the communal dining room. They said they worked with patients to be as least restrictive as possible. They told us they were very proud of the environment and worked hard to raise funds to purchase items to enhance the environment and experience for patients and staff alike.

The mother and baby unit was warm, welcoming and had excellent facilities for both mothers, fathers and their babies. Patients were seen in outpatients on the hospital site. The consultation rooms were purpose built, had appropriate vision panels. Staff had access to emergency alarms.

A full ligature risk assessment was in place which included both the ward and outpatient areas. Cleaning schedules and audits had been completed and were displayed in the communal area.

We spoke with 2 patients; both said the staffing levels on the ward were very good. They said staff were always available and approachable and felt that they really cared. They told us that the mix of roles within the team was very good.

Staff told us staffing levels on the inpatient unit was 4 in the morning and afternoon and 3 at night and these were always met. Leaders told us the multi-disciplinary team on the inpatient unit included nurses, doctors, occupational therapist, psychologist, activity coordinator, nursery nurses, health visiting, midwife liaison and a wellbeing worker who was funded from charitable funds for both staff and patients. The community perinatal team consisted of a range of professionals which included community nurses, doctors, social worker, art psychotherapist, mother and infant therapist, peer support workers, cognitive behaviour therapist, nursery nurses, pharmacist, occupational therapist and nurse associates. Staff told us they received monthly supervisions.

We saw positive interactions between staff and mothers, babies and families. We looked at staffing rotas for the last 3 months and saw staffing levels had been fully achieved. We saw examples of sessions offered by the team included head and hand massage, reflexology, and yoga.

There was a process in place to involve patients in staff recruitment. The service had an active recruitment plan in place. At the time of the onsite assessment the mother and baby unit had 1 health care assistant vacancy, and 1 clinical psychologist vacancy. The community team had a half whole time equivalent social worker vacancy and 2 peer support work vacancies. However, we did not see any impact on the care and treatment patients received due to the vacancies in place.

Patients we spoke with said the ward was “spotless” and “the housekeeping staff were brilliant”.

Staff told us toys were cleaned daily and, plastic plants were also regularly cleaned, we saw a record of this.

We saw staff adhered to infection control practices. We saw each patient had their own cupboard in which they kept baby formula, bottle, utensils etc. This was to avoid cross contamination.

Cleaning schedules and audits were completed, and the results were displayed in the communal living area. These showed cleaning compliance was always met.

Patients we spoke with told us they had access to specific medicines information leaflets in their welcome pack. They said the pharmacist visited the ward and was available to speak to.

Staff told us the ward was in the process of transferring to an electronic prescribing system, but this had yet to be completed.

We saw all medicines were stored appropriately. Staff completed temperature checks of the clinic room and the medicines fridge.

There was a medicines administration policy in place. We reviewed medication administration records, and these had been completed as expected.