New Cross Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Outcomes for women, birthing people and their babies were not always positive. The perinatal death rate was over 5% higher than the Mother and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK. group average. Reviews of mortality found themes that had no impact on the outcome but included failure to complete a partogram, to provide aspirin and failure in risk assessing. There were consistent delays in induction of labour whilst awaiting transfer from the induction unit to the delivery suite and poor compliance with some of the Saving Babies Lives Care Bundle V3 data. There had been 4 Newborn and Infant Physical Examination breeches. Data on emergency category 1 and category 2 caesarean section response time compliance showed that in the last 12 months, the timing of decision to delivery interval for grade 1 and 2 emergency lower segment caesarean section was only 73.75% within the 30-minute target grade for grade1 caesarean section and only 74.4% within the 75 minute target grade for grade 2 caesarean section. The service was not fully compliant with Saving Babies Lives Care Bundle requirements to provide Uterine Artery Doppler scans for women and birthing people identified at high risk of foetal growth restriction, however have since had the divergence closed.There was no process in place for translation of initial calls into triage. The requirement for an ultrasound scan the next working day for reduced foetal movements could not always be met due to capacity. However, the service generally did well with patients being put on the Sepsis 6 pathway, pain relief and most areas of effective foetal monitoring.There were comprehensive guidelines in place for induction of labour. Staff worked well together and had worked to build external relationships. Leaders completed National Perinatal Mortality Review tools which had multidisciplinary input. Regular audits took place, and leaders benchmarked the service against other local hospitals.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Women and birthing people gave examples of how staff assessed and adapted to their needs. Two women who were diabetic said they had been offered suitable dietary choices and staff asked to check their blood sugars before they ate. Another woman who had attended triage alone and had not expected to be admitted, said that staff had provided everything she needed to make her comfortable. However, a woman who had had a caesarean section stated there could have been more support from the ward staff after having the surgery to help her care for her baby as she could not move well. Feedback collated by the local Maternity and Neonatal Voices Partnership showed that women would have liked their partner to have been able to stay with them longer after giving birth. In the 2024 CQC Maternity survey, women rated partner length of stay 4.3 out of 10. This was ‘about the same’ compared with other trusts. Partner involvement during birth however was ‘somewhat worse than expected’.

Staff recorded the needs and preferences of women and birthing people on the electronic recording system. Staff spoke about a recent trial of a video translation app on wheels which they and women and birthing people found helpful. Staff told us 2 tablets with the app were going to be in place on the triage and foetal assessment units. Staff in triage told us there was no process in place for translation of initial calls to triage. They said if they felt the person was not able to fully understand the call, they would be invited in for further assessment. Staff told us antenatal clinics were tailored to individual needs, including those for vulnerable women with social and mental health needs, diabetics, twin pregnancies, and women and birthing people with other medical needs, such as inflammatory bowel disease. There was no longer a specialist female genital mutilation (FGM) clinic, as rates of women presenting with FGM had fallen in recent times. Leaders said there were named midwives for migrant women living in hotels in the city. A staff member said that there was limited access to hot food in the Maternity building for partners, or women and birthing people outside of meals provided on the wards.

There was an interpreting and communication policy that was comprehensive and up to date. Women on a low income were able to access free bus travel via a quick response code and could also claim back some other transport costs.

Women and birthing people were mainly positive regarding delivery of evidence-based care and treatment. Feedback shared in the October 2024 Matrons report stated that staff performed the required observations in triage, read the woman’s notes and ensured she got the water birth she requested. A student midwife also monitored the baby’s heart rate throughout the birth. However, a service user story collated by the local Maternity and Neonatal Voices Partnership suggested that they were given some conflicting advice by different staff members.

Doctors said they could access guidelines and pathways on the trust intranet, and they were confident there were checks, balances and guidelines in place. Staff spoke positively about the prioritisation system for triage being built into the electronic patient record. Staff told us that while the pathway for reduced foetal movements (RFM) followed Saving Babies Lives Care Bundle guidance, the requirement for an ultrasound scan the next working day for women presenting with recurrent RFM could not always be met due to capacity. The results of a retrospective audit of scan appointments between June and September 2024 confirmed this, showing occasions where women waited up to 10 days. Staff told us that a log of maternity scans unable to be completed was escalated to radiology to see if there was capacity there. Staff added that the guidelines for foetal growth restriction had recently been updated to ensure compliance with the Saving Babies Lives Care Bundle.

We reviewed the triage process against Royal College of Obstetricians and Gynaecologists Good Practice Paper No. 17. On the day of assessment, telephone calls were taken by a midwife whose assigned role was telephone triage in a dedicated room away from the clinical area in line with recommendations. However, data from the latest intrapartum matron report from August 2024 showed that there was only a third midwife to take calls at peak hours (10am-8pm) 47% of the time, a drop from 67% and 81% in July and June 2024 respectively. When a dedicated midwife was not available to triage calls, or when this phoneline was busy, waiting calls were redirected to the main staff base which was also distinct from the clinical area. Details of the calls were recorded on electronic patient records, and prompts would appear on the system if a caller had called within the previous 24 hours. We saw a clear system of 8 criteria which warranted attendance including RFM, bleeding and spontaneous rupture of membranes. Time of arrival, time of initial assessment as well as RAG risk rating were displayed on a board in the staff base room. There were comprehensive guidelines in place for the induction of labour. According to a trust paper from October 2024, 2 guidelines needed to be updated before they were fully compliant with National Institute of Clinical Excellence guidelines. Post-dates induction was offered from term + 7 days. There was a thorough guideline in place for water birth. At the time of the assessment the service was not fully compliant with Saving Babies Lives Care Bundle requirements to provide Uterine Artery Doppler (UtAD) scans for women identified at high risk of foetal growth restriction. This was on the service risk register and there was evidence of stakeholder oversight. ‘Superusers’ had been identified to provide training to sonography staff in performing UtAD scans, and we were told the service were on course to offer them from December 2024.

6 women missed first trimester screening in September 2024 due to a lack of scan capacity. 28 women did not receive nuchal translucency screening for Down Syndrome between January and August 2024 due to capacity and were offered Quadruple screening instead.

Women and birthing people stated staff worked well together. Several women mentioned that both the day and night teams knew about their care, and that information was consistently handed over between the staff. We noted on the National Perinatal Mortality Review tools reviewed, parents' perspective of their care and the care of the baby were collated and recorded.

Staff spoke positively about teamwork in the service. A doctor commented that the service was not hierarchical, and people worked well together. The lead for Equality, Diversity and Inclusion (EDI) spoke about how they worked not only with teams in the trust such as the vulnerable women’s team, but also with EDI leads in other trusts to share ideas and good practice. They told us they recently made a connection with a local African and Caribbean community initiative and hoped this was the start of a new working relationship. Results from the trust’s latest staff survey showed that staff in women’s and neonatal services rates ‘We are a team’ 6.39 out of 10, slightly below the overall trust score.

Partners felt the trust was transparent, open to challenge, provided them with relevant information, and had a collaborative approach to working. Partners described joint workstreams around quality and safety and described a definite difference in approach since senior leaders took part in the national perinatal culture program. Communication from the trust was described as “forthcoming” with no attempt to hide or not share things, and projects with partners were becoming more co-designed, with partner input from the start. When asked if the trust shared information and if they were open to ideas, partners described the trust as being open to ideas and receptive to challenge. They said women and birthing people felt listened to when sharing experiences. A partner said that recently the feeding support was described as “hit and miss” when there was not a breastfeeding support worker or volunteer on duty, but said they felt comfortable approaching the service about this. Partners described other joint workstreams around quality and safety and described a definite difference in approach since senior leaders took part in the national perinatal culture programme, describing a unified team who wants to move the service forward. They also offered positive feedback from an equality and diversity perspective, where a transgender couple felt they had a really good experience and were not treated any differently to other couples.

We observed handovers between day and night staff and found staff discussed women and birthing people individually and commented on relevant test results, medication, pain relief given, cardiotocography results where applicable and which women required a medical review.

We reviewed examples of the National Perinatal Mortality Review Tool and saw there was multidisciplinary team involvement in the reviews. There was a transitional care pathway which detailed policy on areas such as transitional care admission criteria from birth on the labour ward or midwifery led unit and readmissions from the community following discharge home. There was also an information sharing policy available for staff which included information on the legal context for sharing information. The hospital was also part of the Black Country Local Maternity and Neonatal System, a partnership to work together to improve maternity and neonatal systems.

Women gave examples of how their health had been supported and promoted including being given advice on smoking cessation, diet, and vitamins as well as provision of vitamins for those on a low income.

Staff were aware of some of the challenges faced by their population such as deprivation and language barriers. The Equality, Diversity and Inclusion lead spoke to us about classes they ran in multiple languages, which covered topics such as what to pack in hospital bags and safe sleeping with visual cues, and healthy eating in a way which encompassed non-western diets. They told us they also featured on Asian radio and TV channels, covering topics such as vaccination and mental health. They told us that they also ran a support group for Lesbian, Gay, Bisexual and Transgender+ parents which people travelled to from outside of the Wolverhampton area.

There was an infant feeding guideline in place. This guideline set out areas such as safety considerations for skin-to-skin contact, support for breastfeeding, and recommendations for health professionals on discussing bed sharing with parents. Health pregnancy service metrics were recorded including smokers and the number of onward referrals made. The trust had been involved in a healthy pregnancy evening initiative where the public could meet midwives, health visitors and healthy pregnancy advisors. We also saw posters in relation to a pregnancy and postnatal support group where women could connect with fellow pregnant people and new parents, receive infant feeding support and receive healthy lifestyle management. NHS healthy start leaflets were in place for staff to give to parents. Maternity dashboards contained details on reducing smoking in pregnancy. This was red, amber, green rated. Green rated areas included carbon monoxide measurement and smoking status recorded at booking appointment, percentage of smokers where CO measurements were recorded at all antenatal appointments and data quality rating on national maternity dashboard for women who currently smoked on booking appointment. Areas where improvement was needed (April 2024 to September 2024) included smoking status recorded at 36-week appointment, percentage of smokers that were referred to tobacco dependence treatment and percentage of smokers at antenatal booking who were identified as CO verified non-smokers at 36 weeks.

Most of the women and birthing people we spoke with during the assessment were satisfied with the outcomes of their care. Feedback shared in the October 2024 matrons report stated that every member of staff encountered “made the whole process as stress free as possible and memorable” for the woman. Another woman “could see how busy the areas were but that when she asked for help, support and advice she was attended to quickly, and everyone made her feel special.”

Most staff were aware of audits and quality improvement projects happening in their areas of work including infection prevention and control, environmental and bed cleaning audits. A senior leader discussed a staff forum where staff members could present audit results and outcomes.

The service benchmarked itself against other hospitals on an NHS England regional maternity heatmap and through the Black Country Local Maternity and Neonatal System. The postnatal service postnatal health and safety podium report (October 2024) showed an overall score of Gold. This meant the ward held all the required mandatory risk assessments that the health and safety team looked for. The service collected data to use to improve outcomes for people; there was an audit programme in place.

Outcomes for women, birthing people and their babies were not always positive. NHS England heat map data October 2024 showed the service scored well in areas such as overall score and unfilled roles, but worse in perinatal death rate which was over 5% higher than the MBBRACE-UK group average. Reviews of cases found some themes which included failure to complete partogram , failure to provide aspirin and failure in risk assessing patients, although it was recorded the issues identified would have had no impact on the outcome. We found delayed induction of labour whilst awaiting transfer from the maternity induction unit to the delivery suite occurred 41 times in September (82%) and 65 times in October (92%). Data on emergency category 1 and category 2 caesarean section response time compliance showed that in the last 12 months, the timing of decision to delivery interval for grade 1 and 2 emergency lower segment caesarean section was only 73.75% within the 30-minute target grade for grade1 caesarean section and only 74.4% within the 75 minute target grade for grade 2 caesarean section. Saving babies lives data showed poor compliance in several areas, action plans were in place. There had been 4 Newborn and Infant Physical Examination breaches between August and October 2024, each occasion noted the reasons for the delayed screen were due to staffing reasons. However, Modified Early Warning Obstetric Score audits showed good compliance rates and patients were put on the sepsis 6 pathway. The department did well in relation to pain relief and most areas of effective foetal monitoring. They were also maintaining a consistent level of Fresh Eyes reviews over the minimum target of 80% as of September 2024.

Women and birthing people said staff asked for their verbal consent before examining them. A woman undergoing induction of labour told us the whole process was fully explained to her before she consented, and another woman who had a caesarean section agreed the procedure was fully explained before she consented. Results from the 2024 CQC Maternity Survey showed that women and birthing people rated having the opportunity to ask questions and involvement in decisions ‘about the same’ as service users from other trusts.

Staff told us they always asked for consent before carrying out observations and procedures. A staff member who spoke Punjabi and Hindi said they spoke to women and birthing people to ensure they fully understand their procedure before consenting. They told us staff also used telephone interpreters when service users’ understanding of English was limited.

The trust wide consent audit was paused during the COVID-19 period. The previous audit results were last reported in May 2023 to the trust consent group and September 2023 Quality Safety Assurance Group. The trust consent lead had recently changed, and the newly appointed lead planned to review the consent audit tool and frequency going forward. There had been no incidents or claims within the maternity unit relating to consent over the last 12 months. There was a consent to treatment and investigation policy.