Healthwatch Rochdale & Healthwatch Oldham publish findings and recommendations after visit to Royal Oldham's postnatal ward

Local healthcare watchdog Healthwatch Rochdale has published a report with its findings and recommendations after carrying out an enter and view visit at Royal Oldham Hospital’s postnatal ward.

The visit – in partnership with Healthwatch Oldham – was unannounced, although the director of midwifery was notified the enter and view representatives – all clearly identifiable by ID badges and with DBS clearance – would be carrying out the enter and view and was given a two-week timeframe for the visit.

The postnatal ward was praised for being clean and tidy with face masks and “readily available” hand sanitiser.

Patients said they felt safe on the ward, which also uses a buzzer system to let people in and out, and staff wear identity name badges.

Healthwatch also praised the services for a new discharge lounge with dedicated midwife and patients said they felt their dietary needs were well catered for.

However, patients said the ward was noisy at nightime and weren’t happy with the discharge time. Information on posters, displays and leaflets was only available in English, and Healthwatch noted it was “not easy to locate the fire exits.”

There were also said to be “ongoing issues” about staff recruitment and retention and staff wellbeing.

Representatives observed the postnatal ward over a two-hour period on Wednesday 30 August, through the eyes of a patient and spoke with postnatal patients and staff members.

On the day of the visit, the ward was full and representatives spoke with 13 patients and 10 staff members. A further 10 staff declined to speak with the Healthwatch representatives.

Eleven of the patients described their time on the ward as ‘good’ or ‘very good’ with 10 saying communication with staff was ‘good’ or ‘very good’. Seven patients said the quality of care they and their baby had received was ‘very good’ and five said it was ‘good’.

Eleven patients told Healthwatch Rochdale they felt ‘very safe’ or ‘safe’ on the ward.

Healthwatch said “general observations” of staff “were not overly welcoming nor inviting towards us. There was a definite air of reluctance to engage with the team, with many declining or avoiding any eye contact.”

It added that the enter and view team was advised the ward was closed the previous night due to being full to capacity with other women diverted to an alternative location.

Common themes highlighted by staff who spoke to Healthwatch were safe staffing levels and staff retention, a lack of time to further upskill or develop training needs, a lack of senior management involvement and presence on ward, and not having enough time to fully support patients with all their caring responsibilities.

Healthwatch added the majority of staff said they enjoyed their job whilst the discharge midwife and lounge were “welcome addition to reduce work pressures and ensure a dedicated, consistent role” whilst the maternity support workers “had greatly helped the midwives with their roles and improve patient care.”

Healthwatch made six recommendations for improvements on the postnatal ward based on patients’ feedback, including discussing birth plans earlier in pregnancy as well as completing a backup plan in case of emergencies, monitoring noise levels on the ward with rules implemented around using devices, and translating information to be more readily available.

Healthwatch recommended for signage to be available in languages other than English as well as for an out-of-hours translation service to be available.

The final two recommendations included clearer exit signs and for staff to inform patients and visitors how to exit the ward, and for a workforce plan to be developed and implemented “for safety assurances” including a “commitment to staff wellbeing, recruitment and retention.”

A response has been received alongside an action plan from Royal Oldham Hospital management team within the required statutory time frame.

Kate Jones, Healthwatch Chief Executive Officer, said: “This was a great opportunity for a joint enter and view project working with our cross-boundary colleagues at Healthwatch Oldham.

“Key issues were highlighted and feedback given to senior staff on the ward on the day of the visit. A full comprehensive report followed. The provider’s response really highlights the impact our report has made to ensure different service delivery on the postnatal ward. The action plan will be tracked and reviewed to ensure a better service is provided to Oldham and Rochdale residents.”

Responding to the report, Faith Sheils, the director of midwifery, thanked Healthwatch Rochdale and Oldham for the visit, saying that some of the staff feedback had been “disappointing” with a personalised poster of each senior manager put up in all ward areas, encouraging staff to make contact should they need to chat or want additional support.

She said: “Families reported staff are kind, caring and approachable, unfortunately Healthwatch feedback didn’t correlate with families.

“Overall, there has been positive feedback from our families and some excellent feedback for our staff which makes me very proud of our team, and they should be very proud of their achievements. It is reassuring some staff expressed enjoying their roles, and important we can learn about how we can continue to develop and improve our services for the best possible outcomes for our families.

“The assistant director of midwifery was delighted to see the positive feedback from staff for the new discharge midwife role she has introduced, this is making families discharges timelier which responds to some family feedback within this report of delayed discharges.

“Following thematic data analysis, this role has recently been extended from 7.5 to 11 hours each day in response to reducing the length of stay for women and their babies.”

Addressing the staffing levels, Ms Sheils said anyone who wants to has the opportunity to shadow the assistant director of midwifery to “provide more insight to her accountability to families, the trust and staff” and that a a 24/7 bleep holder role had been “introduced 12 months ago.”

Ms Sheils also confirmed “further signage” would be explored for the exits, which have to be “staff release only to prevent tailgating and baby abduction risks” before adding: “It should be acknowledged it is challenging throughout the NHS to have paper signage on the walls and have this in all languages, especially given the diversity of populations we do serve.”

She also said “visible support for the toilet, hygiene and infant feeding” had increased from three maternity support workers per shift to four, which “should improve the call bell answering and support women.”

Of the BadgerNet system, an electronic maternity healthcare record system that patients can access, which Healthwatch says is only available in English, Ms Sheils said the system had been “settling in its development” but documents can be changed to patients' preferred language.

She added: “We are also in progress with a padlet of National resources information, this is being developed by our community engagement midwives. The digital midwife will ensure more visible instructions are sent out to women at booking about how to do this on their iPhone.

“We will link in with our digital lead midwives to see if there is a picture, we can upload into BadgerNet App and toggle in all languages, perhaps a ‘what to expect on the postnatal ward’ and engage postnatal ward staff to support the development of this.”

Ms Sheils concluded: “A lot of the women’s feedback was not relatable to the postnatal ward and they shared feedback about their antenatal birth plans, the assistant director of midwifery has added this feedback to an action tracker and will ensure its enacted upon with the appropriate leads for antenatal services.

“I do acknowledge the staffing challenges and this, as we know, is a UK national challenge for all trusts. What has been recognised for the postnatal staff is a ‘back to basics’ campaign to focus strengthening our maternity support worker roles which will then enable better delegation of some responsibilities, releasing midwives to focus on medications and women’s postnatal needs.

“Ongoing action tracker in response to the findings has been created.”

You can read the full report containing details of the findings, recommendations and the service provider’s response on the Healthwatch website, or if you require a hard copy or in an different format, please telephone 01706 249 575.

You can also find out more information on becoming an enter and view representative here.