- NHS hospital
Harrogate District Hospital
Report from 1 May 2025 assessment
Ratings - Maternity
Our view of the service
Harrogate District Hospital maternity service on-site assessment took place from the 22-24 July 2025. The responsive maternity assessment included all 34 quality statements. At this assessment the service was rated good overall.
The maternity service was previously assessed on the 15 November 2022. This assessment was part of the national-review-maternity-services-England-2022-2024 where 131 maternity services were inspected in the safe and well led domains. Harrogate maternity service was one of these services and was rated safe as requires improvement and well led as good. Actions were identified for the maternity service following this inspection.
At this inspection we have rated safe as good.
Leaders and senior managers supported the service and escalation processes were in place. Support was provided by the on-call midwife out of hours. Staff could access specific policies, guidelines and escalation pathways for the MAC, sepsis and deteriorating patient.
The service had a proactive and positive culture of safety, based on openness and honesty. Safety events were investigated thoroughly, and lessons were learnt and actions and learning shared with the multi-disciplinary team. Robust safeguarding arrangements and effective communication existed with the multi-disciplinary team and external partners.
The service reviewed its midwifery skill mix and staffing levels which included plans to increase midwifery staffing for all grades and recruitment was ongoing. Specialist midwives at bands 6, 7 and 8a supported the service.
Midwife to birth ratio compliance was 99.2%-100% from July 2024–June 2025.
Since the last assessment the service has improved staff appraisal rates, commenced simulation training and improved on some mandatory training topics compliance. We looked at how mandatory training, safeguarding and resuscitation training figures had improved following the last CQC assessment. We saw some improvements in these areas; however, not all staff groups had achieved above 90% - which was the trusts training target. Most training categories compliance levels were from 73%-100%.
The maternity service environment was visibly clean and mostly well maintained.
The service had updated 136 of 155 policies, procedures and guidelines. The June 2025 strengthening maternity and neonatal safety report confirmed 28 or 18.1% of local guidelines were overdue for review.
An increase in staff satisfaction was identified through the maternity impulse survey (July 2025) which confirmed 85% of staff said they would recommend it as a place to work; this had increased from 56% in the 2024 survey. Monitoring was in place for actions identified from this survey.
However:
The 2022 CQC report identified no clear system in place to identify and prioritise risks to women in the Maternity assessment centre (MAC). Since the 2022 assessment the maternity service had implemented a triage system, however at this inspection we found people could be harmed as there was no oversight of time to medical staff review to inform obstetric staffing and deterioration and risk processes were not all completed and documented.
Some infection prevention and control (IPC) practices required review, and the IPC audits showed some shortfalls in practice.
Some equipment required maintenance.
There were some shortfalls within systems for example, record storage, records completion, quality audits and the completion of personalised risk assessments.
A review of patients notes identified an inconsistent approach to recording MEOWS which included MEOWS having not been completed, scored and escalated. We could not identify the recording of babies Newborn Early Warning Trigger and Track (NEWTT) and modified early obstetric warning systems (MEOWS) in all charts. Three actions were identified from the MEOWS audit (January – June 2025). One action was for MEOWS to be added to the audit plan to provide assurance of practice. Two key successes observed by the audit confirmed 80% of elevated EWS were escalated within PatienTrack through the automated system and 98% of alerts were marked as ‘followed up’. Key concerns identified 47% of observations were taken ‘on-time’ and 19% of observations were ‘late’ or ‘missed’.
Room, fridge and freezer temperatures where medicines were stored were monitored however, we saw inconsistencies on how these were done.
Missed dose audits had not always been completed.
The resuscitation trolley served three clinical areas which had a trust risk assessment in place. Records were not being completed appropriately, and we found emergency resuscitation medicines that had expired. The team had promptly organised for their replacement.
We found some breaches against regulations: 12 Safe Care and Treatment
People's experience of this service
We spoke with 7 women which included 3 couples who were using and / or had used the service. Women said they had generally had good experiences using the service. On discharge women said their care transitioned to the health visiting team following the support from their midwifery team. Women felt listened to, were not pressured and were encouraged to participate in agreeing their birth plan from their initial antenatal contact with the trust to their post-partum period.
Staff were described as respectful and assisted them with additional support such as massages if wanted. One woman said they ‘could not sing praises enough of their midwives, they were offered a massage, and they felt very peaceful at home with their husband.’
Women said call bells were answered quickly, the environment was visibly clean, although did look tired in places. Women said staff took infection prevention and control precautions such as gelling their hands before and after consultations.
Women confirmed they had a selection of food and also could choose to have food bought in from home. Women could access drinks when needed.
Staff responded quickly when able and gave explanations if the response was initially delayed.
When asked about pain management the women we spoke with said they felt their pain had been managed well in both hospital and community settings.
Not all women knew about the patient survey, how to access spiritual support or how to complain if needed.
Confidentiality was identified as an area which required development in inpatient bay areas, women recognised that private conversations could be heard by others in the bay.