The Fetal Medicine Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant the service was well managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had a shared vision, strategy and culture that focused on delivering high-quality fetal medicine services and ensuring positive outcomes and experiences for women using the service. The service's not-for-profit ethos also reinforced its commitment to education, research and improving fetal medicine practice globally. Leaders and staff consistently described a commitment to maintaining a high standard of care, supported through specialist training and expert clinical oversight.

There was a culture where people were treated with dignity, respect and compassion. Feedback from patients was overwhelmingly positive and reflected a caring and supportive service culture. Staff described the organisation as friendly and helpful and said they felt valued and cared about by managers. During our inspection we observed positive interactions between staff and patients and a calm and welcoming environment that supported patients throughout their care journey.

Leaders recognised areas where further development was needed, including increasing the visibility of their fetal medicine services and maintaining records to a consistently high standard. This provided assurance that there was a willingness to reflect on service performance and consider future opportunities for improvement while maintaining a clear focus on providing safe and effective care.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively.

The provider had capable and experienced leaders who were knowledgeable about the service and demonstrated a commitment to delivering safe, high-quality care. Staff and clinical fellows described leaders as highly knowledgeable and supportive and valued the opportunities provided to learn from experts in the field.

Leaders were visible and approachable. Leaders told us they operated an open-door policy. All staff told us managers were supportive and available when required. They described positive relationships with managers and said they felt respected and valued in their role. Staff also reported that leaders listened to concerns and created an environment where they felt comfortable discussing issues affecting the service.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider’s staff whistleblowing policy and procedure provided guidance around raising concerns, although this was 6 months overdue for review. Staff and leaders told us there was an open culture where staff were able to raise concerns and discuss issues affecting the quality and safety of the service. Staff told us they were comfortable raising concerns and believed they would be listened to and supported.

Leaders encouraged open communication through regular discussions, meetings and appraisal processes. Meeting minutes we reviewed showed staff were invited to raise concerns or suggest topics for discussion, although none were raised. Staff described the working environment as informal and approachable, which supported opportunities to raise questions, share concerns and discuss service improvements.

Patients had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from people and staff and used it to make improvements.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The provider had arrangements to support equality, diversity and inclusion within its workforce and to meet the individual needs of staff and people using the service. Staff described a positive and inclusive working environment where people were treated equally and respectfully. Staff told us they felt all staff were treated fairly and that supportive working relationships existed across teams.

The service employed staff from a range of backgrounds and supported specialist training opportunities for clinical fellows from different countries. The provider's focus on education, research and development contributed to an inclusive learning culture and enabled staff to access specialist expertise and development opportunities.

The service had an equal opportunities policy in place which aimed to ensure that applicants and employees did not receive less favourable treatment on the grounds of any protected characteristic. There was also an equality, diversity and inclusion policy which supported equal access to care for patients and employment for patients and staff.

The service had governance and risk management systems in place and used these to oversee quality, performance and service delivery. However, governance arrangements were not always sufficiently embedded, with inconsistent staff awareness of key risks and weaknesses in the formal review and documentation of risk information.

Risks were identified, recorded and managed through established governance processes. Leaders maintained a risk register and monitored key risks relating to employment checks, information governance and service delivery. Staff understood how to report incidents, hazards and concerns, and managers had oversight of complaints, incidents and safeguarding matters. There was a business continuity policy which highlighted key hazards and mitigations. We also found evidence of clear escalation processes and appropriate management of risks when issues arose. However, staff were not always clear on the risks within the service. Not all staff and managers we spoke with were able to explain the main risks facing the service or describe how these were being monitored and mitigated through governance arrangements.

The provider used information to support service improvement and sustainability. Leaders reviewed service performance, delays and operational pressures and implemented measures to improve patient flow. The service had a local risk register covering a range of risks, including failure to escalate abnormal ultrasound findings and risks related to equipment failure. The risk register included actions to mitigate these risks. However, it did not clearly document when risks were first identified, when they were reviewed, or the outcomes of those reviews. Staff also told us risks were not routinely discussed in governance or staff meetings. Following the inspection, we reviewed the provider’s updated risk register which included review dates and scheduled the risks for discussion at the next governance meeting. However, routine review of the risk register at governance meetings had not yet been embedded in practice.

The provider had governance systems and processes that supported the delivery of safe and effective care. Leaders monitored quality through audits, staff meetings, appraisals and performance reviews. Staff meetings were held every 3 months; however, these did not include clinical staff. This reduced assurance that clinical learning, risks and service developments were consistently discussed with the wider clinical team. However, managers shared learning and key updates through email correspondence and direct feedback with relevant staff. We were provided with minutes from these meetings which included incidents and health and safety. The management team met every 6 months to review service development, and governance arrangements such as audit results and policy reviews.

Governance systems were in place, but they were not always sufficiently embedded to provide consistent assurance. Risk information was not routinely reviewed or discussed in governance meetings, and staff awareness of key risks was variable.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The provider worked effectively with external partners to ensure patients received coordinated and timely care. Staff communicated with obstetricians, maternity services and other healthcare professionals to support continuity of care. Patient records demonstrated effective referral pathways and evidence that scan findings informed ongoing clinical management and follow-up arrangements.

The service had established partnerships with external healthcare organisations, laboratories and specialist providers. Leaders described collaborative working arrangements with tertiary fetal medicine services and external consultants, which supported clinical decision-making, quality assurance and specialist training. These relationships enhanced access to expertise and helped maintain high standards of care.

Patients with severe fetal problems that required further management would be referred to their local hospital for further investigations and management. This supported effective partnership working by ensuring relevant clinicians were involved promptly and had the information needed to plan ongoing care. This also helped to maintain continuity for patients as they moved between the service and other healthcare providers.

The service had good relationships with other external partners such as a local NHS Trust and the Fetal Medicine Foundation itself. If fetal abnormalities were detected arrangements were in place for patients to be seen within 24 hours at the fetal medicine unit at an NHS trust for further investigation and management.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider was committed to learning, improvement and innovation, which was central to the service’s work and strategic approach. The service was closely linked to education, research and the advancement of fetal medicine through its work funding the Fetal Medicine Foundation. This included supporting access to the Fetal Medicine Foundation World Congress at subsidised rates for international fetal medicine colleagues, enabling wider participation in learning and the sharing of innovative practice. The provider’s collaboration with the Foundation also contributed to the development of technology used globally to support fetal medicine and reduce health inequalities.

The Fetal Medicine Centre funded research focused on the early prediction and prevention of pregnancy complications, with the aim of improving health outcomes for mothers and babies. This included a range of randomised controlled trials, conducted across multiple countries and healthcare systems, all of which generated a substantial body of scientific evidence.

The Fetal Medicine Centre also contributed to the Fetal Medicine Foundation Look for Life programme. This programme sought to reduce health inequalities by strengthening access to high-quality ultrasound services globally. The organisation equipped and supported the establishment of specialist foetal medicine centres within university hospitals in the UK and beyond such as Albania and Zimbabwe.