Midland Metropolitan University 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

We rated effective as requires improvement. The service did not always plan women’s care in line with legislation and current evidence-based standards. Staff did not always ensure outcomes were positive, consistent, or aligned with both clinical standards and the expectations of those using the service. As a result, women did not always experience care that met legislative requirements, national standards, or evidence-based guidance.

In our previous assessment, this key question was rated as requires improvement. In the current inspection, it remained requires improvement. This meant people’s outcomes required improvement.

We have not awarded this service a score for Effective.

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

The service did not always make sure people’s care and treatment were effective because they did not always ensure they were seen in a timely way.

Women were not always reviewed in line with national guidance. Women’s needs were assessed in triage by experienced midwives and doctors using a recognised triage system; Birmingham Symptom-specific Obstetric Triage System (BSOTS), but it was not always within the recommended 15 minutes. Women’s care was prioritised based on urgency using a red, amber, green system. The time taken to see them had improved since the service had employed a separate telephone triage midwife as this meant the 2 midwives in triage could concentrate on reviewing the women. In July 2025, there were a total of 1,191 attendances and 76.5% of these women were seen within 15 minutes. This was better than the trust target of 70%. This had improved since March 2025 where compliance was 45.3%. At the week of the inspection 90% of women were seen within 15 minutes.

Women were not always reviewed in triage by a doctor in line with national guidance. In July 2025, 47% of women were seen within the time as per BSOTS standards by the doctors. At this time, there was no dedicated doctor in triage, and they were shared with the labour ward. However, the data they collected was limited as there was no documentation of when the doctors were called in 60% of the cases. The service audited the time taken to be reviewed by a doctor both before and after having a dedicated registrar in triage. Results showed 19% increase in patients being seen by doctor within the allocated BSOTS level of urgency. This showed having a dedicated registrar improved direct patient care but not by enough as only 47% of women were seen within the recommended time frame.

Appropriate assessment tools were used to support the assessment of women’s and their baby’s health and care needs. For example, postpartum haemorrhage risk assessment forms were completed several times during women’s antenatal and perinatal care episodes to ensure the risk of postpartum haemorrhage was reduced.

Staff provided up to date evidence-based practice in line with national guidance to make sure patients had good outcomes.

Women were involved in the assessment of their needs, and support was provided where appropriate to maximise their involvement. Women’s needs were individually assessed at each point of contact during their antenatal, perinatal and postnatal period as staff recognised care plans changed depending on the woman’s condition. Personalised care plans were made if women needed individualised care. They were referred to specialist clinics where required.

Staff kept clear comprehensive care records to support review and evidence of appropriate action taken.

The service did not consistently plan or deliver some women’s care in accordance with legislation and current evidence-based standards.

Whilst policies referred to national guidelines and staff acted in line with the guidance, staff could not always access them easily and not all guidelines were up to date. A few staff told us communication was poor for changes in policy or procedure.

At the time of inspection, the trust had recently moved to a new policy management system, and not all staff could access the policies. As a result, they were accessing the old system which had out of date guidelines. We reviewed several policies and found the transitional care policy did not have a date on it and the sepsis guideline was due for review 24 March 2024. We also found guidelines for treating hypoglycaemia in the hypo box on the antenatal ward were for review in July 2019. Following the inspection, the managers reinforced to all staff how to access the new system and checked all guidelines were in date. A Maternity and Neonatal Safety Investigation (MNSI) report showed the trust guidance for shoulder dystocia was out of date at the time of their review which meant staff could not be assured they were using best practice techniques.

People did not always receive care, treatment and support that was evidence-based and in line with good practice standards. For example, the perinatal mortality review tool (PMRT) and MNSI reviews highlighted instances where staff did not follow national and local guidance. For example, the timing of a woman’s birth changed from 40+4 weeks to 41+2 weeks as it was perceived there were no immediate concerns and the risk for large for gestational age and reduced fetal movements were minimal. This was not in line with national guidance and resulted in harm.

At our previous inspection, we issued a Warning Notice as the induction of labour guidelines did not meet national guidance. At this inspection, the policy had been updated to ensure women were induced in line with national guidance at 41 weeks.

The service used National Institute for Health and Care Excellence (NICE) guidelines to ensure care was evidence-based. The trust’s intranet contained a comprehensive range of policies that reflected current practice. It had guidance for staff around all aspects of maternity care to ensure the right people delivered evidence-based care and treatment.

The trust participated in the Maternity Incentive Scheme. It is a financial incentive program designed to enhance maternity safety within NHS trusts. The trust self-declared their progress against 10 safety actions at the end of each year of the scheme. In year 6, which ran from December 2023 to March 2025, the trust was compliant for 9 out of 10 safety actions. There were actions to improve compliance.

Staff gave clear information to women about the care and treatment needed to support their health. Several clinics and specialist midwives supported women with their physical and mental health needs.

Women’s nutrition and hydration needs were met in line with current guidance. People told us the food was mostly good. The hospital provided options for different diets and women were spoke with were happy with the choices. Women told us they were regularly offered drinks. The service had recently got a freezer with meals and could offer women different options.

The service worked well across teams and services to support women. There were lots of support services for women.

There were good relationships between doctors, consultants, midwives, and midwife support workers who worked together closely to provide care to women. Most staff told us it was a good place to work because they had great respect for their colleagues, and they supported each other well.

Staff had access to the information they needed to appropriately assess, plan, and deliver women’s care, treatment, and support. There were handovers at shift changeover for both the medical and midwifery teams. We observed the medical handover and 3 midwifery handovers. Medical handovers discussed key information. However, we found the midwifery handovers to be long and did not always include the key information required, particularly on the postnatal ward.

Information was not always accessible by all teams when needed due to multiple information systems which did not communicate with each other. For example, there was a different information system used in theatre to the wards and both systems were different to those used by the main hospital. This meant there was a risk if a woman was admitted to the main hospital, the staff would not be aware of the care delivered in the maternity department.

Plans for transition, referral, and discharge considered women’s individual needs and circumstances. Individualised care plans were made for women where required.

There was good collaboration within the Local Maternity and Neonatal Services (LMNS). Staff had a virtual ‘huddle’ each day with 3 other hospitals in the LMNS to identify concerns with staffing and any other issues. Within the meeting, the services determined if anyone needed help and redeployed resources to support it. We observed a huddle on 10 September 2025 and only 2 hospitals attended the meeting. Staff told us normally all hospitals attended, and they were supportive to each other’s immediate needs.

The service had regular meetings with the Maternity and Neonatal Voices Partnership (MNVP) to ensure they were hearing the women’s voices. The MNVP reported a good working relationship with the trust. They felt they were responsive to feedback and felt respected and welcomed by the staff. We reviewed minutes from the meetings where actions were created to improve care for women however there was no log to track the actions and make sure they were completed.

There were 8 transitional care beds for women and their babies who were cared for on the antenatal ward. Transitional care was for babies that needed further support postnatally. The transitional care babies were reviewed daily by the neonatal team who supported the midwives with their care. We reviewed the policy and found it was in line with national guidance. However, the antenatal ward was not an ideal location for transitional care, and the managers were looking to move this to the postnatal ward.

The service engaged with the MNVP to ensure they understood the needs of the community. They had found there had been delays from women being referred into the system early on in pregnancy. To reduce these delays, the Equality, Diversity and Inclusion midwife had been to the family hubs in the area and trained the family support workers to complete the referrals for women to ensure there were fewer delays in referrals.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The staff ensured women who wanted to breastfeed were supported to do so through early bonding. The service had a higher rate of babies receiving a first breastfeed compared to the national average, however we saw feedback from 2 service users who attended the Maternity and Neonatal Voices Partnership meeting who felt little support was offered to help with breastfeeding.

The service participated in the saving babies lives care bundle. Element 1 was reducing smoking in pregnancy. The service was lower than national average for women who were smoking at the time of booking with them. This remained throughout pregnancy and smoking at delivery was lower than national average. The smoking cessation team for Sandwell had nicotine replacement therapies in the family hub and had patient group directives so staff could give these out to women who needed them. They also offered financial incentives to women to stop smoking during pregnancy.

The community team were working with the local maternity and neonatal services to set up vaccinations for pregnant women as a clinic. This was audited monthly including the uptake. They found it needed improvement and were looking to offer a twilight service to be more accessible to people.

The trust supported a free ‘bump to baby’ fayre for women and their families to help find out about the services in the area to help them to have a healthy pregnancy and support them in parenthood.

There was a drug and alcohol midwife who saw women antenatally and created care plans for their care whilst in labour.

The service routinely monitored people’s care and treatment, but they did not ensure outcomes improved and some outcomes had remained poor for a while. Where data was collected, outcomes were not always favourable. Staff did not always ensure outcomes were positive, consistent, or aligned with clinical standards. As a result, women did not always experience care that met required standards.

Reviews using the perinatal mortality review tool revealed national guidance was not always followed. For example, a woman did not have carbon monoxide testing at booking and another woman did not have a fetal wellbeing assessment completed at the hypertension clinic; these were both not in line with national guidance.

The service participated in relevant national clinical audits such as NHS England Saving Babies’ Lives care bundle. The service met most of the required elements of this bundle. This included showing positive outcomes for reducing smoking in pregnancy and reducing preterm births.

The service monitored third/fourth degree tears and their rate was significantly higher than national average. The managers were working to improve compliance. This included implementation of the Obstetric Anal Sphincter Injury (OASI) care bundle which promoted perineal protection techniques. This training was for all midwives and doctors, including community midwives. All women were encouraged to use an application to work on their pelvic floor muscles in the antenatal period; we saw posters for this up in the community and wards.

Outcomes for women were worse than expected from the maternity data reviewed. In 2023, Sandwell and West Birmingham Hospitals NHS Trust reported still birth, neonatal, and extended perinatal mortality rates that were all the highest mortality rate per 1,000 total births amongst the comparator group of 4,000 or more births. All of which saw an increase compared to the year prior, whereas the comparator group average saw a decrease across all three rates. The service was doing a rolling 12-month perinatal mortality rate. In July 2025 it was 5.7/1000 births. This had reduced in the last 12 months from 6.6/1000 in August 2024. The service was working with an improvement project team and their focus for the next 12 months was to reduce their still birth, and neonatal mortality rates.

Women and their babies were put at risk of harm as they did not always have their category 1 and category 2 caesarean section in line with National Institute for Clinical Excellence 2021 guidance [NG192] Caesarean birth. The Director of Midwifery had requested a time in motion for a category 1 caesarean to see the process which occurred. It was felt there was a lack of urgency to ensure women were in theatre in line with guidance.

The perinatal mortality review summary report showed there had been 19 stillbirths and late fetal losses between March and August 2025. Data showed none of these had with issues with care that was likely to have made a difference to the outcome for the baby. However, issues found in the reviews included growth restrictions detected but serial scans not arranged, indication for gestational diabetes testing but not offered, neonatal resuscitation not carried out appropriately and in line with Neonatal Life Support guidelines, babies’ temperature not maintained on transfer to the neonatal unit and lack of use of interpreter at antenatal appointments for woman who spoke poor English. We saw actions were created to improve care for women such as ordering a transfer cot to maintain temperature for a baby on transfer to the neonatal unit. However, since implementing this the temperature of babies on admission to the neonatal had become worse. The service was going to audit this to review reason for delays in temperature recording and support plans for improvement.

There was a Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) pathway to improve outcomes for premature babies. PERIPrem data showed their compliance with implementation of the care bundle. Managers told us they were on track with implementation and, in some areas, performing above the regional average. The compliance to the care bundle was reported monthly, with findings and recommendations shared across the specialty to support continuous improvement.

There was a program of repeated audits to check improvement over time, but managers did not always ensure staff received feedback on the results of these to drive improvement and action plans were not always completed.

Managers looked at metrics and made changes to improve outcomes for women. For example, the matron noticed there was a significant difference between how quickly women were triaged during the day and night. They found women at night were triaged much slower despite number of attendances being lower. They had investigated this, spoken to staff, completed teaching on the Birmingham Symptom Specific Obstetric Triage System. They had seen data improve from 42% of women being seen within 15 minutes to 72%. The week prior to our inspection 91.3% of women were seen within 15 minutes of arrival to triage.

Women did not always give birth in the right place for them. The incidence of babies born before arrival was higher than average, and the service had been identified as being a national outlier. The equality, diversity and inclusion lead phoned each woman who had given birth before arrival to find more information about this and put actions into place to make improvements. There had also been 4 women who had given birth in triage in August 2025 rather than on the labour ward.

The service monitored out of pathway births. Between January and June 2025, 3 women birthed at trust outside of care pathway. There was an Out of Pathway Review Tool which had launched in June 2025 together with all the Local Maternity and Neonatal Services (LMNS) in the area. There was shared learning with the LMNS and Perinatal network.

The service monitored admissions into the neonatal unit. They were consistently above the national Avoiding Term Admissions into Neonatal Unit (ATAIN) rates. National average was 6% and in June 2025 the term admission rate was 6.5%. The transitional care unit opened at the service at the end of June 2025 and there was an ATAIN working group who were working with the staff to bring the rates down.

The trust participated in the Mother and Babies: Reducing Risk through Audit and Confidential Enquiries (MBRRACE-UK) program. Their results were below or similar to national values for 8 of the 12 indicators. However, 4 indicators were above MBRRACE-UK and national values. There were actions in place to improve these outcomes for women.

Third- and fourth-degree tears were 56.0 per 1000 births which was significantly higher than national average of 29.0 per 1000 births. The trust had recognised this and had commenced the obstetric anal sphincter injury care bundle training for all midwives and doctors. All women were encouraged to use an application to work on their pelvic floor muscles in the antenatal period and pelvic floor risk assessments were completed in the community.

The service was lower than national average for preterm births which suggested effective antenatal care. The National Neonatal Audit Programme showed there were several standards which were better than national standards including deferred cord clamping, retinopathy of prematurity screening and breast milk at 14 days and at discharge.

Staff assessed and monitored women regularly to see if they were in pain. Pain relief was discussed with women in the antenatal period and when they arrived in the labour ward. The service had received complaints about delays in pain relief being administered during induction of labour. They had since introduced prescribing pain relief for when women were admitted for induction of labour to reduce delays due to prescribing.

The service had noticed a delay in consultant care for women antenatally. They had introduced a separate consultant ward round alongside the labour ward consultant round to ensure antenatal women were reviewed promptly each morning. Following the two ward rounds, the consultants met and had a formal handover to ensure the labour ward consultant had an overview of the antenatal women and what interventions were needed.

The infant feeding team provided specialist support for women with complex feeding needs. They were progressing towards United Nations Children’s Emergency Fund (UNICEF) baby friendly initiative accreditation and were stage 1 at the time of the inspection. The service felt there was a risk that they would not achieve stage 2 due to inadequate infant feeding knowledge and skills of the maternity staff. This was on the risk register with controls and planned actions for improvements.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained consent from women for their care and treatment in line with legislation and guidance.

Women were provided with clear information about their proposed treatment, enabling them to make informed decisions. One patient told us “I feel involved in decisions throughout even though I trust the staff to make decisions for me.”

Each woman who underwent surgery signed a consent form, confirming staff had discussed the risks and benefits of treatment beforehand. Consent was reviewed before surgery and confirmed using a checklist within the surgical pathway. We observed a woman giving consent for her caesarean section and found no issues with the process.

The service audited caesarean section consent in September 2025 and found good compliance.

Staff demonstrated an understanding of how and when to assess a patient’s mental capacity to make decisions about their care. There was a mental health team who supported the midwives if they needed further advice.