Midland Metropolitan University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We rated responsive as requires improvement. We looked for evidence that the service met people’s needs. Staff did not always follow national guidance which meant women were coming to avoidable harm. The service did not always make sure women were at the centre of their care and treatment choices. The service did not always make sure that people could access the care, support and treatment when they needed it. At our previous assessment, this key question was not rated. At this assessment we rated responsive as requires improvement. This meant people’s needs were not always met. The service did not always ensure timely access to care, support, and treatment.

We have not awarded this service a score for Responsive.

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

The service did not always make sure women were at the centre of their care and treatment choices. They did not always work in partnership with them, to decide how to respond to any relevant changes in their needs.

Women were not always seen promptly by the doctors when they had concerns. Medical reviews in triage were not always timely, particularly overnight due to limited doctor availability. The service had recognised this and since September 2025 they had employed a senior doctor in triage 12 hours a day. Initial data showed improvements in response times for women, but this was not enough as even with the dedicated registrar in triage only 47% of women between 1 and 12 September 2025 were seen within the recommended triage time.

Staff did not always follow national guidance which meant women were coming to avoidable harm. The service used the perinatal mortality review tool (PMRT) to review baby deaths. We reviewed cases where national guidance had not been followed. The PMRT thematic review report showed there were no themes across the stillbirths and late fetal losses but found issues which needed addressing which could have contributed to the baby deaths. Actions were created to improve care for women and their babies.

Staff did not always risk assess small or larger babies in line with guidance which meant they were not always treated on the appropriate care pathway. During the PMRT and Maternity and Neonatal Safety Investigation reviews we found a case where slow growth at 28 weeks was detected but not acted upon and another case where a large baby required a growth scan in line with guidance and this was not completed.

Care plans generally reflected individuals’ physical, mental, emotional, and social needs, including those related to protected characteristics under the Equality Act. There were personalised care plans for women requiring additional support. Women were mostly involved in planning and making shared decisions about their birth and care.

Women did not always have a choice about where to give birth. There was no home birth service available. Between July 2024 and January 2025, 2 women gave birth at home with no support as they wanted a home birth, and this option was not available to them.

The wards had recently changed their visiting times to 24 hours a day, 7 days a week, to ensure birthing partners felt welcome and had open visiting to the wards.

Not all women had one-to-one care in labour. Data between March and August 2025 showed 97.83% of women in labour received one-to-one care. This was not in line with national guidance which states maternity services should provide a model of care that supports one-to-one care in labour for all women. These episodes were reported as red flags in line with national guidance.

Women did not always receive face-to-face postnatal community care. Face-to-face and primary home visits were increasing but they were unable to fully facilitate all in person postnatal appointments due to lack of staff. In June 2025, 293 women out of 815 women booked had face-to-face appointments, the rest had telephone appointments.

The service made reasonable adjustments to ensure women received appropriate care and treatment. Women with mental health needs or learning disabilities were provided with individualised care plans. All women with mental health needs were seen by a mental health midwife at 36 weeks and had a postnatal care plan.

Antenatal clinic appointments were arranged to suit families’ needs, with regular clinics available for diabetes, endocrine issues, substance misuse, and mental health. Where there were health inequalities, the service actively tried to arrange appointments all on one day to save on travel and offered bus passes free of charge to women and their partners to ensure appointment were attended.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. The consultant midwife and the Equality, Diversity and Inclusion Midwife reached out into the community to ensure different communities voices were heard. For example, they had recently been to visit the Chinese community and found that it was important in their culture to educate the older generations to ensure the message was passed on to the younger generation. They were going to follow up this session in 6 months.

The Equality, Diversity and Inclusion Midwife had found certain other communities had generational influences and had low uptake for screening. They had reached out through the Maternity and Neonatal Voices Partnership (MNVP) and were setting up an access groups to be able to provide education on important public health information to all generations and promote early access in pregnancy for screening.

The MNVP were working with the Local Maternity and Neonatal Services to look at the continuity of carer model. They had 10 staff who worked with them and out of these 7 spoke different languages of the community which enabled them to aid with women’s communication needs.

Bereaved women and their families did not always have access to specialist care and support. There was a bereavement service Monday to Friday from 9am to 5pm. The service was not out of hours or at weekends.

The service did not have a rainbow clinic for women who had suffered a previous pregnancy loss to access. This was not in line with the Ockenden report recommendations. The service was working towards full implementation in January 2026.

There were not enough midwives in the community to delivery continuity of care for women and their families. Not all women had a named community midwife and there were no enhanced continuity of care teams. However, we saw feedback from one woman who did who said “The midwife always had a smile and seemed genuinely interested in helping me. I felt lucky to have the same midwife throughout my pregnancy.”

There was no enhanced continuity of care team to support women in deprived areas which was a national recommendation. The Director of Midwifery told us this was something they wanted to bring into the community to improve outcomes for women, especially those with multiple risk factors.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. There were no communication aids on the labour ward for women who were deaf or hard of hearing. There was no hearing loop and no communication tools. The service had portable digital devices with video interpreters, but staff told us they mostly used telephone interpreters as it was easier, and the video interpreters were not always appropriate for women in labour.

At our previous assessment in June 2024, we issued a Warning Notice as women did not always receive interpreting services as appropriate. We found at this inspection this still happened. The midwife for equality and inclusion was working to improve their provision of interpreting services. They found it was not always used when it should and were encouraging use. The service had also done an audit into babies born before arrival to hospital. They had called all women who had given birth before arrival to the hospital to find out what had happened. They found 10 women had called triage but were unable to understand the advice due to communication barrier and no interpreting service was used and therefore had not come to hospital in time.

There were large posters available in different areas around the departments displaying key information for patients. For example, there was a large floor poster highlighting ’10 steps to spot jaundice in black and brown babies’ and another on ‘Pelvic floor problems’.

Staff understood the health and social needs of its community. Efforts were being made to improve accessibility for those facing barriers to care. The service addressed digital poverty by providing devices with SIM cards offering free data and calls, enabling access to the maternity digital application containing antenatal information.

The service had a range of information available for women in different languages. For example, videos about fetal movement monitoring.

The CQC maternity survey 2024 showed the service was better than expected for before women were induced, whether they felt they were given appropriate information and advice on the risks associated with induction of labour. One woman we spoke with who had an induction of labour told us “All the staff were excellent at explaining everything.”

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. People knew how to give feedback about their experiences of care and support including how to raise any concerns or issues and can do so in a range of accessible ways. One midwife told us they used a telephone interpreter to complete a feedback form as a woman wanted to give feedback but was unable to write in English.

Managers told us they did daily walkarounds and spoke to the women and their families to engage with them. Feedback from these interactions was typically simple and any issues were easily resolved.

Communication emerged as the most common theme in complaints as well as delays in care. In triage, women fed back they did not feel heard by the midwives, and it was difficult to get through on the telephone. The service had introduced a new call system which recorded the calls, recorded how long women waited, had call waiting and call back functions. Managers were able to listen back to calls to monitor for any improvements.

The service received 36 complaints between March and August 2025 and 8 of these complaints were related to treatment being delayed. The average response rate from the trust was 31 days. At the time of the inspection there were 20 outstanding complaints to be responded to.

The service was working to get a QR code for feedback forms to be in different languages to make it easier for women to give feedback.

Staff were familiar with the complaints policy and knew how to manage complaints appropriately. All formal complaints were processed through the hospital’s patient advice and liaison service and then assigned to the relevant manager. Managers investigated complaints, identified themes, and they reported good support from the Equality, Diversity and Inclusion lead who led on complaints.

Learning from complaints was not always evident when we spoke to staff. They could not give us any examples of anything that had changed following a complaint. They told us they got feedback when they were involved but did not get regular feedback about complaints and the themes.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it. Women were not always able to access care in a way that met their needs. Women experienced delays in care, particularly in triage, induction of labour and caesarean sections.

The service were often unable to meet demand for induction of labour and caesarean sections. Delays in care posed potential risks to women and their babies. Some women experienced delays in induction of labour and in procedures such as artificial rupture of membranes. The flow through the maternity department was poor. Women were not cared for in the appropriate areas due to lack of availability of beds. This caused delays for women who were waiting interventions.

During the inspection, we saw 5 women experienced a delay in either induction of labour or caesarean section between 9 and 10 September 2025. The service completed harm reviews when women experienced delays over 24 hours.

The service undertook an elective list for 3 caesarean sections a day on Monday to Friday mornings. We were told this often overran into the afternoon due to capacity issues. The service had put forward a business case to increase capacity to 2 additional lists by 2026.

Every day women were scheduled for induction but staffing and bed shortages often prevented them from attending. Consultants and labour ward coordinators reviewed the induction list daily and prioritised women based on their level of risk. When delays persisted, the maternity escalation procedure was activated. This included updates to the operational pressure escalation levels score and corresponding actions. If all inductions could not proceed, a multidisciplinary team, including a consultant, met to discuss the next steps. We observed delays being discussed in safety huddles. Although the service attempted to coordinate with Local Maternity and Neonatal Services for support, they were often also at full capacity and therefore offered limited support.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of women in accessing their service. The Equality, Diversity and Inclusion lead and Consultant Midwife had identified groups within the communities where there was low uptake for screening, or generational bias and lack of knowledge. They had reached into these communities and created groups or done teaching, including with their families to bridge the gaps in knowledge.

The service did not ensure all people found the maternity areas easily. The Maternity and Neonatal Voices Partnership gained feedback from women about their experience at the hospital. Frequent comments included difficulty accessing areas of the hospital due to signage only being in English and many did not read English.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service used people’s feedback and other evidence to improve access for people more likely to experience barriers or delays in accessing their care. For example, bus passes were provided to families who fed back they were not attending appointments due to the cost of travel to the hospital and phone, and sim cards were provided to ensure women could access their information digitally.

Women who spoke different languages were given a language card so this could be shown to the healthcare professionals without the need to communicate, and they could arrange translation.

Staff had a good understanding of the people who used their service that were most likely to experience inequality in experience or outcomes and took steps to minimise barriers to inclusion. However, we found a case which were investigated by the Maternity and Newborn Safety Investigations (MNSI) that found evidence that ethnicity impacted the outcome of the birth. Feedback from the MNSI stated there was evidence that ethnicity impacted on the patients care. Their experience of not having their birth preferences fully explored and their voice not being acknowledged reflected findings from national projects. One included the “Sands Listening Project” which is a project that collates learning from bereaved black and Asian parents experiences. The clinical director told us they looked at still birth reports and see if any harms were related to language barrier or related to their ethnicity.

The service mostly took action to prevent or minimise the inequality in experience or outcomes for people. Examples of this included, making reasonable adjustments for people, providing culturally appropriate care and responding to potential or actual discrimination within the service.

Staff felt confident about understanding women’s equality-related needs and felt able to meet them. The service had created an equality and inclusion pocket guide to inform staff about understanding different cultures, ethnicity and the impacts of this on their care and pregnancy. For example, the guide informed staff how to recognise infection from a caesarean section wound in women with brown skin, thrush on the nipple in brown skin, and supporting visually and hearing-impaired women.

The consultant midwife reviewed the common faiths the women practised and recognised there was a gap in the faith-based bereavement packs offered to families. They developed Sikh bereavement packs alongside the Sikh chaplain.

The service were working with the Local Maternity and Neonatal Services to address poor outcomes for asylum seekers and how to improve the inequalities.

They had 6 moses baskets in the service which were lent out to women who needed them.

Women were supported to plan for their birth from their initial antenatal booking appointment but were not always given the choice of where to give birth or how they could give birth.

Women were mostly supported to make informed choices about their care and plan their birth in advance. This meant they mostly had enough time to make informed decisions about their labour. They were given options around whether they would like to give birth in the midwifery-led unit or the labour ward; there was no home birth service. However, women did not always have timely discussions regarding the birth of their baby. We reviewed Maternity and Neonatal Safety Investigations incidents and found there was not a robust process in the trust for discussions regarding a vaginal birth after caesarean (VBAC) to ensure individualised care. We found 2 cases where discussions were not had at an appropriate point or revisited which impacted on the woman’s outcome. For example, one woman felt they had no option for mode of birth as there was no medical indication for a caesarean and therefore proceeded with induction of labour which was not their choice.

Women’s decisions and what mattered to them were delivered through personalised care plans that were shared with others who may need to be informed. Where women had specific needs, such as mental health needs, they were referred to the appropriate team to support them.