Midland Metropolitan University Hospital

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

At our last assessment we rated this key question requires improvement. At this assessment, the rating remains requires improvement. This meant there was still work to be done to ensure effective leadership, embed new processes, see sustained changes and ensure continued 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 vision and values which had been developed in co-production with the neonatal team but there was no clear documented strategy. The quadrumvirate could not articulate a clear strategy for the service.

The vision was ‘to deliver outstanding perinatal services by:

• ensuring services were delivering safe, personalised, and positive experiences.
• Providing access to high-quality care, delivered as close to home as safely possible.
• Engaging with families, communities, and stakeholders to continually improve care through lived experience and collaboration.
• Supporting and developing their workforce, fostering a culture of learning, teamwork, and mutual respect.

Several new processes and quality improvement groups were being introduced and embedded within the service. The senior leadership team was actively working across multiple areas to drive improvements in care, though significant progress was still needed. In July 2025, 72% of actions within the perinatal improvement plan were complete and only 4% were delayed. There will still areas where they were significant outliers including high stillbirth and neonatal deaths. These were key priorities for the next 12 months to see a sustained improvement with perinatal mortality outcomes.

The service was working with a quality improvement team for a yearlong improvement plan. This started the week after we inspected the service and involved staff from all levels to ensure there was representative input with key ideas. Their overarching aim was to improve perinatal outcomes. There would be targeted outcomes which would be created following a week long event in November 2025.

Leaders did not always share information readily or involve staff in decision making which left them feeling like they were not integral to the team. One staff member told us “The voice of the staff does not hold weight” and another said they felt like an afterthought. For example, the senior leadership team introduced birthing partners staying overnight to the staff on a Friday to go live the following Monday without consultation with the teams. The staff raised their concerns with the freedom to speak up guardian, it was then put on hold, and the staff were involved in the process. It had been implemented by the time of the inspection.

Managers held monthly team meetings, but these lacked key information to keep the teams updated. We reviewed minutes and found important information to drive improvement was not always discussed in these meetings such as incidents, complaints, patient feedback, audits and compliance with national guidelines.

Staff felt the culture within the service was gradually improving, though further development was necessary. One midwife told us the introduction of “team of the shift” helped to understand the pressures other areas were facing. There had been changes within the management teams which had impacted upon the culture, but most staff reported a more positive culture and felt supported and valued. Although, several midwives told us the culture was great on the wards but there was a culture problem stemming from the top down.

The 2024 NHS Staff Survey results showed morale had improved from the previous year and was above the sector average. There were improvements in other areas such as thinking about leaving, work pressure and stressors. These all pointed to gradual improvements in overall staff wellbeing over time and were broadly in line with the average results.

Equality and diversity were becoming a priority within the service. An Equality, Diversity and Inclusion midwife had been employed by the service to drive forward this priority. Staff consistently reported these values were actively promoted, with efforts made to identify and address inequalities for both staff and women using the service.

Leaders within the service demonstrated the necessary skills and credibility to lead effectively but senior leaders were not always visible and approachable and lacked experience in some areas. This meant staff did not all feel supported. Staff told us their immediate managers and most matrons were visible and some did regular shifts in their areas. However, staff told us they did not often see managers above matron level in the departments. Some staff told us they did not feel senior managers were supportive and as a result felt they did not fully understand the operational pressures the ward areas faced.

The maternity service was led by a quadrumvirate who were mostly relatively new to their roles. This included the Head of Midwifery, Clinical Director for Obstetrics and Gynaecology, Directorate General Manager and Clinical Director of Neonatal services. They all reported a good working relationship together and met weekly to ensure they were all sighted on any issues. There was an interim Director of Midwifery who had been in place for 2 weeks at the time of the inspection. They worked at the other trust within the group and split their time between the two.

The senior leadership team demonstrated the capabilities required to manage the service but required support in some areas. Improvements had been made since the last assessment, although further work and challenges remained. There had been many changes in the trust following our previous inspection including moving to a new hospital in November 2024 which the leadership team had managed. The senior leadership team shared a commitment to driving service improvements and reported a cohesive and collaborative working approach. However, a few staff told us that decisions being taken by senior managers were not always shared with the staff.

Leaders were knowledgeable about issues and priorities for the quality of services and had accessed support and development in their roles. Leaders told us their priorities were to improve perinatal mortality rates, listen to the women and their families, improve staffing and improve the flow within the departments. There was work underway to make these changes. The trust was being supported in a yearlong improvement journey. The leaders were being supported alongside the ‘improving together’ quality improvement team to embed and sustain changes to drive better outcomes for women and their families.

The Director of Midwifery was keen to ensure the Head of Midwifery felt supported and ensure they had clear direction and development opportunities within the role.

The service mostly fostered a positive culture where people felt they could speak up and their voice would be heard but staff did not always feel this was the case.

Leaders and staff demonstrated openness, honesty, and transparency, with many staff reporting their immediate managers were approachable, listened attentively, and provided regular feedback. While most staff felt encouraged to raise concerns, a few expressed they did not always feel heard or their concerns were acted upon, when raised with more senior managers. To support those who felt less comfortable speaking up directly, anonymous reporting options were available.

There was a Freedom to Speak Up Guardian (FTSUG) who staff were aware of and felt comfortable approaching. Information about this role was displayed throughout the workplace. We were told staff accessed this when required. For example, the leaders brought in the new 24-hour visiting policy for birthing partners without involving the staff on the wards. The FTSUG received over 30 calls about this and fed back to the senior managers and the process was stopped until the staff had been involved more in the process. Leaders were transparent with us about this process and how they had got this wrong regarding a lack of communication and involvement with the teams.

Some staff noted the culture had begun to improve and they felt heard by their immediate managers. However, there were also mentions of apprehension about speaking up due to the lack of action from managers when they did.

The new interim Director of Midwifery had set up open sessions alongside the FTSUG, one in the hospital and one in the community for staff to come and speak to them.

There were 3 safety champions within the trust executive team who completed walkabouts monthly. We saw in September 2025 the Chief Nurse attended all maternity areas and felt staff were open and honest. They discussed issues raised with the senior team and agreed several routes to support the staff.

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

Leaders acted to review and improve the culture of the organisation in the context of equality and diversity. There was an Equality, Diversity and Inclusion midwife who alongside the consultant midwife drove improvement for not only the women but the staff who worked at the service.

The community hub considered the needs of the staff and had a prayer mat and room available for staff who wanted to use this.

Leaders did not always take action to prevent and address bullying and harassment at all levels and for all staff. Staff fed back to us that they had raised incidents of bullying, and these had not been addressed.

Leaders told us they would make reasonable adjustments to support disabled staff to carry out their roles well.

Staff completed incivility training and bias training to try and reduce inequalities in the workplace.

Leaders did not always action to prevent and address bullying and harassment at all levels and for all staff. Staff fed back to us that they had raised incidents of bullying, and these had not been addressed.

Leaders did not always ensure there were effective and proactive ways to engage with and involve staff, with a focus on hearing the voices of staff with protected equality characteristics. Staff did not all feel confident that their concerns and ideas resulted in positive change to shape service and create an equitable and inclusive organisation. There was more work to be done in this area.

The service had clear responsibilities, roles, systems of accountability. However, governance systems still needed improvement. Staff did not always act on the best information about risk, performance and outcomes to ensure high-quality care for women.

There was a detailed governance structure of meetings but there was no evidence of actions taken from these meetings to drive improvement. There was a dedicated maternity governance team, including a lead obstetrician and a detailed framework for risk and governance management. Senior leads held regular meetings focused on improvement plans, safety, audit, quality, and governance. Most meeting minutes showed concerns were identified, and action were developed, but no action logs were provided. This meant there was no evidence that actions were acted on, and improvements made. Some meeting minutes were brief and did not contain the level of detail needed to inform staff who did not attend.

The service had created a monthly perinatal oversight and assurance group in June 2025. This was part of the perinatal improvement plan and would feed into the quality committee and support regional oversight meetings with NHS England and the Integrated Care Board. Minutes showed detailed discussions based on current improvement projects, national audit programmes and action plans.

There was a Perinatal Mortality Review Tool meeting where all perinatal mortality cases were reviewed but there was no clear action log to drive improvements. They had external personnel such as doctors from other organisations who professionally challenged them. There were issues with data collection for perinatal mortalities, and the Director of Midwifery had recently met with NHS England to discuss how this could be improved. Their mortality rates formed a basis of their improvement work.

Matrons provided monthly reports to the head of midwifery to provide assurances around their data. The quadrumvirate produced a monthly maternity and neonatal underlying data report to quality committee. Detail was documented in the report about how the service was working to improve compliance in areas where outcomes were less favourable for women.

Local audits and reviews were completed in line with their trust policy, but we did not see action plans were completed to drive improvement. Audits we reviewed were completed but did not always drive improvement through action planning and communication with the teams. For example, we reviewed notes audits for all areas and areas for improvement were noted but the midwifery led unit and ward A4 had no action plans. We reviewed team meeting minutes, and the notes audits results were not discussed. As a result, we saw issues remained each month and did not improve.

Audit results were not always shared with staff. Staff we spoke with could not recall recent audit results and changes needed to make improvements. Information was mostly shared with staff through email and encrypted social media application groups, but staff often did not have a chance to check their emails. Team meetings occurred but they did not always discuss audits, complaints and other key governance information.

There was a monthly risk and governance newsletter and staff told us this was informative but did not always get the chance to read it. The service recognised this and had recently introduced a 90 second video which updated the staff on risk, incidents and governance.

The clinical director had a monthly obstetric specialty meeting where important safety issues were shared with the Consultants. There was also a quality half day each month and they used this opportunity to update doctors on mortality and lessons learned.

The service had outcomes, such as rate of third/fourth degree tears, which were significantly higher than national average and needed to make improvements to the outcomes for women. There was a working group who were aiming to improve compliance. Initiatives included focused teaching sessions for all staff and increase in pelvic floor education to staff and women, particularly in the antenatal period.

There was a risk register for maternity services. It was discussed at the quality committee meeting, and we saw from minutes that risks were actively added and removed with controls. There were 6 high-risk ‘red’ items on the risk register which included:

• Maternity Theatres: the potential non-availability of a second theatre.
• Community midwifery staffing: high vacancy rate.
• Antenatal clinic: demand for the diabetic service exceeding the current capacity.
• Maternity theatres: lack of availability of the emergency maternity theatre team to meet the needs of the delivery suite after 1pm.
• Labour ward staffing: high acuity due to lack of an on-call midwifery roster overnight.
• Triage: Intermittent failure of the telephone system due to poor Wi-Fi connectivity.

The service understood their duty to collaborate and work in partnership. Staff shared information and learning with partners and collaborated for improvement.

The service collaborated with other hospitals within the Local Maternity and Neonatal Service (LMNS) and the Maternity and Neonatal Voices Partnership (MNVP) to ensure women received consistent and appropriate care for themselves, their babies, and their families. The service had an insight visit in February 2025 from the LMNS to review assurance and progress from previous visits. Points for consideration were made, and support was offered to the trust from the region.

The consultant midwife and the Equality, Diversity and Inclusion midwife engaged with charities and created links with the communities. They reached out to health groups and existing outreach programmes, with plans to deliver joint teaching sessions for women. Their goal was to identify barriers faced by women, gather their perspectives, and determine next steps for improvement.

There was good partnership working between the safeguarding teams and specialist teams such as the perinatal mental health team, substance misuse teams, children’s services and social services. The work closely with the unborn network who want to improve outcomes for unborn babies through early identification of safeguarding concerns and putting interventions in place.

The community midwifery team worked to integrate themselves with different communities. They had monthly meetings with third sector agencies to gain their support in assisting with educating their communities. For example, they had recently presented at a Sikh community event to increase public health knowledge around maternity. They also ran clinics from family hubs to ensure they were more accessible.

The community midwives worked across the system to try and bring in third sector agencies and hear women’s voices from all different backgrounds. For example, they had met with agencies to discuss driving forward mental health in pregnancy. They worked closely in community family hubs and held clinics in these to try and be more accessible to the communities they served.

The MNVP were looking to reach out to women who had been in prison to support them in pregnancy.

The service did not consistently achieve effective and continuous learning, innovation, or improvement across the organisation and local system. Staff did not consistently contribute to learning around safety and the quality of care.

While leaders demonstrated a commitment to improvement through various initiatives and working groups, not all staff were informed about the improvements needed to be engaged in these efforts. Information was sent mostly by email, which staff did not always have time to access. Consequently, there were gaps in awareness regarding ongoing developments and learning within maternity services.

Staff were actively encouraged and supported to dedicate time to improvement and innovation initiatives. Numerous working groups and projects were contributing to the enhancement of care quality for women.

The service had previously received poor feedback from the student midwives. The service had brought in monthly drop-in sessions with the students to speak with senior staff to share learning experiences. They had since been awarded a ‘gold leaf’ award from a partner university.

The leadership team had maintained a focus on addressing issues and driving improvements, but this had been challenging due to moving to a new hospital and had been difficult to maintain momentum on making significant improvements. They were hopeful that with new support for the leadership team that improvements would be seen.