Princess Royal 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

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 as inadequate. At this assessment the rating was requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We found a breach of breach of regulation 17: good governance due to the service not having an audit schedule and staff did not routinely complete local audits. Staff did not have access to up-to-date policies and guidance due to several being outside of the review date.

However, policies and guidance did reflect the current National Institute for Health and Care Excellence (NICE) guidance. To develop the vision the trust used key words from feedback received from women and their families through the friends and family test. Key words were also obtained from feedback from staff within the maternity and clinical teams via the staff survey.

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.

We scored the service as 3. 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.

Maternity services had co-produced a vision and strategy ‘University Hospitals Sussex NHS Foundation Trust maternity vision and road map’. The newly developed strategy was developed as part of the process of the trust coming out of the Maternity Safety Support Programme (MSSP).

To develop the vision the trust used key words from feedback received from women and their families through the friends and family test, MNVP quarterly survey and MNVP walkarounds. Along with feedback from staff within the maternity and clinical teams via the staff survey.

Following the last maternity inspection in 2021, maternity services across the trust entered the Maternity Safety Support Programme (MSSP) in February 2022. The service had a maternity improvement plan in place which was monitored every 2 months by the maternity improvement group.

The divisional vision was, “To be a leading provider of maternity care where supportive compassionate care and kind communication create a safe, empowering and personalised experience for all families”.

Staff we spoke to during the assessment could tell the team key words within the vision and key values were displayed on boards around the maternity service.

The divisional goals were aligned with the NHS Three Year Delivery Plan for Maternity and Neonatal Services (2023) and the trust Maternity Improvement Plan. The goals included delivering the highest standards of safety and quality of care, reducing health inequalities, workforce development, enhancing service user experience, increasing innovation, technology, community and partnership.

We scored the service as 2. There had been several changes to the leadership team which had caused some instability within the service and some services felt they were not integrated into the wider service. The service now had inclusive leaders who understood the context in which they delivered care and treatment.

There had been several changes in the leadership team which had caused some instability within the service with some staff reporting they felt they were not integrated into the wider service. Staff told us they had raised concerns about risks due to poor staffing and high acuity within the service, but did not feel their concerns were heard.

Staff reported they were unhappy and this was further supported by senior leaders who told us they were aware staff were not happy. Senior leaders reported there was sickness within the team with some staff being off with stress and anxiety.

The maternity safety champions last visited the maternity unit in August 2025 following concerns reported around staffing. The maternity safety champions met with staff to discuss their concerns and to address the issues around staffing with both the head of midwifery (HOM) and director of midwifery (DOM). Although there was no information to identify any potential outcome of the visit.

The divisional clinical operating model included overarching cross site clinical director roles alongside dedicated site-specific medical leadership. The recently in post head of midwifery (HOM) covered both Princess Royal hospital and Royal Sussex County Hospital. The director of midwifery (DOM) reported to the trust board.

The senior leadership team felt the executive team understood and supported their vision for the maternity service.

The maternity service had a team of professional midwifery advocates (PMA), who provided pastural support and restorative supervision to staff. All midwives and maternity support workers were supported by a PMA.

In the event of an incident, debriefing was facilitated by trauma and risk management (TRiM) trained practitioners from both medical and midwifery backgrounds with individual support and counselling services available. The TRiM practitioners were trained to deliver psychologically informed responses to traumatic events.

We scored the service as 2. Staff did not always feel able to speak up and that their concerns would be heard and acted on to drive improvement.

There were processes to promote the freedom to speak up guardians (FTSUG) to staff. The FTSU guardian reported back to the maternity leadership team to discuss themes and concerns. The FTSUG escalated directly to the director of midwifery or head of midwifery.

Staff told us they did not always feel able to raise their concerns with the FTSU guardians, without feeling that they would receive a negative response from the senior leadership team. The regional and LMNS insight visit in August 2025 identified in their report there had been an increase in the number of FTSU concerns raised in 2024 to 2025.

The maternity senior leadership team aim was to strengthen staff engagement and to provide direct feedback to staff. However, feedback from staff was, there was a lack of visible action or meaningful response to concerns raised regarding staffing and concerns around the flow of the maternity unit.

The trust had rolled out civility training and promoted an open-door policy. The medical team had developed a questionnaire for staff, to find out more about their wellbeing and civility with other team members. Civility training promotes respectful and considerate behaviour from all staff members of the maternity and obstetric team.

Women, and their families knew how to complain or raise concerns, and how to give feedback on the service and their treatment.

We scored the service as 2. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services.

The trust 2025 staff survey identified concerns regarding discrimination, and an action plan was developed. The service was developing succession planning for future leaders, ensuring ethnicity of the workforce was reflected.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services.

The trust told us they were committed to fostering an inclusive and equitable working environment and there had been an investment in workforce race equality standard (WRES). The service planned to establish a divisional equality, diversity and inclusion group to make sure the service were working alongside national guidance.

Some staff across the trust were taking part in the NHSE regional reverse mentoring programme. The programme was a reflective approach to cultural learning, leadership development and to increase diversity across the trust.

We scored the service as 1. The service did not have systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems were not always operating effectively to ensure risk and performance issues were identified. Staff did not have access to up-to-date policies and guidance due to several being outside of the review date. We found safeguarding training levels were not aligned to national standards and there was no formal audit plan.

The divisional meeting fed into the executive performance and quality meeting. Meeting minutes were reviewed and although there was a clear oversight of maternity services identified within the minutes, we found there was not always a clear action plan.

There were several policies and guidance that were outside of their review dates. This meant there was a risk staff did not always have access to the most up to date, best practice guidance and may not always practice in accordance with it.

However, policies and guidance did reflect the current National Institute for Health and Care Excellence (NICE) guidance.

The trust reported they were experiencing challenge with reviewing and updating clinical guidelines. Updating maternity guidelines were currently on the women and children’s risk register. The trust reported that it did not have the resources to keep up with updating all current guidelines across all 4 locations.

Senior leaders described a risk-based approach to incident review, with targeted reviews undertaken in response to identified themes. For example, any possible incident linked to sepsis would be reviewed. However, audits were not routinely completed, which meant there was a lack of continuous and systematic review of potential safety incidents, themes and trends. As a result, the service could not be assured of the overall quality and safety of the maternity service.

The trust recorded all maternity safety and quality information on the maternity dashboard. This information covered organisational aspects, such as closures, activity, workforce and clinical indicators. However, some maternity dashboard data was not benchmarked against targets, so the trust could not always be assured that the service was performing well against trust-wide or national standards.

The service maintained a risk register which was regularly reviewed; however, some risks had limited mitigation and there were ongoing delays in resolving them. There were also several risks which had been added to the risk register since 2022 and 2023 with no clear action for resolve. For example, the concerns regarding the temperature and ventilation of the obstetric theatre at the Princess Royal Hospital was first added to the register in July 2022.

The trusts maternity services were under a Maternity Safety Support Programme (MSSP) led by NHS England. The MSSP improvement plan was monitored as part of the maternity improvement group led by the chief nurse for the trust for compliance at twice monthly meetings attended by the trust and relevant stakeholders. This included action plan and workstream reviews of multiple aspects of governance, safety and outcomes. The action plan had 163 initial actions and following our assessment the trust told us 91 actions were completed and closed.

Staff could describe their role in the governance process and had regular opportunities to meet discuss and learn from the performance of the service. They knew how to escalate issues to the clinical governance team and divisional management team.

We scored the service as 3. 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.

Service leaders attended regular meetings with the Local Maternity Network System (LMNS) to review governance and incidents.

Leaders worked with the Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Meeting minutes showed current work being undertaken between the local MNVP, maternity service and the LMNS.

The maternity safety champion and non-executive director supported services to monitor safety and outcomes. Maternity safety champions worked closely with the maternity and neonatal voice partnership (MNVP) and undertook walk arounds of the service.

We scored the service as 2. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

There were improvements seen throughout the service, however, there was still a lack of oversight due to not completing maternity audits and benchmarking all data against local and national outcomes.

There were gaps in governance, including the absence of a formal process for induction of labour (IOL) and CTG fresh eyes auditing, which limited assurance on how improvements were monitored. However, staff did contribute to programmes such as the Patient Safety Incident Response Framework (PSIRF) and multidisciplinary review meetings, supporting reflection and learning.

The service had strong external relationships to support improvement and innovation. We saw evidence of regular engagement of leaders and service users, to review and improve the service such as the Maternity and Neonatal Voices partnership (MNVP) steering group.

Senior leads met regularly to discuss and monitor risk as part of the trust maternity and neonatal improvement group.

The consultant midwife led a physiological birth working group which was a collaborative initiative involving midwives and obstetric staff from all 4 locations. Physiological birthing experience is the natural progression of labour without medical interventions such as epidural, inductions or caesarean sections. The group focused on how to support women with positional techniques and strategies for improving care during the latent phase of labour. It was also an opportunity to share learning between teams and provide evidence-based care.