Bradford Royal Infirmary

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved women and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question Good. At this inspection the rating has stayed the same.

We looked for evidence that women were always treated with kindness, empathy and compassion. We checked that women’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take women’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We have not awarded this service a score for Caring.

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

We always treat women with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.

We scored the service as 3. The evidence showed a good standard of kindness, compassion and dignity. The service always treated women with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We spoke with women who were using or had used the service recently as part of our overall assessment. They told us staff attitudes and behaviors when interacting with them were discreet, respectful and responsive, providing them with help, emotional support and advice any time they needed it. They told us staff were kind and helpful and took time to speak with them and reassure them about any concerns they had about any part of their pregnancy.

We spoke with staff about meeting the religious or cultural needs of women and they told us they treated women as individuals, did not make assumptions and asked women how they wished their care and treatment to be delivered. We observed staff being respectful, kind and ensuring women’s privacy and dignity was maintained.

We observed service user feedback display boards in differing clinical areas. The display board on the induction suite highlighted positive and negative comments. Women spoke positively about the care they received, comments included “I felt my midwife was kind and knowledgeable” and “amazing midwives, patient and super helpful on the night shift”. Negative comments included “I waited a long time to come in for my induction, this made me feel frightened and alone” and “comfier chairs and tea making facilities in the rooms would be good”. Leaders told us they had made improvements following feedback for example, single side rooms had been introduced where possible to maintain privacy and dignity. The service had developed digital content online on the induction of labour pathway to explain the induction process. Women were encouraged to access this for awareness. The service had commenced an outpatient induction process to reduce waiting times on the induction suite for women.

Staff supported patients to understand and manage their care, treatment or condition. We observed staff directing patients to other services when appropriate and, if required, supporting them to access other services.

The service did not always treat people as individuals and make sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff told us they considered individual needs when care planning, this included being aware of cultural backgrounds and protected characteristics. Staff also gave us examples of this, including ensuring interpreting services were provided as soon as they were identified as being required. However, feedback was mixed regarding this. We reviewed feedback from the MNVP service user feedback in May 2025 which showed both positive and negative examples. Feedback in May 2025 showed both positive and negative examples. Feedback was collated from 4 respondents stating religious belief across Muslim, Christian and Hindu faith.

Women spoke positively about the care they received, and comments included, “Had a really good experience, fully explained what was happening. Midwife was supportive, great, breastfeeding support. Husband was with me throughout.” and “The support I received after birth was great, the breastfeeding team really helped me with getting m my baby latched on.” and “Community midwife was very good. During the delivery the midwife was wonderful., and provided a good experience, was calming and understanding.”

Negative examples highlighted: “Positives: Amazing infant feeding support by infant feeding team, however, lacking this provision on weekends and evenings/nights Some regular ward midwives were knowledgeable and supportive of my breastfeeding choices but on one occasion I found it very difficult for my wishes and my own personal breastfeeding knowledge to be listened to (a couple members of midwifery staff) and felt hugely pressured to give a bottle when it wasn't needed” and 1 woman shared that despite having significant wounds which caused long term discomfort, she was not kept informed and prepared for the effects following episiotomy.

Feedback in September 2025 showed both positive and negative examples. Feedback was collated from 8 respondents, 4 respondents said they were Muslim, and 4 said they did not practice a religion.

Women spoke positively about the care they received, and comments included, “My birth was beautiful, I got the experience I planned for and had an amazing team of midwives who looked after me.” and “I have had additional support from the birch clinic and breastfeeding specialist due to my ADHD and mental health issues. They all knew and understood my condition without me having to over explain it. My additional needs have been acknowledged and catered for. The approach is personal and not rushed.”

Negative examples highlighted “I can’t shake the feeling that the way I was treated was because of my age, the way I look, and the fact that my husband’s English isn’t perfect. It felt like racism in its rawest form. This experience has stayed with me, and it always will.” and “Horrendous experience at Bradford. Wasn’t listened to nothing was explained and have been traumatised by my experience at Bradford” and “Not enough privacy”

Women’s cultural and spiritual needs and traditions were mostly respected, and staff worked with women and families to make sure these were met, including making sure food and hydration was appropriate and cultural traditions were understood and supported. We spoke with women from differing ethnic backgrounds who told us they felt staff respected their views, backgrounds and traditions.

We saw personalised care boards in labour rooms to write personalised plans on. Plans were agreed with women on admission. Differing examples included ‘I would like lights to be dimmed’, ‘I would like prayers playing throughout my labour’ and ‘I want to be upright and move around, if possible, throughout my labour’.

Staff had access to an electronic interpreting tool available in many differing languages and made sure that any information given to women and their families was accessible and, in a format, they could understand, specific to their communication needs whether it be language or other communication needs. We observed leaflets and posters in differing languages throughout the maternity service.

Staff and women told us information about support services was readily available and shared to make sure women and families knew where to turn for support and advice.

People’s independence is not always promoted, so they know their rights and have choice and control over their own care, treatment, and well-being.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and well-being.

In the 2024 National maternity survey, some women reported a lack of breast-feeding support postnatally. Several respondents described issues with a lack of support with breastfeeding their baby. This included a lack of information and a lack of consistent support from midwives. For example, one individual stated, ‘the limited information on medical grade pumps meant they had to stop breastfeeding and led to them feeling as though they had failed their baby’.

We spoke with 12 women in total during the on-site inspection. Three women we spoke with told us midwifery staff and health care support workers were available to support with breastfeeding but felt the staff were not always readily available to support as and when required. Some midwifery staff we spoke with acknowledged that availability, acuity on the ward and time factors did at times impact on the availability to offer consistent support with breastfeeding.

Senior leaders told us they had plans to train additional maternity support workers (MSW) to support women who require support and advice surrounding breastfeeding. Staff would be supported to become breastfeeding champions with support from the specialist feeding midwife.

Staff told us there was an infant feeding specialist midwife available for specialist support which women could be referred to if required. The service had a dedicated parent educator midwife available offering women support and advice regarding antenatal and postnatal care which included breast feeding support and advice. The service also had an extensive section on the Trusts maternity website signposting women and families to parent education.

The service offer parent education classes specifically dedicated to breastfeeding via online classes for women and partners. The parent educator told us the classes were offered in differing languages, and women and partners were encouraged to participate in the calls.

Feedback from some women and their families described a lack of involvement in some aspects of their care. This included themes such as long waits in antenatal clinics, delays in induction and poor communication.

Midwifery staff told us there were often delays in women's induction, due to other clinical priorities within the department and the availability of staff to oversee the process.

However, generally, staff told us they tried to take time to ensure women remained at the centre of their care planning. We saw information and education aids across all wards and departments we visited to support this. We observed staff in discussion with women and their families, and we saw active and interactive care planning processes which considered the wishes and preferences of women and their families whenever time allowed.

We listen to and understand people’s needs, views and wishes. We respond to these in that moment and will act to minimise any discomfort, concern or distress.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff told us they were able to respond to women’s individual needs in a timely way. For example, staff told us they ensured enough time was available to risk assess and plan care accordingly.

We heard positive feedback from women we spoke with. Women were mostly happy with the care, treatment and support they received and had their needs attended to in a timely way. We observed staff discussing individual needs with women during initial assessment. Staff told us this information was recorded on the electronic patient record.

Women were given the opportunity to meet with a staff member to discuss their birthing experience, especially if the experience was not what they had wanted or expected. This gave women the opportunity to ask questions and understand why and gave the trust the opportunity to learn from experiences and make improvements.

The service collated feedback from the NHS Friends and Family Test (FFT). The FFT gives patients the opportunity to submit feedback to providers of NHS funded care or treatment, using a simple question which asks how likely, on a scale ranging from extremely unlikely to extremely likely, they are to recommend the service to their friends and family if they needed similar care or treatment.

FFT participation is encouraged throughout the maternity pathway. Service users can provide feedback via paper surveys or electronically through QR codes positioned at inpatient bedsides. Following hospital antenatal appointments, an automated text message invites patients to complete the survey. Development is underway to extend this automated service to community appointments, aiming to further increase response rates and breadth of feedback.

Results for maternity services from June 2024 to May 2025 are split between Antenatal, Birth and Postnatal (Ward & Community). For Antenatal services there were 260 responses over the period varying between 5 and 48 per month, of which 85% were positive, which was less than the 92% national average. For Birth services there were 197 responses over the period varying between 5 and 76 per month, of which 98% were positive, which was greater than the 92% national average.

We care about and promote the well-being of our staff, and we support and enable them to always deliver person centred care.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the well-being of their staff and supported and enabled staff to always deliver person-centred care.

Staff told us there were clear structures to provide all staff with adequate and timely support following an incident. For example, there were set structures in place for debriefing following an incident. Senior staff told us they had introduced ‘press pause’ training to ensure all staff are supported and differing needs taken into account following specific incidents. Attendance is not mandatory but is an example of how the service supports staff’s’ emotional needs.

The service does not have a specific maternity psychology service for staff; however, staff did have access to the trust wide psychology services when required.

Maternity services were informed on the 15 September 2025 that they were one of the named 14 Trusts across the country to be inspected. Baroness Valerie Amos had been appointed to lead the independent investigation into NHS maternity and neonatal services to drive urgent improvements to care and safety. Senior leaders told us they had contacted the psychology team to offer interim support to all maternity staff. All maternity staff were signposted to little minds matter who had agreed to run wellbeing group sessions to support staff.

In the 2024 NHS staff survey, approximately 184 respondents were of the occupation group Registered Nurses & Midwives. Four of the questions under ‘Health and safety climate’ also fell under the ‘Morale’ theme, whereby midwives were more likely to report unrealistic time pressures, inadequate supplies and equipment, and insufficient staffing numbers. For one further question under the ‘morale’ theme, midwives had the highest proportion of respondents who said they often think about leaving the organisation, with 37% compared to 27% for all staff.

Senior leaders acknowledged the increased demand in acuity and complexity of women attending the service and that this had increased regionally. Leaders gave assurance that they had reviewed the birth rate+ tool. A plan for uplift in midwifery staff was discussed and agreed at board level. We reviewed public board papers (July 2025) which evidenced the approved uplift in maternity staffing.

At the last inspection in May 2024 the report highlighted insufficient midwifery staffing numbers. We reviewed the Trust actions in response to this, which evidenced staffing reviews had been completed using the Birthrate+ tool and recruitment had been approved at board level in June 2025. The service had recruited 41 newly qualified midwives due to commence in October 2025 and November 2025.

Managers used the Birthrate+ tool plus professional judgement to calculate the number of staff needed. We observed staff recording planned verses actual numbers on staffing notice boards to reflect accurate staffing numbers on duty. Staff told us they could escalate staffing issues to labour ward co-ordinators who could pull staff from other areas. When staffing gaps could not be filled beds were closed to ensure safe staffing.

There was a commitment to having the right staff, with the right skills in each area across maternity and neonatal services. This included recruitment processes that are explicit about training expectations, newly appointed neonatal staff are required to undertake the Qualified in Specialty (QIS) qualification as part of their job role. Additional Band 6 educators had been introduced to provide better support and development opportunities for neonatal nursing staff.

The service has a substantive pastoral support midwife who focuses on the support and wellbeing of the workforce. The pastoral support midwife also supports newly qualified midwifery staff. The Pastoral and Preceptorship midwife role was launched in Bradford January 2022 as a method of maximising retention. The plan was to develop the role around the needs of the workforce.

A freedom to speak up ambassador existed within the team allowing staff members to have confidential discussions regarding concerns which are then escalated to the wider FTSU team for investigation. Staff members we spoke with said they felt comfortable raising concerns.

Senior leaders told us they had appointed an experienced legacy midwife to offer support to students and staff of all grades within the maternity service.The service had agreement from the Trust Board that they could over recruit by 15 additional midwives, (over and above BR+ agreed establishment funding), to back fill maternity leave. Senior leaders told us the pastoral and legacy midwife played an important role in mentorship and retention of staff.

Leaders told us they instigated a monthly tea trolley activity. A theme is chosen each month, and refreshments are served to those on shift that day. This initiative allows the opportunity to provide information about support services (i.e. childcare services, staff psychology services, financial wellbeing services-list not exhaustive), share important messages from the trust and share learning opportunities. It also allows for brief “corridor conversations” with a Professional Midwifery Advocate (PMA) allowing staff to arrange a scheduled one to one either face to face or via teams.

Over the past 12 months tea trolley “guests” have included the equality, diversity and inclusion team, members of the trust executive team, library services and staff psychology services, midwives from the quality and safety team.

Feedback is achieved through surveys of different staff groups. Staff members alongside clinical support are asked to provide anonymous feedback via an electronic form after each shift. A more general feedback survey is sent to all new staff at 6 months and 12 months to understand how the team is impacting on retention, all those who have joined the trust since 2022 have been asked to complete a feedback questionnaire. The labour ward coordinators were also surveyed to assess how the legacy midwife supporting junior staff enhances their role as coordinator. Feedback received was overwhelmingly positive. Suggestions for improvement include additional legacy hours in clinical areas.

Newly qualified midwives attend 4 preceptorship days during their first year of employment. This is protected time and allows for reflection and development of peer support. These days are delivered by the education and training department. The pastoral support and legacy team support during these sessions which allows midwives to arrange one to one session if required and to discuss any challenges they may have had as a collective group, often problem solving amongst themselves and strengthening their peer support network.

Rotational staffing agreements were in place to ensure equitable workforce distribution and reduce burnout in high-pressure areas. The service recognised challenges around staff rotation, with reluctance from some professionals to work across different areas. We discussed rotation with some midwifery staff who told us they felt included in decision making surrounding rotation and agreeing what additional training was required.

Senior leaders told us there was an active focus on supporting career progression whilst maintaining service needs, ensuring that staff had opportunities to specialise whilst still contributing across different areas.

Staff were supported in workforce diversification and leadership development, particularly for internationally trained colleagues. There was an emphasis on providing structured leadership programs to ensure equity in professional development.

There was a diverse working forum for global majority staff, themes of learning from the group’s lived experience are fed into wider workforce governance groups.

Staff told us there was a preceptorship lead midwife in post. The preceptorship package was aligned to the national preceptorship standard.

Leaders were able to explain systems and processes in place to support staff with health and well-being following incidents.

There were several processes in place for staff to escalate concerns. The service had introduced two pastoral support roles which included one full time and one part time members of staff who were supernumery in these roles. They promoted freedom to speak up (FTSU) and encouraged staff to speak up. They acted as a resource for staff to raise concerns in confidence which were all then referred onto the Guardian.

The service assess the level of support needed by clinical teams and individuals immediately following any safety event, taking guidance from the staff themselves. This support may be discussed during routine safety huddles or at the point of event notification. The leaflet “Looking After Yourself Following a Difficult Event” is freely available in clinical areas and provided individually to staff as needed

Individual conversations and support meetings are routinely facilitated by the quality and safety team and line managers as part of a ‘check-in’ process aligned with the Trust’s support pathways. With staff consent, line managers and matrons are informed to provide ongoing support.

During working hours (Monday to Friday), staff trained in immediate psychological first aid, known as ‘Press Pause’, offer support. This evidence-informed approach aims to reduce psychological distress by providing a caring presence, educating about common stress reactions, and empowering individuals and teams by reinforcing strengths and coping skills. It also facilitates connections to natural support networks and referrals to professional services when required. The service had a Press Pause Standard Operating Procedure (SOP), outlining when and how to use this support.

Press Pause training was implemented in April 2025. This programme, led by Trust psychology services and supported by senior leadership and the Consultant body, trained senior frontline clinicians, including obstetric consultants, labour ward coordinators, and department managers, to provide psychological first aid. This approach is used in situations such as fetal bradycardia and difficult newborn resuscitations.

Trust psychology offers 1:1 and group sessions upon staff request, particularly when Press Pause has not been facilitated after adverse incidents. These sessions have supported staff affected by maternal deaths in both acute and community settings.

Professional Midwifery Advocates (PMAs) provide 1:1 restorative supervision and support. The Quality & Safety team notifies PMAs of incidents and requests they contact relevant teams.

Leaders told us additional Press Pause training sessions are planned for 2026, including obstetric anaesthetic staff.