Bradford Royal Infirmary

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 looked for evidence that women and communities had the best possible outcomes because their needs were assessed. We checked that women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question as requires improvement. At this inspection the rating has changed to Good. This meant women’s outcomes were consistently good, and women’s feedback confirmed this.

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.

We maximise the effectiveness of women’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 3. The evidence showed a good standard of patient needs being assessed. The service made sure women’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There were systems and pathways which ensured support for vulnerable women or women who lacked capacity. Anyone identified at antenatal appointments as potentially needing more support were immediately referred to the Acorn continuity of care team. Referrals that met a threshold for enhanced support were referred to the Acorn team, typically at booking. This included, substance misuse, domestic abuse, asylum seekers and refugees, non-English speakers, those experiencing financial deprivation and families being supported by children’s services.

Specialist midwives worked closely with community midwives, and they shared some caseloads of complex and high-risk women to provide continuity of care. All documentation for these women were recorded in a confidential section of the electronic notes as an addendum.

We reviewed 5 care records on the electronic system. We saw staff could access and navigate to search for potential risks. The records evidenced that informed consent had been discussed and agreed. Any needs or potential risks were identified, and individualised management plans were created. Referrals were made as required to partner agencies such as children’s social care, adult social care, and the learning disability team. The service had access to a learning disabilities lead for advice and support 24 hours a day, 7 days a week.

Information and communication aids were available for those with specific communication needs. These included easy read information with simplified terminology and interpreting and translation services both audio and visual, using a screen. Translation services were used to make patient information leaflets available in alternative languages. Staff were aware of the importance of never using family members. This was to make sure women were not being coerced or threatened by family members and also to make sure there were no breaches of confidentiality. Staff said they ensured they always had time alone with the women to determine whether there were any safeguarding issues they needed to be aware of such as domestic violence. Staff gave examples of recent cases and were able to explain management and resource available.

We plan and deliver women’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard of delivering evidence-based care and treatment. The service planned and delivered women’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service planned and delivered women’s care and treatment with them and in line with legislation and current evidence-based good practice and standards such as National Institute for Health and Care Excellence (NICE) and The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. They also followed WHO (World Health Organisation) guidelines in theatre.

We saw evidence of the Trusts submission to the NHS screening performance indicators for April to June 2025. Indicators showed performance was in line with key performance indicators.

We saw that staff could access both internal and external guidelines and standard operating procedures easily online.

The trust used an online storage system for all clinical guidelines and pathways which staff could access easily. There were computer terminals staff could access should they need to check policies or standard operating procedures.

Staff were also able to access support from a range of staff from different clinical disciplines such as dieticians and physiotherapists and specialties if they needed advice about specific patient conditions.

Escalation protocols were clearly displayed and when we reviewed maternity related policies, we found these were regularly reviewed by clinicians and based upon up-to-date evidence-based practice.

We work effectively across teams and services to support women, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard of how staff, teams and services worked together. The service worked well across teams and services to support women. They made sure women only needed to tell their story once by sharing their assessment of needs when women moved between different services.

The service worked effectively across teams and services to support women, making sure they only needed to tell their story once by sharing their assessment of needs when they moved through their birthing journey. Twice daily handovers were attended by multi-disciplinary staff, and patients were discussed in detail particularly when there were additional concerns, or higher risks associated with them.

Staff we spoke with told us that teams worked well together and that due to midwives rotating across different wards and departments within maternity services, staff had a good understanding of work across the service. This helped with the flow of patients and assisted smooth transfers.

Staff had access to the information they needed to appropriately assess, plan and deliver women’s care, treatment and support using electronic records. We observed staff access electronic patient records in order to update treatment plans and care provided in real time.

Plans for transition, referral and discharge considered women’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When women were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when women were referred between services due to additional health needs.

Staff were able to explain the close links they had with external agencies in the community and organisations.

We support women to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard of women being supported to live healthier lives. The service supported women to manage their health and wellbeing to maximise their independence, choice and control. The service supported women to live healthier lives and where possible, reduced their future needs for care and support.

Wards and units had information available for mothers to help them to make informed choices. There were posters and leaflets on how to keep healthy and keep babies safe and well. For example, we saw posters encouraging women to stop smoking and information about the importance of healthy eating. We also saw relevant information promoting breast feeding and its benefits.

Staff gave women practical support and advice to lead healthier lives. Resource sheets were also available which included information on telephone help lines, websites, and apps. The Trust website also has links to many useful advice options surrounding leading healthier lives.

Staff were trained to support women with newborn infant feeding. Mothers requiring additional support were identified through routine post-natal care and information was documented in the post-natal notes. Breastfeeding women were signposted to local breastfeeding charities and leaflets and information on the Trusts website were available. The trust was working towards implementing UNICEF level 2 breastfeeding support and had a target to achieve this during 2026. Leaders told us about the work what was underway to support breastfeeding for example staff training and antenatal education. We reviewed the services action plan for achieving the Unicef UK Baby Friendly Initiative accreditation in maternity services which included the strategy, action dates and staff responsible.

The service monitored women’s care and treatment to improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of women themselves.

We scored the service as 2. The evidence showed some shortfalls. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service had developed an annual clinical audit programme based on national, local and incident specific requirements. Clinical audits identified when staff were not following guidelines and action plans were used to support staff to improve their compliance.

The organisation submitted performance information to Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). In the MBRRACE perinatal mortality surveillance report published in May 2025 (based on births in 2023), Bradford Teaching Hospitals NHS Foundation Trust reported stabilised and adjusted rates of stillbirths, neonatal mortality and extended perinatal mortality which were above the national average. The stillbirth rate of 3.7 per 1,000 births was above the national average for Level 3 Neonatal Intensive Care Unit (NICU) trust births in the year 2023 of 3.6 per 1,000 births, however this was within 5%. The stillbirth rate excluding congenital anomalies was also within 5% of the national average.

The neonatal mortality rate was above the national average by 5% or more for trusts with a level 3 NICU in 2023, with 2.0 per 1,000 births compared to the average of 1.8 per 1,000 births. The neonatal mortality rate excluding congenital anomalies was also over 5% higher than the national average.

The extended perinatal mortality rate of 5.7 per 1,000 births was above the national average for trusts with a level 3 NICU of 5.4 per 1,000 births, however, was still within 5%. The perinatal mortality rate excluding congenital anomalies was also within 5% of the national average.

Senior leaders told us stillbirth data since the 2023 report was published had significantly improved and we saw evidence to support this. We reviewed the services reducing inequalities initiatives projects information. It was evident the service was working towards reducing inequalities. Work was ongoing via the outstanding quality improvement and transformation approach to support the service in its improvement journey. For example, the continued provision of personalised parent education for women/families with additional needs such as sight or hearing impairment, learning struggles, same sex couples and surrogacy.

Deprivation level and ethnic background can often impact on patient outcomes, with more mothers at this trust being in the most deprived region nationally or from Asian or Asian British backgrounds. Stillbirth rates are higher for babies born to women from South Asian and Black ethnic groups, and those in more deprived areas. South Asian mothers are also more likely to have babies born early or small for gestational age and are at higher risk of perineal tears and major obstetric haemorrhage.

Senior leaders told us case reviews, lessons learnt forums with mental health and system partners, development of multi-agency action plans and a deep dive were in progress in order to improve performance. Leaders told us that all maternal deaths, follow the Trust’s standard local governance process, which includes:

• Immediate internal review within 72 hours
• Review at the Maternity Safety Event Review Forum (MSERF)
• Escalation to the Trust’s Safety Event group and Quality of Care Panel
• Sharing of findings at multi-agency forums, including the Perinatal Surveillance Meeting with representation from the Local Maternity and Neonatal System (LMNS), Integrated Care Board (ICB), and Maternity Voices Partnership (MVP).

The Maternity Incentive Scheme (MIS) is a financial incentive program run by NHS Resolution to improve maternity safety in NHS trusts in England. The scheme encourages trusts to implement a set of ten key safety actions, such as ensuring staff attendance at training and improving data quality. Trusts that fully comply with these actions are reimbursed a portion of their maternity insurance premium, which is funded by an extra contribution from participating trusts.

The maternity incentive scheme provides assurance to the trust board and Integrated Care Board (ICB) that the service is on track to achieve compliance with all six elements of the current version of Saving Babies Lives Care Bundle (SBLCB) through quarterly quality improvement discussions with the ICB. The last West Yorkshire & Harrogate Local Maternity & Neonatal System and Bradford Teaching Hospitals NHS Foundation Trust Saving Babies Lives Care Bundle v3.2, review Meeting took place on 02 September 2025.

We reviewed the last submission of Saving Babies Lives Care Bundle v3.2, Quarter 1 2025-2026. The Trust’s overall compliance had slightly decreased from 93% (Q4 24-25) to 88% (Q1 25-26), it was acknowledged this had been impacted by the amendments to auditable standards and evidence requirements following the introduction of v3.2. The report referenced evidence submitted showed sustained improvement where high levels of reliability had already been achieved.

The service monitored maternal suicide. Between 2020 and 2024, seven maternal suicides were reported in the Bradford District and Craven area, with an additional two suicides reported across West Yorkshire & Harrogate between 2022–2024.

In response the service had undertaken a local deep dive into the seven cases, in collaboration with the Integrated Care Board and Perinatal Mental Health Leads. We reviewed data which evidenced detailed case reviews, lessons learnt forums with mental health and system partners and the development of a multi-agency action plan.

Senior leaders told us they conducted regional mortality reviews in West Yorkshire & Harrogate. In total, 30 maternal deaths had occurred across West Yorkshire & Harrogate over the past three years, with primary themes being suicide and cardiac causes. In response, a regional maternal mortality review was underway. Meetings were scheduled up to December 2025 to review data and learning.

We reviewed the latest NHS Maternity Services Survey results from 2024 and saw the trust performed ‘About the same’ as other organisations in relation to involvements in decisions, opportunity to ask questions, and ‘Much better than expected’ in relation to information and explanations regarding mental health and well-being.

The Trust had received 112 completed questionnaires, with a response rate of 29%. This is lower than the 41% average for all 120 trusts and marks a decrease from the 36% trust response rate in 2023. Senior leaders told us they had involved the Maternity and Neonatal Voices Partnership (MNVP) in order to drive response rates moving forward. MNVP leads attend community centres across the local community to raise the profile of the importance of the questionnaires to ascertain women’s lived experiences throughout the maternity pathway.

We do not always explain to women about their rights around consent and do not always respect these when we deliver person-centred care and treatment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff mostly understood how and when to assess whether a woman had the capacity to make decisions about their care. However, they did not always gain informed consent from women for their care and treatment in line with legislation and guidance.

The West Yorkshire & Harrogate Local Maternity and Neonatal System (WY&HLMNS) completed an assurance site visit in February 2025. The purpose of the visit was to gain insight and assurance of safe, effective and responsive maternity and neonatal services, identifying and sharing innovative practice. They made recommendations to senior leaders which included, enhanced training on informed consent, exploration of continuity of care models and improved response to service user concerns.

We discussed concerns raised with senior leaders during the inspection. Immediate action was taken to address the concerns raised, for example bespoke ‘baby lifeline’ staff training on informed consent and putting it into practice was instigated in October 2025. Forty midwifery staff members were listed to attend the course with additional dates for a further 5 LMNS places had been scheduled in July and November 2025. Attendance included both obstetric and midwifery staff from all clinical areas.

Leaders told us that staff who had completed the training would cascade the training to differing teams. Leaders informed us consent training was one of their biggest focuses currently, matrons and unit managers were involved in linking into obstetric teams. Cascade training was due to commence as part of the annual mandatory training programme for 2026 delivered by staff who had attended the full day course.

The Trust provided evidence to support escalation of the concerns at board level.

Staff could access relevant policies including Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The consent policy referenced current relevant best practice guidance, such as making best interests’ decisions and Gillick competency.

During our inspection we observed staff requesting permission to examine women and explaining what they planned to do and why. They waited for women to respond before beginning examinations.

For pregnant people where concerns regarding their mental capacity were identified, capacity assessments are initiated, particularly where medical interventions are anticipated. Decisions are made collaboratively, involving family members, advocates, and the multidisciplinary team. Hospital passports and easy read resources are used to support understanding and communication.