Bradford Royal Infirmary

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

This means we looked for evidence that the service met women’s needs.

At our last inspection of responsive in 2020 we rated this key question requires improvement. At this inspection the rating has improved to good.

We looked for evidence that women and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of women and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that women could access care in ways that met their personal circumstances and protected equality characteristics.

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 made sure people are at the centre of their care with treatment choices made in partnership with them.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Senior leaders told us they had developed a midwifery pathway for vulnerable expectant mothers, to ensure equitable, safe, and compassionate care for all pregnant women and birthing people who may be considered vulnerable or where concerns regarding their mental capacity are identified.

The service had a range of support for individuals and families across a range of vulnerabilities. This included asylum seekers or refugees (AS&R), people misusing substances or alcohol, women and birthing people with learning disabilities or diagnosed or suspected neurodiversity, women and birthing people with mental health conditions and women and birthing people experiencing domestic abuse, subject to sexual exploitation, modern slavery, homelessness, suspected trafficking and/or teenage pregnancy.

Key principles included early identification and referral. Vulnerabilities are identified at the earliest opportunity. Referrals are made to the complex care panel and relevant specialist services to ensure timely and appropriate support.

Teams worked closely with external agencies, including social care, advocacy services, substance misuse teams, and refugee support organisations to ensure a coordinated approach to care, safeguarding, and continuity. Care plans were tailored to individual needs, with reasonable adjustments made to appointment length, communication methods (e.g. interpreters, visual aids), and location (e.g. home visits). This ensures accessibility and engagement.

The Mental Capacity Act and associated policies are followed to ensure decisions are made in the best interests of the individual, with advocacy support where needed.

Vulnerable patients are supported by named midwives or continuity teams, with enhanced postnatal care provided for up to 28 days. This included robust handovers to health visiting services and contraception planning. All care plans and referrals are clearly documented in the electronic patient record (EPR), ensuring transparency and consistency across services.

Staff actively encouraged people using the service to make informed choices about their care and treatment and worked with them to plan their birth choices. They made reasonable adjustments for them to receive coordinated care with other services and providers where required. The service had a standard operating procedure (SOP) to manage the steps required when women choose to birth at Bradford Teaching Hospital Foundation Trust (BTHFT) but live outside the Bradford District. It details the process and information required for transfer between health care professionals at BTHFT and other Trusts. It provides guidance pertaining to the referral, booking and ongoing antenatal care for women who are out of area (OOA) or OOA Caseload.

The service used a decision-making tool in the maternity service called the BRAIN tool. The tool is used to help parents make informed decisions about labour and delivery. It prompts questions such as: What are the benefits of the intervention, risks, are there alternatives, how do women feel about the intervention and what if they do nothing. This tool is designed to empower women and family members to make informed decisions about their care during labour.

Leaders informed us the service were currently reviewing differing options for a digital element allowing women access to individual personal care records. Final options were to be reviewed at board level moving forward, with a view that the finance team are clear that maternity services need a voice in what system is chosen. Leaders acknowledged women require a central system that they have ownership and control of in order to support person centred care, ensuring choice and control.

The maternity service provides tailored, compassionate care to meet the diverse needs of the women and birthing people accessing services. Staff provided examples that demonstrated how individualised care was delivered in practice. Examples reflected the service’s commitment to equity, inclusion, and personalised care, aligning with national priorities for maternity safety and quality. The service demonstrated proactive planning, multidisciplinary working, and flexibility to ensure all women receive compassionate, respectful care tailored to their needs. Staff provided examples of where they had made adjustments for women with physical disabilities, sight impairment, mental health concerns and learning disabilities.

A range of planning tools are used to ensure the specific needs of women and birthing people are documented and followed by all professionals involved in care. For example: birth plan, trauma-informed plan, personalised care plan, autism health passport and VIP passport (learning disabilities).

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

We scored the service as 3. The evidence showed a good standard. 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 service actively worked to meet the needs of local people and families travelling from outside of the area as well as the diverse community it serves. The service actively engaged with families to understand the changing needs of those using the service.

The service had a neonatal transitional care unit (TCU) consisting of a 9 cot/bed facility located within the postnatal ward. Since its establishment, day-to-day care on the TCU has been provided by a neonatal staff nurse supported by a maternity support worker. Midwifery care for mothers requiring ongoing support continues to be delivered by the midwifery team on the postnatal ward.

In 2023, the service expanded with the development of a Band 6 lead nurse post, focused on quality improvement (QI) and enhancing the family experience. Additionally, funding from the neonatal intensive care unit (NICU) enabled the recruitment of 4 registered nursing associates, all of whom had recently joined and were integrating into the team.

Senior leaders told us the investment marked a significant step forward in the service. It enhanced daily operations through improved education and support but is also expected to reduce hospital stays and improve patient flow.

The transitional care unit (TCU) at Bradford Teaching Hospitals plays a vital role in supporting the Neonatal Intensive Care Unit (NICU) by helping to maintain low admission rates for term babies, as evidenced by Avoiding Term Admissions into Neonatal units (ATAIN) data. The TCU provides a safe and appropriate setting to care for late preterm and term infants with additional needs prior to discharge.

Enhancing the experience of families in transitional care is a key priority for the neonatal service. The service was actively working to improve facilities and the information provided to parents. A central focus of quality improvement efforts was to optimise the patient journey through the implementation of clearer, standardised guidelines ensuring a smooth and consistent transition from the labour ward and delivering high-quality care for all late preterm infants.

Staff made adjustments to support people with protected characteristics. The hospital passport was frequently used for those with a learning disability and, or autism.

The service had access to enhanced teams for example, teenage pregnancy, perinatal mental health and multiple births. These services offered support up to 6 weeks pre- and post-delivery. The chaplaincy service provided support for all who required it.

Practitioners built trusting relationships with families and the wider professional networks around families, to bolster and enhance support already available, fostering strong working relationships to ensure that families are supported through a collective network.

The service also offer support to women via the Acorn and Jasmine continuity care team. Care is delivered by the same small team of midwives during pregnancy, birth and after the baby is born to ensure relationships are formed.

Parent education midwives offer stork walks to induct women and families into the maternity unit as a whole. Women told us they benefited from the induction as they were informed of useful resources. They were provided with contact information, parking, pre and postnatal advice and were signposted to clinics, maternity assessment, labour unit and maternity wards as part of the induction.

There were a number of events held by the service so that they were able to understand the diverse health and care needs within the community. For example, the service held targeted focus groups in partnership with the Maternity and Neonatal Voices Partnership (MNVP), a group of parents, volunteers and professionals who work together to help shape and develop maternity services.

However, not all feedback we reviewed was positive regarding care and treatment. Feedback collated from May to August 2025 highlighted mixed responses of both positive and negative feedback regarding care and treatment. Concerns raised highlighted alleged discrimination, disrespect, lack of information and choice, not being listened to/monitored and on occasion a lack of privacy and dignity.

The MNVP worked closely with senior leaders and met regularly to discuss feedback both positive and negative and look at ways to inform learning in order to prevent recurrence. Senior leaders acknowledged the importance of the MNVP role and the need to continue to work closely as a team to review and action concerns raised by women and families.

The service provides appropriate, accurate and up-to-date information in formats that are tailored to individual needs.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service complied with the Accessible Information Standard. Patient information was available in different formats including easy read leaflets and posters which could be translated into different languages if required. Staff and managers told us the population the trust served had differing culturally diverse communities and so information could be tailored and adapted accordingly. Patient information could also be provided in alternative formats such as large print if this was needed.

We saw information in various formats and languages to ensure that all people using the service had up to date and accurate information to help them to make informed choices and play an active part in their care, treatment and birth planning.

Administration staff had access to log patient’s requirement for British Sign Language (BSL) or a lip reader for each appointment attended.

Posters had been circulated for display around the Trust as a trigger to remind patients to inform staff of their needs.

Leaflets had been produced within the digital patient information hub enabling them to be viewed with a screen reader.  Work was ongoing to get more of the Trust’s leaflets in this format as currently those displayed on the internet in a pdf format could not be viewed with a screen reader.

Patient information on the intranet was translatable using the google translate icon at the top of the webpage into over 100 different languages and also included a series of videos. The induction of labour webpage was a recent development within the maternity service.

The service has invested in language line carts for all clinical areas enabling bedside translation in all languages and BLS interpreting using an iPad. All community midwives carried a smart phone with the language line app supporting accessibility to interpreting services.

Spoken language interpreters were available 24/7 and delivered by an external provider. The provision was available face to face, and virtually through telephone interpreting either on demand or pre-booked, through spoken video or audio interpreting.

Staff ensured that patients could obtain information on local services, patient’s rights and how to complain. This was available in different languages and formats and supported by the PALS (patient advice and liaison service) team of the trust.

We make it easy for women to share feedback and ideas or raise complaints about their care, treatment and support. We involve them in decisions about their care and tell them what’s changed as a result.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Managers investigated complaints and concerns thoroughly and made appropriate recommended actions. Managers regularly shared feedback from complaints with staff at various meetings. The service used the learning from complaints and concerns as an opportunity for improvement to local practice and procedures.

Between 1 September 2024 and 31 August 2025, the maternity service received a total of 54 complaints. In that time 51 complaints have been closed, 2 complaints remained open as still under investigation, and 6 cases were withdrawn, due to the patient choosing not to proceed with the complaint or consent not obtained.

The service had a complaints policy. The policy stated that complaints should be responded to within 3 months, or 6 months by exception and agreement with the complainant.

The service had demonstrated significant improvement in timeliness of complaints handling, with all closed complaints addressed within 5 months, and 67% responded to within the standard 3-month timeframe. Senior leaders told us ongoing efforts were in place to improve early consent gathering, manage complaint complexity effectively, and continue to ensure compassionate, timely responses.

The service had various ways of gathering feedback and actively sought it so that they could improve services and make meaningful changes as a result of it. The service welcomed feedback from women and families through surveys, complaints and compliments and through the local MNVP, with which leaders were actively involved.

Leaders and staff told us they ran a service for women and families called better births for Bradford. This is managed by parent educators and band 7 midwives and is an internal maternal and neonatal voices partnership run by the service. We saw evidence of improvement plans highlighting action, dates and who was responsible. One example included information sharing with another local hospitals’ voices group sharing best practice and looking at innovative ways of user feedback in order to improve.

The service worked closely with Bradford Volunteer Doulas which is a birth-focused service that has provided short-term, person-centred support to families living in areas of high deprivation across the Bradford District since 2011. The service is fully funded by the West Yorkshire Integrated Care Board and commissioned through Bradford District and Craven Health and Care Partnership. Bradford Volunteer Doulas is part of the Bradford Maternity and Neonatal Voices Partnership network and maintains a strong, direct relationship with Bradford maternity services.

The service routinely collected feedback from all families they support, asking about both their experience with the doula service and their wider maternity care.

Bradford Volunteer Doulas staff maintained daily communication with midwives and work particularly closely with the Continuity of Care teams. These strong working relationships are essential to ensuring that the families they support receive holistic, needs-based care. The Doulas also have regular contact with a range of specialist midwives, including those leading on parent education, perinatal mental health, diabetes, birth matters, safeguarding, and the ward matrons.

Some examples where this partnership had enhanced care include providing a side room on the postnatal ward for a woman who was hard of hearing; arranging additional consultant appointments; and organising taxis to ensure that women experiencing financial hardship can attend their appointments.

Senior leaders told us seeking service user feedback in the NHS was essential for improving the quality and safety of care. It ensures that services are patient-centred, responsive, and tailored to individual needs. Feedback helps identify strengths and areas for improvement, supports staff development, and drives continuous service improvement. It also promotes accountability, informs decision-making, and helps build trust between service users and healthcare providers. By listening to patients, the maternity service can deliver more effective and compassionate care. The service provided multiple examples of change to practice following service user feedback. We reviewed an example from the birth matters service surrounding location of the service. Service user feedback included “Parking is very limited and adds unnecessary stress to visits to hospital for appointments” and “Having the session in the maternity unit was quite triggering.” Following this feedback a change of location from the Maternity Unit to a local Family Centre took place in February 2024.

The Bradford Birth Centre manage public social media pages to share patient stories and pertinent information. Families engage with administrators of these groups to provide feedback or share their experiences. The parent education team hosts the ‘Bradford, Antenatal, Birth and Beyond’ social media page, which serves as a platform for communicating key messages and updates to families. This page also facilitates the sharing of feedback from teams such as the home birth continuity of carer team.

The maternity matrons team conduct weekly walk arounds in clinical areas to engage directly with service users, gathering real-time feedback on care experiences.

BTHFT actively partners with MNVP leads to ensure patient voices inform service development and improvement. The MNVP led the ‘15 Steps Challenge’ in May 2025, involving service user representatives and receiving overwhelmingly positive feedback. MNVP representatives regularly visit the unit, engaging staff and patients and reporting insights to the senior leadership team to drive continuous improvement. Likewise, a representative from the senior leadership meeting also attends the MNVP meetings where service users attend and feedback discussed.

The MNVP maintains a website and social media page inviting feedback on maternity services. Bradford hosts several maternity circles, community groups attended by pregnant women and new mothers to provide peer support, parenting information, and access to health advice.

Maternity departments prominently displayed posters informing service users how to submit compliments or complaints via PALS. Information on providing feedback via this channel is also available on the BTHFT website.

Senior leaders recognised the importance of actively engaging and involving patients and families in learning responses to seek their input and develop a shared understanding of what happened. All families where a detailed investigation is taking place are contacted and provided with opportunities to contribute and share their experience.

We saw examples of "we said you did" on display boards in all areas of the service. Display boards showed evidence that staff had listened to patient feedback from “friends and family feedback” and had made appropriate changes to practices as a result.

We make sure that everyone can access the care, support and treatment they need when they need it.

We scored the service as 3. The evidence showed a good standard of equity of access for women who used the service. The service made sure that women could access the care, support and treatment they needed when they needed it.

Service users told us they could access care, treatment and support when they needed to and in a way that worked for them. There were many examples given of reasonable adjustments being provided when needed, and this was timely and in line with best practice. We saw evidence of hospital passports in use. Staff were able to talk us through examples, and we heard about individual experiences where adjustments had been made.

Transitional Care was staffed by both neonatal nurses and 4 registered nurse associates. This helped minimise separation of mums and babies as they could remain together and be admitted to transitional care from birth. The perinatal services had a clear pathway for Transitional Care services which was aligned with the British Association of Perinatal Medicine (BAPM) Transitional Care Framework for Practice.

The service worked hard to understand the community’s needs to ensure that all women had access to care, support and treatment in the way that they required and when they required it.

We reviewed Birmingham Systems Specific Obstetric Triage System (BSOTs) audit data submitted by the service dated June 2025. The aim of BSOTS is to ensure the patient receives the level and quality of care appropriate to their clinical needs and priority is determined on clinical grounds rather than purely on the timing of arrival to the unit. A woman’s experience of triage is usually separated into 3 sections; when the woman calls with concerns (telephone triage), attend the unit and is initially assessed (triage) and receives ongoing care (ongoing care assessment).

The overall data findings were positive; there were no omissions in the majority of ongoing care in relation to guidance. There was evidence of recommendations and actions, who was responsible and when action should be completed.

The service did not always actively seek out or listen to information about people who are most likely to experience inequality in experience or outcomes.

We scored the service as 3. The evidence showed a good standard. 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.

We reviewed the West Yorkshire & Harrogate LMNS review of concerns report dated May 2025 collated following the LMNS site visit in February 2025. Feedback was mixed, evidencing both positive and negative feedback from service users. Women and birthing people who were interviewed generally reported positive experiences. However, some instances were identified surrounding poor communication and lack of cultural awareness. Leaving some women feeling dismissed, unheard and disempowered.

Recommendations were suggested for further learning and action. Examples included exploration of continuity of care models, improved response to service user concerns to ensure women and birthing people feel heard, particularly when raising concerns and further engagement was considered to better understand the depth and breadth of the service user experience, especially for those from the global majority.

BTHFT maternity services LMNS assurance visit took place on 26 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 practices. An overview and summary of the visit was provided on the day and an outcome report was received in April 2025 which noted positive aspects to the service. Leaders told us the report had highlighted areas to consider for further development.

An action plan was not generated for these actions as they were already included within the services 3 Year Maternity & Neonatal Service delivery plan which is monitored via the Women’s Service’s Quality & Safety meeting on a quarterly basis.

A summary of the visit was included within the February Maternity & Neonatal update paper which was presented at March Quality Committee and the report from the Chair of the Quality Committee shared at Trust Board in April 2025.

The service had clear processes surrounding the continuity of care for women using the service as an inpatient and in the community. We spoke with differing specialist midwives who supported the service model. Leaders told us they were the only maternity service in the LMNS and one of a few regionally, who had continued to provide any continuity of carer teams.

The Acorn team was well established and had resumed intrapartum care, and the Jasmine team was launched in February 2025. Both teams cared for women and birthing people who have vulnerabilities including mental health, substance misuse, asylum seekers, social deprivation.

The service was considering recruiting a consultant midwife with a health equity role to support delivery of enhanced continuity of care to disadvantaged groups of the population. The service has had a full time Diabetes specialist midwife in post since April 2023. This full-time role is currently being covered by 2 midwives as the full-time post holder is undertaking a part-time secondment. Leaders were aware of the need for specialist input in this area.

Senior leaders told us they were aware further work was needed in terms of gathering user voice and making sure service users felt listened to. They gave multiple examples of ongoing work, for example:

• QR codes are displayed in all clinical areas for women to provide feedback via the Trust Envoy platform.
• Each clinical area has a patient feedback display board which includes positive feedback and any areas and actions for improvement. The feedback is also shared within the services governance meeting structure.
• The matron undertakes a daily walk around in their clinical areas to speak to women about their care and experience.
• Senior midwives walk around takes place monthly, capturing patient experience. Any concerns raised are addressed at the time.
• Any service users who contact PALS or submit a formal complaint are spoken to within 48 hours to acknowledge receipt of complaint and address any urgent escalations.
• MNVP information and posters displayed in all areas. MNVP lead attends the unit on a weekly basis and speaks to service users regarding their care.
• Better Births Bradford user group is facilitated by the parent education team on a 6-weekly basis. Feedback from this group is included within the Unit Managers meeting agenda.
• Maternity Care Quality Commission patient experience survey improvement plan in place.

We also reviewed the WY&H LMNS report submitted following the site visit in February 2025. The report highlighted there was evidence of a significant commitment to reducing health inequalities. Numerous innovative approaches were demonstrated, including.

• provision of food bags provided by food banks
• coat and school uniform rails in outpatient settings, this is running independently now due to strong community engagement.
• collaboration with the Good Things Foundation to provide data and devices to families in need, enabling better access to virtual services.
• supporting access to services via individual transport arrangements and coordinated appointments.
• free parking had been secured for families, ensuring they are not faced with additional costs when accessing neonatal and maternity services.

The service captures inequalities data to support targeting specific demographics, improving access to services, whilst expanding community engagement. Initiatives such as the Better Births group and targeted outreach programs in local schools and communities aim to address health inequalities. The service provides bespoke maternity classes in different languages, delivered in groups or one to one and face to face.

We saw evidence of an improvement plan dated July 2025. There were clear set objectives, with a named person responsible, an end date, progress to date and method of assurance. The plan covered the concerns raised in May 2025. Further engagement was also considered to better understand the depth and breadth of service user experiences, especially for those from the global majority. Senior leaders planned to engage with MNVP leads to plan and implement engagement.

We support women to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of their life.

We scored the service as 3. The evidence showed a good standard of supporting women to plan for the future. Women were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of women with complex needs. The trust provided us with examples of this which included the local authority, police and others to make sure women and babies were safe.

Women could access specialist mental health services and specialist midwives developed support plans with women during pregnancy and after childbirth. The service also provided information and clinics to support women to plan for various outcomes including multiple births, high risk pregnancies and for women who were vulnerable or required enhanced care and treatment.

All midwives, support staff and theatre practitioners participate annually in a dedicated two-hour training session as part of the Equality & Personalised Care (EPC) study day. The session is facilitated by a member of the specialist bereavement midwifery team and is designed to equip staff with the skills to deliver competent, compassionate, sensitive, and trauma-informed care to bereaved families, in alignment with the National Bereavement Care Pathway.

The bereavement team comprises of 1.0 WTE Band 7 midwife and 1.64 WTE Band 6 specialist midwives, ensuring a consistent daily presence of at least one specialist bereavement midwife on the unit, seven days a week, between 08:00 and 18:00.

The team deliver personalised, care to women, birthing people, and families experiencing pregnancy loss, including miscarriage, stillbirth, and termination of pregnancy for life-limiting fetal conditions. Their support spans the entire care continuum, from antenatal contact in cases of anticipated poor outcomes, to intrapartum assistance including memory-making and completion of legal documentation, and postnatal follow-up care delivered either virtually or in person, according to family preferences.

The team ensure continuity and consistency of care. They collaborate closely with key stakeholders such as screening midwives, the Butterfly Pathway and the Sudden Unexpected Death in Childhood (SUDIC) team. Their contributions extended to the development of standard operating procedures (SOPs), patient information leaflets, and service improvement initiatives in line with national policy. They also liaised with the MNVP as required.

The team facilitate two specialist clinics comprising of the Tender Loving Care Clinic (TLC) and the Snowdrop clinic. The TLC clinic provides enhanced surveillance and emotional reassurance for pregnant individuals who have experienced a previous loss. It aims to promote continuity of care throughout their pregnancy journey

The Snowdrop clinic provides a consultant-led service offering investigation results, follow-up debriefs, emotional support, and future pregnancy planning.

In addition to internal service delivery, the team maintains partnerships with external leading charitable organisations and local support groups.

The bereavement team actively participate in monthly Trust Perinatal Mortality Review Tool (PMRT) meetings and Maternity Safety Event Review Forums (MSERF), ensuring that the patient perspective is consistently represented.

The team also engages in regular audits weekly, monthly, and quarterly to ensure adherence to policies and procedures, including those required for compliance with the Human Tissue Authority.