Bedford 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 there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question as inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

At our previous inspection the service was found to be in breach of legal requirements under good governance and staffing. Relating to the management of incidents and the culture within the service. At this assessment only minimal improvement were observed, and the service remained non-compliant with both regulations.

We have not awarded this service a score for Well-led.

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

The service had a shared vision and strategy and was working to improve the culture.

In 2024, the trust published a 5-year vision and strategy outlining its goals and the actions required to achieve them. The maternity service adopted this strategy as part of its commitment to delivering high-quality care. This strategy had been developed in collaboration with staff, patients, partners and the public from across the trust’s networks. The vision statement was THRIVE, which stood for: Teamwork, Honesty and Openness, Respect, Inclusivity, Valuing People and Excellence.

Staff we spoke with were aware of the vision. The maternity service had 5 strategic pillars to achieve the vision which were: Equality, Diversity and Inclusion, Maternity Clinical Pathway, Listening to Service User Voice, Staff Wellbeing and Workforce Development, Training and Education.

Staff we met were welcoming, friendly and helpful. We observed effective teamwork across the service, with staff working collaboratively to deliver high quality care and enhance patient experience. Most of the staff we spoke with were positive about the service; however, many highlighted that low staffing having a negative impact on staff morale. Staff also reported that, while the overall culture within the service had improved since our last inspection, however there were still occasional instances of incivility between colleagues.

We observed effective multidisciplinary working however, some midwifery staff reported that the working relationship between midwives and paediatric doctors could be strained at times. This was due to a lack of responsiveness from paediatric doctors when midwives requested a review or attendance at a delivery. Midwifery staff expressed concerns that their clinical judgement was not always trusted, which they felt could pose a risk to neonatal safety.

Since our previous inspection, the trust reported ongoing cultural improvement work ongoing in response to the episodes of unacceptable behaviour and language, including racism and discrimination. As part of this cultural work the trust commissioned a maternity services culture project, beginning with a staff-wide questionnaire. The results aligned with the findings from our previous inspection, with 95% of participants indicating they had witnessed disrespectful and or negative behaviour.

In March 2025, the trust shared the questionnaire findings with staff and outlined several planned actions in response. These included co-producing an anti-racism charter, a civility charter and a code of conduct with staff; delivering civility workshops, increasing visibility of the leadership team, providing cultural competency training re-launching the managing violence and aggression pathways. However, the trust did not provide an update on the progression of these actions.

Leaders had the skills, knowledge, experience and credibility to lead effectively however, they were not always compassionate and inclusive.

Maternity services provided by Bedfordshire Hospitals NHS Foundation Trust were delivered across their Bedford Hospital and Luton and Dunstable Hospital sites. The service had a defined leadership structure cross-site and a hospital specific leadership structure. The cross-site triumvirate consisted of the director of midwifery, general manager and clinical director of gynaecology and obstetrics who were also the safety champions for the trust. The Bedford site had a quadrumvirate that consisted of a head of midwifery, a senior service manager, a clinical lead for obstetrics and a neonatal lead. The service was also supported by board level maternity and perinatal safety champions, comprising the chief nurse and a designated non-executive safety champion.

Leaders had the experience, skills and ability to run the service. However, staff did not always feel leadership was compassionate and inclusive. Staff reported that some of the midwifery leaders were not consistently visible or approachable, and that they were not always consulted before changes took place. One example shared was the introduction of midwives on the maternity wards conducting all the newborn and infant physical examinations (NIPE) checks, in addition to managing their existing caseloads. Each NIPE check can take approximately 45 minutes to 1 hour, and prior to this change, they were undertaken by neonatal doctors, which helped to ease midwives’ caseloads. Staff reported that this change increased their workload, negatively impacted morale, and impacted patient experience, with some women expressing concerns that midwives appeared too task focused.

There were clear lines of reporting from the site leadership team, through the quadrumvirate to the trust board. The site leadership team reported that the trust quadrumvirate were very involved and approachable. The site quadrumvirate had a good understanding of the service they managed and reported working well together. The service had monthly governance meetings, and a review of the meeting minutes between April and June 2025 showed consistent attendance, with apologies recorded as necessary. The meetings covered key areas such as governance and compliance updates, workforce, quality improvement projects, research and audits and future planning. Information from these meetings was then shared with staff via a monthly newsletter.

The service also held meetings for perinatal safety champions. However, the trust only provided meeting minutes for the April 2025 meeting, so the frequency of these meetings could not be confirmed. The April meeting was well attended, with representation from midwifery, obstetrics, and neonatal teams, as well as the trust quadrumvirate and board-level safety champions. The agenda was standardised, addressing topics such as governance compliance, workforce, mandatory training, culture, stakeholder feedback, and patient experience.

People did not always feel they could speak up and that their voice would be heard.

Staff at all levels reported feeling comfortable speaking up; however, they also shared that concerns raised did not always lead to action being taken. This failure to follow through negatively impacted morale and discouraged future reporting. This issue remained unchanged since our previous inspection. According to the 2024 NHS staff survey, there had been a slight decline in the score under the heading “We each have a voice that counts”, dropping from 6.68 in 2023 to 6.64 in 2024.

The service had a freedom to speak up (FTSU) guardian and staff were aware of how to access support. The NHS staff survey 2024 included trust specific data on staff awareness of FTSU guardians. The results showed that 86% of staff trust wide, were aware of the trust’s freedom to speak up guardians. Between January and March 2025, staff raised 27 concerns through the freedom to speak up guardian. The main concerns reported were workload pressures, colleagues’ behaviour, allegations of bullying and favouritism and concerns about the attitude of managers following bereavement. These findings highlighted the ongoing need to continue to improve the culture within the service.

Staff also had access to professional midwifery advocates (PMA). Staff reported the PMAs were very approachable and useful when they required support.

The service displayed information about how to raise a concern in patient areas. Women and their families could complete the friends and family test (FTT) on the unit. Data from the service showed 95% of responses were positive in March, 99% were positive in April and 97% were positive in May 2025. The service monitored themes from negative feedback and complaints. The service received 10 complaints between April and May 2025. Common themes included poor communication with women, poor staff attitude and delays or failure in diagnosis and monitoring of concerns. Five of these complaints had been closed with the remaining 5 awaiting statements to progress the investigations.

The service took part in the Care Quality Commission (CQC) maternity survey 2024. The service performed at about the same level as other trusts in 16 questions, somewhat worse than expected in 4 questions and worse than expected in 4 questions. The question the service performed worse than expected in were; staff introductions, staff working together, respect and dignity and the opportunity to ask questions. The trust had developed an action plan in response to the findings which included but were not limited to, reinvigorating the ‘Hello my name is’ initiative, the introduction of cultural competency training and promotion of the birth reflection service.

Staff of all backgrounds did not always feel valued and respected.

Staff and leaders, we observed were broadly representative of the population of people using the service. However, some staff reported they did not always feel valued and respected by leaders and colleagues. They felt this was largely due to poor staffing and redeployment impacting staff wellbeing. Staff also reported that trust level senior leaders were not always approachable as they were not always visible on the Bedford hospital site, this was not an improvement from the previous inspection.

Staff reported there were also still incidents of division in the form of microaggressions however, this had reduced since our last inspection, and the service had actively put things in place to try and avoid division. This included all midwives being referred to as such and the removal of the title; internationally recruited midwives for midwives who trained abroad.

The NHS staff survey 2024 included trust specific data on Workforce Race Equality Standards (WRES) and Workforce Disability Equality Standards (WDES). This data is representative of the trust as a whole and not specific to maternity services. The finding showed 25% of white staff and 26% of staff from other ethnic groups had experienced harassment, bullying or abuse from staff in the last 12 months. 59% of white staff believed the organisation provided equal opportunities for career progression or promotion, while only 50% of staff from other ethnic groups felt the same.

Findings from the hospital workforce disability equality standards question showed, 19% of staff without long-term conditions or illnesses had experienced harassment, bullying or abuse from other colleagues in the last 12 months. Whilst 28% of staff with long-term conditions or illnesses had. 56% of staff without long-term conditions or illnesses and 51% of staff with long-term conditions or illnesses believed the organisation provided equal opportunities for career progression or promotion. These findings highlighted there was room for improvement with workforce equality.

The trust developed an equality, diversity and inclusion (EDI) framework which was developed to support the trust being ‘inclusive by instinct’. The framework had people aims and patient aims. The people aim were; empowering leaders, building line manager confidence in EDI and empower all staff. The patient aims were; continue to improve accessibility for patients and provide accessible information for all. They also had actions to help comply with the aims above, this included but was not limited to development of cultural awareness and competence, building on their anti-racism statement and development of an anti-racism charter.

According to the trust website staff had access to a range of equality networks they could join. These included the; BAME network LGBTQ+ and allies’ network and the disabilities and allies staff network.

The service did not have systems of good governance and risks were not always managed in a timely way. They did not act on information about risk, performance and outcomes, or share this securely with others when appropriate.

Leaders did not always operate effective governance processes throughout the service. The governance team included a cross-site head of governance, a cross-site quality compliance manager, a safety governance lead midwife, an audit and guidelines midwife and a bereavement specialist midwife. However, the service had vacancies within the governance team and confirmed that recruitment was ongoing.

The service had regular opportunities to meet, review performance and share learning. However, staffing gaps within the team resulted in backlogs of incidents and out of date guidelines. The service had monthly governance meetings which were attended by multidisciplinary staff alongside monthly cross site meetings. We reviewed the meeting minutes between March and June 2025 and found both meetings to be well attended and comprehensive. The meetings had standing agenda items of discussion, which included but was not limited to clinical updates, finance, training and education, submissions to external organisations, audit and clinical guidelines, safeguarding, workforce and risk.

During our assessment we identified several out-of-date guidelines and escalated this to the service. On our follow up visit, we observed that some progress had been made. As of 31 July 2025, the service reported they had 44 policies overdue for review as there was ongoing work to make all policies cross-site. These included policies on the use of medicines, manual handling, paediatric escalation and emergency cover. The service reported arranging monthly policy review meetings with multidisciplinary attendance to review all out-of-date policy with an aim to have this completed by September 2025.

At the time of our assessment, the service had 41 open risks on its risk register. However, these risks were not being managed in a timely manner. The risk register included key details such as a risk identification number, title, risk owner, description, the current rating and the date it was last reviewed, however, the risk register did not identify what date the risks were added.

According to senior leadership, the top 3 risks for the service were the use of room 1 as theatre, maternity staffing and clinical digital use. The quadrumvirate provided updates on each of these risks. Regarding the risk of room 1 being used as a second theatre, the quadrumvirate reported the trust had undertaken an options appraisal. At the time of our assessment an option had not yet been decided as presentation to the trust board was required. In response to the staffing risk the service carried out a staffing exercise in January 2025 and were awaiting the report. Regarding the reliance on paper records, the service reported plans to introduce an electronic patient record systemin February 2026. These risks had also been identified during our previous inspection, and we minimal progress had been made toward resolving them.

Data and notifications were submitted to external organisations. The service showed evidence of submitting all qualifying cases to the Maternity and Newborn Safety Investigations (MNSI). All NHS trusts are required to tell the MNSI about specific safety incidents that happen in maternity, which are then investigated if they meet the MNSI criteria and where relevant safety recommendations are made. The trust had referred 118 cases to MNSI since April 2019, 40 of which were rejected. Seventy-two investigations had been completed, and 6 cases were currently ongoing. The MNSI aimed to complete all investigations within 6 months.

Data provided by the service confirmed that perinatal mortality review tool (PMRT) meetings were held to review care and report on perinatal deaths that had occurred within the service. However, the meeting minutes lacked consistency making it unclear how frequently these meetings they occurred. Additionally, the roles of attendees were not documented, so it could not be confirmed whether the meetings were multidisciplinary.

The service submitted collated data to Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) as required. The trust also produced a quarterly board report of PMRT data.

The trust was not compliant with 5 of the 10 safety actions set out in the clinical negligence scheme for trusts (CNST): maternity incentive scheme (MIS) year 6. The MIS is a financial incentive programme designed to enhance maternity safety within NHS trusts. It rewards trusts that can demonstrate they have implemented a set of core safety actions. The trust did not provide any information on actions they plan to take to ensure compliance with year 7. This meant we could not be assured that the trust would be compliant with the safety actions for the upcoming year.

The service collected data and analysed it. The trust submitted data to the maternity services data set (MSDS). The MSDS is a comprehensive dataset that captures patient-level information from the booking appointment until discharge.

The service had a local dashboard which had set metrics the trust uses to monitor whether their clinical outcomes were in line with national targets. These metrics included the number of bookings before 10 weeks gestation, massive obstetric haemorrhage, 3rd and 4th degree vaginal tears etc. Data showed the service did not meet the national target for the number of bookings before 10 weeks gestation, obstetric emergency training, 3rd and 4th degree tears and stillbirth rates.

In addition, the service submitted data to the local maternity and neonatal system (LMNS) dashboard. The LMNS is a collaborative framework designed to enhance maternity and neonatal services. It serves as a platform for partnership between the service and key stakeholders within Bedfordshire, Luton and Milton Keynes health (BLMK) and care partnership. The LMNS dashboard had similar metrics to the local dashboard however, this dashboard allowed the trust to benchmark themselves against other trusts within their LMNS and facilitate shared learning across the networks.

Managers and staff carried out a programme of repeated local audits to check improvement over time. Local audits included but were not limited to the national maternity and perinatal audit, diabetes national audit, venous thromboembolism VTE in pregnancy and augmentation in labour. Each audit had an auditor and a clinical audit and effectiveness lead.

The service understood their duty to collaborate and work in partnership. However, they were not always open, transparent and receptive to scrutiny.

The trust did not always work collaboratively with other trusts within the Local Maternity and Neonatal System (LMNS) to share learning from incidents. The LMNS held a monthly forum where each trust was expected to share incidents, their outcomes and the resulting safety actions to support learning across the region. Service leaders were reported to be defensive by stakeholders and not proactive to share incidents, their outcomes and safety actions to support learning in the region at these meetings.

The service did however, work collaboratively with the maternity and neonatal voices partnership (MNVP) chairs to better understand the needs of the local population and ensure the voices of women were heard. As part of this, MNVP chairs conducted walk arounds of the maternity unit using the NHS England’s 15 step toolkit. This is a toolkit that explores different healthcare settings through the eyes of those who use them and their relatives and carers. These walk arounds included the MNVP team and the service’s patient experience midwife. The MNVP chair communicated directly with women during these walk arounds, and hosted listening groups in the community. The feedback collated was then shared with the service to support improvement efforts.

Monthly MNVP meetings were held with the head of midwifery and the MNVP chair, to discuss findings and any ongoing work. The MNVP reported active involvement in co-developing action plans in response to women’s experiences. Data provided showed the MNVP contributed to the development of an action plan in response to the Care Quality Commission 2024 maternity survey results.

The service did not always focus on continuous learning, however there was evidence of innovation and improvement across the organisation and local system.

Following our previous inspection that took place in November 2023 and other external reviews, the trust launched a perinatal improvement programme aimed at delivering high quality perinatal care, supported by well-trained and motivated staff. The programme had 4 workstreams, each with defined priority milestones and progress was supported through monthly meetings attended by a range of stakeholders. However, a commitment to learning and continuous improvement was not always actioned in a timely manner. This was evidenced by the backlog of incidents and lack of progress on concerns from our previous inspection.

Leadership did however, promote innovation and participation in research. At the time of our assessment the trust employed 1 whole time equivalent (WTE) research midwife and had plans to recruit an additional WTE research midwife. The trust was actively involved in research studies. This included the digital imaging versus ophthalmology (DIvO) trial and SNAP2, which is a trial testing whether women who have experienced a hypertensive pregnancy can achieve better blood pressure control.

In addition, the trust made efforts to recognise and celebrate staff contributions. The trust participated in the diseases attacking the immune system (DAISY) award programme. DAISY is an international initiative that honours and celebrates the skilful, compassionate care nurses and midwives provide every day. The trust also ran the recognising outstanding support worker excellence (ROSE) awards, which recognises and celebrates outstanding support workers. Staff members could be nominated for these awards by colleagues or patients.