Harrogate District 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We looked for evidence that 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. Some further development of governance, audit and monitoring processes was required to ensure quality, sustainable care, treatment, and support. The service has mostly acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate.

We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The maternity service had developed a strategy since the last assessment whose ambitions included ever safer care, excellent outcomes and a positive experience which were underpinned by the trusts values of kindness, integrity, teamwork and equality (KITE). The KITE values were displayed throughout the service. Staff were able to identify the values. The strategy included priorities which included areas such as improving choice, perinatal mental health and patient information.

The service had developed its strategy to align and support the delivery of national strategies, quality improvement programmes and best practice recommendations, for example, the maternity incentive scheme, Ockenden recommendations, Saving Babies’ Lives Care Bundle. We saw some identified in the evidence we reviewed, for example, the saving babies’ lives care bundle assessment, findings and proposed actions were included as part of the Perinatal mortality review audit (2017 – 2022).

The service had adopted the trusts ‘Impact’ approach to ensure improvement was at the centre of its culture. The strategy included the ‘True North’ ambitions framework and metrics. The True North ambition was to put the patient and child first. Metrics used included: moderate and above harm events, patient experience, children’s patient experience and the 18-week referral to treatment standard.

Leaders said the strategy included feedback from women and staff. We spoke with different staff groups who confirmed their involvement in the development of the strategy. However, not all staff could describe the maternity strategy in detail.

Discussions with staff confirmed a positive culture within the service and said they felt well supported by their leaders. Leaders said they were proud of their staff and described the service as the best staffed in the region.

Leaders said the outcome of the last NHS SCORE survey which measured and identified the culture within the service was positive, despite staff burnout being identified. Leaders recognised not all staff engaged in the survey so implemented the ‘Korn Ferry listening culture coach programme.’ Ongoing listening events took place with different staff groups and an action plan resulted from these events. Following the inspection the trust shared the action plan which identified 8 actions. Progress was identified against these actions; 4 actions were risk assessed amber and remaining actions were green rated.

Staff knew who their managers were and said they were visible on the unit. Managers participated in the manager of the day rota and as such visited all areas to identify any concerns and provide support where needed.

We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles and demonstrated a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

The trust board appointed a non-executive director as the maternity safety champion who was present at monthly meetings. In total 2 board level safety champions (maternity and neonatal) were identified. Board level safety champions and ‘You Said, We Did’ information was shared in the maternity risk management newsletter – June 2025.

Bi-monthly executive walkabouts took place within the maternity service and were reported within minutes of the maternity and neonatal safety champions group (17 March 2025). The March 2025 walk around was reported as mostly positive with some staffing concerns raised. The groups medical lead attended the board workshop bi-monthly. Consultant staff could access the group lead should any issues arise, the group lead meet with the Chief Executive Officer monthly.

Staff said leaders were approachable and visible throughout the service. Senior staff confirmed their presence throughout the service. We spoke with different staff groups whilst we were completing the assessment and heard a mixture of responses from staff about their experiences working within the service. Staff mostly said they felt supported by senior midwives and service leaders. Junior staff felt supported and described staff as kind and helpful to each other.

Senior staff said the service was currently reviewing its staffing structure. Some new senior staff had been appointed or had recently returned from leave. The service also had specialist midwives who could advise and support staff and patients in specific areas, for example fetal well-being midwife and pelvic specialist midwife.

Succession planning was in place and was supported by the specialist midwives who tried to ensure succession planning within their areas. Staff said they could access additional training and education to support career progression.

Leadership development opportunities were available, including opportunities for staff. Team leaders from Harrogate worked 1 day/week in Ripon to improve support for the 3 midwives based there.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The ‘Speaking -up policy’ was available for staff to access and clearly identified who staff could go to for support. The executive leadership team oversaw the policy and its development. The Executive Director for Nursing, Midwifery and Allied Health Professional was the lead director and designated executive manager under this policy.

Staff were informed of the freedom to speak up guardian role at monthly trust induction sessions and as part of the monthly pathway to management course. One maternity (July 2024-July 2025) concern was raised and had been resolved.

Managers and staff accessed the feedback from patients, carers and staff and used it to make improvements. Women, their families and staff could meet with the senior leadership team to give feedback and be involved in decision-making about service changes.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The ‘Workforce Disability Equality Standard 2024’ (WDES) annual report was presented to the trust board. This was so the board members could discuss and note the 2023 WDES metrics and action plan, which attempted to address areas that required improvement for disabled colleagues. WDES was measured through metrics, based on workforce data from the electronic staff records (April 2023 to March 2024), and staff feedback from the November 2023 NHS Staff Survey. The WDES action plan identified 2 actions whose timescales were ongoing, February 2025 and December 2024.

The ‘Workforce Race Equality Standard 2024(WRES) annual report was presented to the trust board. This was so the board members could discuss and note the 2024 WRES metrics and the action plan. The WRES focused on metrics regarding minority ethnic employees and their work experiences. WRES was measured against data from the electronic staff records and staff feedback from the NHS Staff Survey. The 2021 Census was sourced from the Office of National Statistics to contextualize the information in the report. The report communicated the internal data and metrics for the last twelve months; the progress made to date and proposed an action plan. The WRES action plan identified 2 actions whose timescales were ongoing, January and February 2025.

For both the WDES and WRES action plans information was not provided as to the progress made to-date. However, we saw staff feedback within both reports which confirmed progress had been made in some areas, for example, both reports communicated a decrease in bullying. 3.7% of black minority ethnic staff believed the trust provided equal opportunities for carer progression or promotion compared to 2023. Discussions with leaders confirmed the service followed the trust wide WDES and WRES and separate maternity action plans were not identified for these areas.

The annual ‘Public Sector Equality Report 2024/25’ was presented at the people and culture committee on the 28 May 2025. The minutes confirmed the trusts equality, diversity and inclusion work provided assurance the trust was compliant with its Public Sector Equality Duty.

Staff networks were developed to support and involve staff. These included the REACH (Race, Equality and Cultural Heritage) staff network, lesbian, gay, bisexual and transgender/transsexual people, network and working families and carers staff network and neurodiversity staff network. The trust had recognised the importance of supporting, understanding and involving its staff so had provided safe spaces where colleagues could talk, take time out for themselves, share experiences and manage their situations.

Leaders identified outcomes of the 2023 - 2024 staff survey whose response rate was 46%; the staff response rate had increased by 3% from the 2022/3 survey. Leaders identified one area to focus on was to improve the lived experience of colleagues with protected characteristics. To support these leaders said staff training via e-learning in equality and diversity had been promoted.

Leaders said midwives attended the 'Pathway to Management' training which included information on the workforce race equality standard to promote their understanding.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff to help them carry out their role.

Leadership accountability for staff well being was supported through the Employee Assistance Programme, which was available to all staff. The programme offered confidential counselling, cognitive behavioral therapy (CBT), and access to other therapeutic support. Guidance for managers in supporting their teams was provided and managers were encouraged to seek formal advice from their designated human resource team and policy guidance where appropriate. This dual approach ensured that staff and leaders were equipped with the tools to create a psychologically safe and inclusive working environment.

We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 2. The service had clear responsibilities, roles, systems of accountability or good governance. However, further development of audit and monitoring processes was required to ensure quality, sustainable care, treatment, and support. The service has mostly acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Governance:

Governance information identified respective roles, responsibilities and accountabilities clearly. Clear directorate and trust oversight was maintained through a committee framework. This framework confirmed ward to board, regional and national communication pathways existed. Discussions with staff confirmed an awareness of the governance framework. However, we were told not all staff had received training in all areas, for example, the Patient Safety Incident Response Framework (PSIRF). Senior staff confirmed staff were made aware of PSIRF but had not received training in this area.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Close working relationships existed with the local maternity and neonatal system.

The trust was embarking on an ambition digital maturity journey with an overarching Strategic Programme providing oversight. The Board Assurance Framework provided an overview of the digital ambition in the trust. Staff could access digital, data protection, quality and information security procedures. Information was in an accessible format. Staff could access equipment and information technology needed to do their work.

The trust self- assessment of the ‘2025/26 Data Security and Protection Toolkit’ outcome against the assessment on the 27 June 2025 confirmed the standards were met.

The service had identified a Caldicot Guardian and Data Protection lead persons. Staff completed e-learning on information security and information sharing. The training report dated 29 July 2025 confirmed information governance and data security training compliance as 80%.

Confidentiality breaches, including near misses, were reported on the trust’s electronic risk management system.  The information governance lead was notified of all data breach or near-miss events, and they externally reported confidentiality breaches when appropriate. From 19 June 2024 to 8 May 2025 the service had 6 data protection breaches which included: ultrasound data inputted in another patients notes, data breach and confidentiality breaches.

The information governance systems and processes included confidentiality of patient records. We observed a staff member on Pannal had shared their password and logged into the computer system for another staff member so they could use the computer system.

Theatre records were scanned into the hospitals electronic theatre system. However, in the early pregnancy assessment unit and antenatal clinic we saw women’s records stored in an unlocked cupboard and unlocked notes trolley which risked confidentiality and non-compliance of the UK General Data Protection Regulation (GDPR). GDPR identified how organisations must handle personal information. We raised this with a manager in the antenatal clinic who advised that as the notes trolley was within line of sight there was no requirement to lock the trolley.

We were told there were 18 outdated patient leaflets identified as of the 23 July 2025. Policies, guidelines and standard operating procedures when updated were presented and ratified at the bi-monthly maternity quality assurance meeting (MQAM). Following this the trust board received progress updates.

Leaders said the business case template now related to the ‘IMPACT and True North’ objectives which made the submission of a business case easier.

The trust board had oversight of performance of antimicrobial prescribing and stewardship. Staff said the service was alerted by email.

Management of risk, issues and performance:

Risk management guidance was in place. Learning from risk was identified through risk management newsletters. The maternity risk management group met bi-monthly to have oversight of the maternity service. Oversight included: risks, incidents, staffing, training compliance, infant feeding and the progress made against the implementation of Saving Babies’ Lives (v3.2).

The risk register was reviewed bi-monthly and updated at the Maternity Risk Management Group (MRMG) meeting. The June 2025 strengthening maternity and neonatal report confirmed the risk register was formally reviewed on the 27 May 2025. Staff confirmed the main risks, and 11 active risks were identified. The risks included a breach of triage timescales due to insufficient midwifery staffing in the maternity assessment centre (MAC) and delays in facilitating induction of labour; both were risk scored 8 and 6 respectively.

The maternity service reported into national reporting systems in the event of an adverse outcome meeting the set criteria; NHS Early Resolution Scheme (ERS), Perinatal Mortality Review Tool (PMRT), Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) and the Clinical Negligence Scheme for Trusts (CNST). The trust confirmed in year 6 they were fully compliant with the clinical negligence scheme for trusts (CNST) 10 safety actions.

The perinatal mortality and morbidity group met monthly to review incidents from the previous month where mortality or morbidity was highlighted. The PMRT link person was invited to all reviews and the local arrangements with three other trusts existed to act as independent reviewers of cases. The June 2025 strengthening maternity and neonatal report confirmed three third trimester stillbirths

Actions which related to the previously reported PMRT cases were ongoing and monitored through the maternity quality assurance meeting. The target dates for completion of the 7 actions ranged from 1 July 2025 – 1 November 2025, two actions were identified as complete. The risks at review for the remaining actions were rated from Low to High, the 2 low risks related to shared learning with the multi-disciplinary team. The medium rated actions related to the development of processes, responsibilities and remits to improve experiences.

Leaders described the governance processes applied to still births. Reviews took place through several committees and at trust board, the Rapid Review of Serious Event (RROSE) panel and the perinatal mortality review tool (PMRT).

The bereavement lead midwife produced a quarterly report on baby deaths which was shared with the associate director of midwifery. Staff identified 4 neonatal deaths in 2023. This meant the trust neonatal death rates were 5% higher than the average for similar trusts. MBRRACE notifications identified one baby death in 2024. There were 2 third trimester stillbirths in 2025, and one third trimester neonatal death. Nationally the ambition was to reduce baby deaths by 50% by 2030. Staff were advised to consider this for future practice and or learning to understand whether there had been a reduction over the past years and how the trust compared itself with comparator sites. We noted that the perinatal deaths audit (2017-2022) identified no inequalities as a contributing factor to events.

The trust had comprehensive policies and guidelines in place to support an escalation and / or major incident. In addition, the maternity service had a separate maternity escalation guideline. We saw full capacity action cards which were to be completed in the event of an incident. The policies included a trust wide major incident plan, trust bed management and escalation policy and bed management critical care beds.

The trust used the operational pressure escalation level (OPEL) system which identified the pressure the maternity unit was experiencing to inform decision making and risk. For example, OPEL1 indicated patient flow could be maintained, and the trust were able to meet anticipated demand with available resources.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Management:

The planned, surgical and children’s care structure identified the specialities and lead people for each area. The structure was led by a clinical director, operations director and nursing and midwifery associate directors. The maternity and gynaecology group were supported by a matron, service manager and a group clinical lead who was to be confirmed. Additional managers, lead persons and directorate support functions also supported the specialities.

Leaders said the maternity leadership teams met with the ‘Planned Surgical and Children’s Care’ Directorate monthly on the first Wednesday of each month. The following week they attended quality and board meetings. Discussions included complaints, patient safety incidents, mandatory training and finance. Managers attended a workshop whose agenda was set by the trust board. At the most recent meeting they looked at winter pressures, the West Yorkshire Association of Acute Trusts (WYATT) and the trusts 10-year plan. The maternity Inpulse survey outcomes were also presented at this meeting.

Staff Handovers:

Twice daily safety huddle discussions included safeguarding, incident reports, staffing (medical and midwifery). Information from these meetings informed the staff and senior teams of any potential risks and was used to inform the situation, background, assessment, and recommendation (SBAR) communication tool. We were told that SBAR was used however we did not receive the outcomes of any SBAR audits.

Workforce:

Leaders said a staff engagement plan had not been developed, but described engagement platforms used to communicate with staff, for example, monthly meetings with the community manager, shared learning and quality boards, learning from handovers.

Staff attendance at team meetings and staff meeting minutes confirmed learning and updates were received in areas such as complaints, incidents, service developments.

Leaders identified some outcomes of the 2023 - 2024 staff survey whose response rate was 46%; the staff response rate had increased by 3% from the 2022/3 survey. Leaders identified the areas they needed to focus on included: quality of appraisals, staff saying they did not always know what their work responsibilities were, staff worked additional unpaid hours and to improve the lived experience of colleagues with protected characteristics. Some responses included staff encouragement to complete training on equality and diversity and additional appraisal training for team leaders.

Maternity Dashboard/Audits:

Leaders said the maternity services dashboard and maternity audit schedule were in development. The service had adopted the trusts ‘Impact’ approach to ensure improvement was at the centre of its culture and to put the patient and child first. Both the maternity dashboard and obstetric maternity audit plan (v2) confirmed the audits which were either ongoing or planned to commence. The audit schedule confirmed some commencement dates had passed. The service participated in national clinical audits and had a comprehensive programme of repeated audits to check improvement over time.

The maternity dashboard confirmed the progress made against named audits, for example, smoking rates, post -partum haemorrhage (PPH) and third- and fourth-degree perineal tears.

The service monitored its key performance indicators (KPIs) through the performance dashboard (v2). Performance monitoring included areas such as bookings, birth activity, delivery types, pre-term births

We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The Harrogate and the Maternity and Neonatal Voices Partnership (MNVP) workplan – April 2025 – March 2026 was agreed. Seven objectives, actions, resource requirements and progress to date sections were identified. Each objective had identified the progress made for quarter 1 (Q1).

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Leaders said regular communications with the Maternity and Neonatal Voices Partnership (MNVP) had taken place. A neonatal lead person had been recruited to contribute to the MNVP. The MNVP lead had recently reached out to local charities as it was recognised that some areas had pockets of deprivation. To be able to reach these women a weekly drop-in clinic took place in the antenatal clinic. A recent initiative the ’15 step challenge’ was completed by the MNVP and 7 service users.

The maternity voices 15 steps audit was completed earlier in 2025 and one of the recommendations was to review notice boards as they were seen to be too busy with too much information. An additional recommendation related to the review of antenatal clinic waiting times on site for which further detail is in the access section.

A ‘Supporting Neurodivergent Service users and staff’ PowerPoint presentation was used to inform staff. The presentation informed staff of what to expect, the tool kits in use to assist them and considerations for antenatal to post-natal care pathways.

Staff said the family support group was well attended. In addition, other members of the multidisciplinary team attended, for example, physiotherapy, infant feeding lead, talking therapies and the Maternity and Neonatal Voices Partnership.

We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service met the requirements of the maternity incentive scheme year 6.

The service had initiated a frenulotomy service. A patient information leaflet – aftercare following tongue tie division was given to parents. The leaflet explained the aftercare required and what to expect post-surgery. Should parents require support they received the feeding coordinator’s contact details and were informed of where the Harrogate breast feeding club was based.

The service had developed education and guidance in areas such as trauma informed care, skin to skin contact in the first 2-hours post birth.

Two staff completed the Maternity Incentive Scheme (MIS) year 6 – safety action 3. Quality Improvement initiative - Improving rates of and decision making for deferred cord clamping. (date: 30 November 2024) study. Recommendations and next steps were identified.

Artificial intelligence (AI) antenatal screening and screening translation videos had been developed. The AI screening video also included English information summaries as the video played.

Parents could attend the ‘Pregnancy and birth revisited follow-up’ service following the birth of their baby. This allowed the capture of women’s and families experiences through their maternity pathway to inform the future development of the service. Sign posting to other organisations and charities was provided should additional support be required.

The Midwifery and Neonatal Voices Partnership (MNVP) introduced ‘Midwife of the Year’ to mark International Day of the Midwife.

The Antenatal Day Unit was planned to open in September 2025. Staff said this would alleviate the current pressure on the Maternity Assessment Centre as planned antenatal attendances would be seen and treated in the new Antenatal Day Unit.

Leaders worked with Maternity and Neonatal Voices Partnership to develop an enhanced community team for vulnerable women. Staff had received training as part of this new initiative. The training subjects included: equality and diversity, neurodiversity, safeguarding, vulnerabilities and cultural competency.

In January 2025, the Humber and North Yorkshire Local Maternity and Neonatal System Trust Review took place. Following the assessment the outcomes of the Humber and North Yorkshire Local Maternity and Neonatal System trust review was shared and included 3 actions. One action was to arrange a follow up in Summer 2025 and understand what progress had been made. Confirmation that this visit took place was not confirmed. The trust did not share the outcomes of the review.