Liverpool Women's 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

Our rating of well-led improved. We rated well-led as good.

Leaders ran services using reliable information systems and supported staff to develop their skills. There were clear and effective governance, management and accountability arrangements. Staff were clear about their roles and accountabilities. Staff understood the service's vision and values, and how to apply them in their work.

Staff felt respected, supported and valued. They were focused on the needs of people receiving care. Leaders engaged with partners and the wider community to plan and manage services. Leaders promoted a work culture based on equality, diversity and inclusion. Staff were supported to speak up or raise concerns.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The hospital’s vision was to be the recognised leader in healthcare for women, babies and their families. The vision was underpinned by a set of 5 values and behaviours relating to care, ambition, respect, engagement and learning.

The operational plan 2025/26 outlined the annual strategy for the maternity services as part of the overall 5 year divisional transformation strategy. The operational plan included strategic objectives around improving quality, safety and people’s experience and workforce, diversity and leadership. Progress against the objectives was reviewed as part of routine divisional and departmental meetings.

Information about the vision, values and strategy was displayed in the areas we inspected, and staff had a good understanding of these.

The NHS maternity staff survey 2024 data for the family health division showed improved response scores from the 2023 survey in indicators such as appraisal, development and flexible working opportunities, experiencing discrimination based on ethnicity and well-being support from line managers. The survey also showed deteriorating response scores from the 2023 survey for indicators such as recommending the organisation as a place to work, having enough staff, staff feeling appreciated and their work being valued by the organisation.

We received multiple whistle blower concerns over the past 12 months with negative feedback about the culture within the maternity services. Allegations included bullying, bias, racial discrimination and lack of visibility relating to senior managers.

We were not able to substantiate these concerns during our inspection. We spoke with over 50 staff across the maternity services, through discussions with individuals in the clinical areas we inspected and through staff focus groups involving midwifery and medical staff across a range of job grades. The overwhelming feedback from staff was positive and most of the staff we spoke with told there was a friendly and open culture focussed on teamwork and providing high quality care.

Staff told us the culture had significantly improved in the last 18 months through additional recruitment. They told us they enjoyed working in the service and felt supported to carry out their roles effectively. Staff told us there was greater sense of teamwork and trainees and new recruits felt supported by their peers and managers.

The maternity services at the hospital formed part of the family health division. There was a divisional triumvirate leadership team consisting of medical, nursing and operational leads. There were clearly defined leadership roles in the mat base ward, delivery suite, MAU and MLU with experienced midwifery managers, shift coordinators and matrons along with clinical consultant leads for the medical staff.

The service had a director of midwifery and a head of midwifery. The maternity services also included specialist staff with specific responsibilities, such as digital midwives, research midwives, practice based educators and leads for safeguarding and managing medical emergencies.

The divisional and departmental leaders understood the risks to the services and had clear oversight on quality and safety, governance and performance issues through daily involvement and quality monitoring.

Staff told us they understood the reporting structures clearly and spoke positively about the support they received from line managers. They told us managers and senior leaders were visible, approachable and provided them with good support and guidance.

We identified a regulatory breach around the provision of supernumerary leadership on the mat base ward during our previous inspection in January 2024. During this inspection, we found improvements had been made. The mat base ward, MAU, MLU, IOL and delivery suite had senior midwife supernumerary shift coordinators in place on each shift. Allocation of supernumerary shift leaders was monitored and there had been no instances where shift leaders were not supernumerary in the past 12 months. Shift leaders we spoke with told us they were allocated sufficient time to carry out their management duties.

The service had a freedom to speak up, raising concerns and whistle blowing policy that provided guidance for staff around how to raise concerns internally and externally. The hospital had appointed 2 freedom to speak up guardians.

Staff told us they felt confident they could raise any issues with their managers and that managers listened to them. Staff were aware of the freedom to speak up process and understood how to contact the freedom to speak up guardians if needed.

The freedom to speak up guardians told us they felt supported in their role but did not always get protected time to carry out their role. We raised this with senior managers during the inspection and they told us they would ensure the guardians are allocated sufficient time to carry out the role effectively. Senior leaders also told us they planned to align the hospital's freedom to speak up process with the University Hospitals of Liverpool Group policies to enable greater transparency and oversight.

The freedom to speak up guardians submitted a report to the hospital group board every 6 months. The report for May 2025 included details of key themes raised by staff, an overview of freedom to speak up training implementation and details of steps taken to promote freedom to speak up processes among staff.

Staff told us the service had an inclusive working culture, and they were treated with respect and equity. Staff told us managers engaged with them regularly and they felt confident their concerns were listened to. The staff we spoke with told us they had not experienced any instances of unfair treatment, discrimination or harassment.

Staff received training in equality, diversity and human rights and had equality, diversity and inclusion policies in place to provide support and guidance. Managers told us equality, diversity and inclusion was embedded in the culture of the service. They told us they routinely engaged with staff to maintain an inclusive, diverse, and supportive work environment.

The hospital had an anti-racism lead in place and had launched an anti-racism and discrimination programme, and anti-racism training had been undertaken by senior leaders and managers across the service.

Processes were aligned with national standards such as the workforce race equality standard (WRES) and the workforce disability equality standard (WDES). Hospital-wide WRES and WDES data (2023/24) showed there had been increased representation in senior roles and higher overall workforce diversity. However there was still a disparity in the likelihood of white staff being appointed from recruitment shortlisting compared to black, asian and minority ethnic (BAME) or staff with a disability across all posts.

Managers engaged with staff on a daily basis to monitor work culture and to identify and resolve any bias or discrimination. There were support mechanisms for staff with protected characteristics, including flexibility around working arrangements and shift patterns. Staff could access support from anti-racism hubs and race equality networks. Additional training such as transgender awareness training and neurodiversity training had been launched to raise staff awareness. Health passports and reasonable adjustments policies were in place to support staff with additional needs, such as neurodiversity.

The 2024 NHS staff survey responses showed the hospital performed worse than national average for key indicators relating to staff morale and engagement, but performed similar when compared with regional peers and other specialist maternity hospitals.

Findings from the 2024 survey had been reviewed and the maternity services had implemented an action plan based on 3 priorites; safety culture, feeling valued at work and not enough staff to do job properly. Improvement actions included additional recruitment of maternity support workers in the mat base ward and improved engagement and support for staff across the maternity services to improve career progression oppurtunities and staff welfare.

Staff in the maternity services also participated in pulse surveys every 3 months and action plans were in place to improve in areas such as workplace disagreements, burnout, job security and growth opportunities.

Staff engagement also took place through daily discussions, team meetings, senior leadership walk rounds, newsletters and through other general information and correspondence that was displayed on notice boards and in staff rooms. Staff in the maternity services could also attend twice yearly big conversation engagement events and `great place to work' staff forums.

The maternity services had clear governance structures in place that provided assurance of oversight and performance against safety measures. There were monthly family health divisional board meetings, risk and governance meetings and weekly senior midwifery leadership group meetings to discuss performance, governance and risk across the maternity services. Staff also took part in routine departmental and specialised staff group meetings.

Recent meeting minutes showed key discussions took place around performance, risk, governance, audit findings and incidents. Action logs were in place for key performance indicators and these were followed up at subsequent meetings.

Staff told us information on performance, risks and governance was discussed during daily handovers, safety huddles and during routine team meetings.

Managers understood the key risks to the services and maintained departmental and divisional-level risk registers. The departmental and divisional risk registers showed that key risks were identified, and control measures were put in place to mitigate risks. Risks had a review date and an accountable staff member (such as matrons or clinical leads) responsible for managing that risk. Staff were aware of how to record and escalate key risks on the risk registers.

Routine audit and monitoring of key processes took place to monitor performance against safety standards and organisational objectives. Information relating to performance against key quality, safety and performance objectives was monitored and cascaded to staff through team meetings, huddles, performance dashboards and newsletters. Staff told us their performance was routinely monitored and they received feedback following audits to aid learning and improvement.

Managers were aware of their responsibility to report notifiable incidents. There was a system in place to ensure safety alerts relating to safety, medicines and medical devices were cascaded to staff and responded to in a timely manner.

The hospital became part of the University Hospitals of Liverpool Group in November 2024 and senior leadership structures were being aligned to the group model. There was also a plan underway to align strategic objectives, policies and procedures with group level processes.

The maternity services were assessed against national standards (such as Care Quality Commission fundamental standards) as part of the `be brilliant accreditation scheme' (BBAS). Recent compliance in the MLU, MAU mat base ward and delivery suite ranged between 77% and 86%, demonstrating high standards of compliance against the accreditation standards. Action plans were in place to improve areas for improvement identified as part of the accreditation visits.

People who used the service told us care and treatment was well co-ordinated, and staff engaged and kept them informed about their care and treatment.

Staff in the maternity services worked closely with community midwifery services, local maternity and neonatal system (LMNS) networks, local and regional acute and specialist children’s hospitals and ambulance services to plan and deliver effective referral, admission, transfer and discharge pathways for people who used the service, including emergency and trauma pathways.

Service commissioners and partners told us they held regular engagement meetings with the maternity services to discuss quality and safety and delivery of care pathways.

Service partners and stakeholders told us staff in the maternity services worked collaboratively to deliver effective services. They gave examples of partnership working in initiatives relating to admission and referral pathways and engagement within the wider community to promote maternity services, especially to vulnerable or hard to reach communities, such as people who did not speak English as a first language and refugees or asylum seekers.

Staff told us they routinely engaged with local communities and people who used the service to gain feedback and improve people’s experiences of using the service. Examples included feedback surveys, focus groups and routine engagement events (such as engagement events with local faith groups and local football grounds).

The Liverpool maternity and neonatal voices partnership (MNVP) was actively involved in engagement with people who used the service and local communities. They conducted scheduled walk rounds of maternity services and conducted listening events to help improve delivery of services.

The MNVP actively engaged with maternity staff and were involved in service improvements, such as updates to information and guidelines for staff and people who used the service and involvement in upgrades to the IOL suite and MLU areas.

The infant feeding team and a pharmacy discharge area were also placed in the maternity base ward as improvements following feedback from people who used the service.

Staff told us there was a culture of learning, innovation and improvement across the maternity service. They told us learning from audits, quality monitoring and quality improvement programmes was shared to aid learning and improvement.

The service had made improvements in areas identified as shortfalls at our previous inspection in January 2024, such as processes for monitoring and managing people with deteriorating health and staff leadership on the mat base ward.

We saw evidence of learning and improvement resulting from findings from audit results, incidents and complaints and shared learning had been cascaded to staff to improve services.

Quality improvement projects undertaken as part of the deteriorating patient collaborative had led to improvements in triage time performance in the MAU and improvements in early warning score observations compliance across the maternity services. The services had also completed quality improvement projects relating to cystic fibrosis and pregnancy and the implementation of safety huddles in the delivery suite.

The maternity services had completed 7 service evaluations during 2024/25, including for pre-term birth intervention, evaluating routine screening for fear of childbirth and evaluation of isolated polyhydramnios referrals

The maternity services were involved in a number of clinical research studies. Recent Research trials underway in the delivery suite included a trial to compare Carbo Prost with Oxytocin as initial treatments for women with clinically diagnosed postpartum haemorrhage after giving birth in UK hospitals and a trial of manual versus instrumental rotation of the fetal head in malposition at birth. A clinical trial was in progress in the mat base ward to look at whether diagnostic accuracy of newborn eye screening for congenital cataract could be improved with digital imaging.