Queen'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

Areas for improvement in governance limited the service's ability to proactively manage risks and ensure sustainable improvements. Critical issues, such as staffing shortages, medication errors, and patient flow problems, were not consistently captured in the risk register or addressed through established governance processes. Delays in resolving incidents and embedding lessons from adverse events reduced the effectiveness of safety governance. While several operational risks, such as triage staffing, delays in review, and patient flow, had been recorded on the service's risk register, the inspection found that these risks were not always addressed. Concerns raised during the inspection were subsequently reflected in a Section 31 letter of intent, prompting further targeted action by the trust. Freedom to Speak Up initiatives, while present, were undermined by staff perceptions that their concerns were not always acted upon or resolved effectively. These challenges hindered the service's ability to deliver safe, sustainable care.

However, the service demonstrated a clear vision and culture aligned with its organisational values of Passion, Responsibility, Innovation, Drive, and Empowerment (PRIDE). Staff felt supported and valued, and the leadership team was described as approachable and visible. Partnerships with external organisations and the local community were strong, enabling inclusive and collaborative care. The service promoted diversity, equality, and inclusion within its workforce, with measures such as staff networks and inclusive recruitment practices in place.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service demonstrated a clear shared vision, strategy, and culture aligned with its organisational goals and values. The trust's vision was to support and develop a maternity team equipped to deliver outstanding care, empowering staff to provide safe care for women, birthing people, and their families. The vision was underpinned by the PRIDE values, which stood for Passion, Responsibility, Innovation, Drive, and Empowerment. Staff were familiar with these values and were observed embodying them in their work, striving to provide compassionate and high-quality care.

The maternity strategy was aligned with the trust's six corporate objectives for 2023/24, which included delivering high-quality, patient-centred care; fostering a diverse and inclusive workplace; developing the workforce; restoring core services; improving performance; and addressing inequalities for both staff and patients. Leaders had a structured plan to achieve these objectives, ensuring alignment with the wider organisational goals and local community needs.

Staff reported feeling respected, supported, and valued within the service. Leaders fostered a culture of trust, compassion, and openness, enabling staff to voice concerns without fear of reprisal. The service promoted equality, diversity, and inclusion in daily operations and was committed to addressing any workforce inequalities. Opportunities for career development were available, demonstrating the service's investment in staff growth and satisfaction.

Efforts to embed the vision, values, and strategy across all levels were evident, and staff understood how their roles contributed to achieving strategic goals. The service's culture was focused on learning, improvement, and delivering high-quality, person-centred care in collaboration with patients, staff, and external partners.

The service recognised and addressed potential risks to achieving its strategy, including local challenges, and monitored progress against these plans to ensure the sustainability and effectiveness of services

The service had inclusive leaders at all levels who demonstrated an understanding of the context in which care and treatment were delivered. While leaders exhibited the capacity and integrity required to drive improvement, opportunities remained to strengthen their knowledge of operational risks and improve the documentation and follow-through of key discussions during leadership meetings. These improvements would further enhance their ability to manage risks proactively and support the delivery of high-quality, safe care.

Leadership within the maternity service included a quadrumvirate providing strategic oversight. It comprised of the clinical group director for women and children, the clinical group director of midwifery, the clinical group director of nursing, and the clinical director of operations. It also has a team, defined as triumvirate, which was responsible for the operational delivery. The triumvirate consisted of the clinical director for women's health, the head of midwifery, and the general manager for women's health. This leadership structure was supported by a wider senior team and formal governance arrangements, including bi-weekly performance and risk meetings, a monthly maternity assurance board, and regular forums involving safety champions and Local Maternity and Neonatal System (LMNS) partners. The quadrumvirate team met monthly to discuss key issues, including updates from the Care Quality Commission (CQC) well-led domain and input from the maternity safety support programme advisors However, meeting minutes were not detailed, lacking comprehensive documentation of discussions and actions taken.

Staff described the senior maternity leadership, including the director of midwifery, head of midwifery, and matrons, as visible and approachable, which marked an improvement since the last inspection. Medical staff echoed these sentiments, indicating positive engagement across professional groups.

Despite their inclusivity and responsiveness, leaders did not always demonstrate full oversight of how effectively risks were addressed across the service. For instance, the quadrumvirate was aware of risks such as insufficient medical cover in triage and had taken steps to mitigate these prior to the inspection. However, delays in triage continued to be observed, indicating that the impact of this risk had not been fully resolved. Some risks, including the potential for medication errors linked to single prescription charts, used throughout pregnancy, were not consistently escalated through governance systems.These issues were raised during the inspection and promptly acted upon by leadership in an open and constructive manner.

Leaders reported enhanced access to the board and stated that the board demonstrated increased support for maternity services, which was a positive development. The organisation demonstrated commitment to fostering leadership that embodies organisational values, ensuring visibility, approachability, and inclusivity.

The service was actively working towards fostering a positive culture where staff felt empowered to raise concerns, confident that their voices would be heard. Staff reported that they felt able to speak up and escalate issues, but many expressed frustrations that their concerns were not always acted upon or resolved effectively. This perception had limited the impact of the freedom to speak up initiatives in fully addressing the underlying issues within the service.

A Freedom to Speak Up Guardian was in place, providing staff with an independent avenue to raise concerns. The guardian produced an annual report for the trust board to ensure that senior leadership remained informed about the culture and challenges across the organisation. While this structure provided oversight, its effectiveness in driving actionable change at the service level was not consistently evident.

Leadership within the service acknowledged the need to improve the culture around speaking up. Efforts were being made to create a more inclusive environment where concerns raised by staff were treated as opportunities for learning and improvement. Staff we spoke to expressed hope that these initiatives would result in meaningful change, but many felt that improvements in responsiveness and communication were still required. This approach aligned with the service's commitment to fostering openness, honesty, and transparency.

The service valued diversity within its workforce and demonstrated efforts to foster an inclusive and fair culture by improving equality and equity. The service acknowledged the need for continued focus on improving the workplace culture, addressing disparities, and supporting staff with protected characteristics under the Equality Act. Leaders demonstrated a proactive approach by engaging with staff, promoting inclusion, and striving to build an equitable and representative workforce.

Several staff networks were in place to support this commitment, including the Ability not Disability Network, Black, Asian, and Minority Ethnic (BAME) Network, LGBT+ network, Men's Health Network, and Women's Network. These networks were seen as valuable by staff, including internationally educated midwives, who highlighted the BAME Network as particularly beneficial for peer support and communication.

Leaders were actively working to review and improve the service's culture. Staff noted incidents of incivility, particularly affecting newly qualified members of staff. However, management had recently begun addressing these behaviours by monitoring staff conduct, organising workshops, and implementing staff support groups. This demonstrated the service's commitment to tackling bullying and harassment at all levels and promoting a respectful and supportive workplace environment.

The service took steps to ensure equality of opportunity in the recruitment process. Measures included making recruitment and selection training mandatory for all interview panellists, rotating panellists to reduce bias, and encouraging staff to participate in equality, diversity, and inclusion (EDI) partner training. These initiatives aimed to create a fair recruitment process, enhance workforce diversity, and ensure that the workforce better reflects the population it serves.

The service demonstrated a structured approach to governance, with clear lines of accountability and engagement with external oversight bodies. However, gaps in risk management and proactive governance were identified. These limited the service's ability to mitigate risks effectively and ensure sustainable improvements. The concerns raised during the inspection highlighted areas where governance within the service could be improved.

The service had established governance structures with clear roles, responsibilities, and systems of accountability, supported by a dedicated governance team. This team included the quality assurance, governance and safety lead, the quality improvement and assurance midwife, and the lead midwife for safety, among other roles. The governance team facilitated various quality assurance activities, including the submission of data to external organisations such as the Maternity Incentive Scheme and the Maternity and Newborn Safety Investigation (MNSI) programme. However, the inspection identified significant weaknesses in the governance systems, particularly in risk management.

The governance team held regular meetings and reported having access to the trust board. Some risks identified during the inspection, such as challenges with medical staffing in triage and patient flow delays, had been recorded and mitigated through the risk register prior to the inspection. However, the continued presence of these issues at the time of the inspection indicated that actions taken had not yet fully resolved their operational impact, and not all emerging risks, such as the use of single prescription charts across episodes of care, had been consistently escalated through established governance processes.

The inspection highlighted that some risks, such as medication errors linked to the use of single prescription charts across multiple admissions, were only addressed reactively following escalation by inspectors, rather than through established governance processes.

The service conducted after action reviews (AAR) to support learning from adverse events. However, attendance at these reviews, particularly by clinical staff, was inconsistent, limiting their effectiveness in embedding learning into practice. Several incidents logged through the trust's local freedom to speak up and events system highlighted recurring issues, including delays in triage assessments, prolonged wait times for medical reviews, and harm caused by delays in transferring patients to appropriate clinical areas. Despite these incidents, there was insufficient evidence that lessons learned had been effectively disseminated or embedded to prevent recurrence.

During the inspection, the Care Quality Commission issued a letter of intent under Section 31 of the Health and Social Care Act 2008, outlining significant risks requiring immediate mitigation. These included: routine breaches of the Birmingham Symptom Specific Obstetric Triage System (BSOTS) timelines for initial triage and medical reviews. Staff shortages caused delays in care, contrary to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. Bed shortages resulted in delays in transferring patients from triage to labour and antenatal wards, with some women waiting in inappropriate clinical areas. These findings highlighted in the governance framework's ability to identify and address critical risks proactively.

In response to these findings, leaders implemented measures to address immediate concerns, including reallocating medical staffing to provide dedicated triage cover during peak hours, improving attendance at AARs, and revising the risk register to include the risks identified during the inspection.

Leaders reported improved visibility of maternity services at the trust board level, with the maternity governance team presenting regularly. However, ongoing challenges, such as staffing shortages, service-wide flow issues, and delayed implementation of an electronic patient record system, continue to impact the service's ability to deliver safe, sustainable care.

The service demonstrated an understanding of its duty to collaborate and work in partnership, enabling seamless care for people. Partnerships with external stakeholders and agencies were a key feature of the service's approach to delivering safe and effective care. This included collaboration with the Maternity and Newborn Safety Investigation (MNSI) programme and the Maternity Safety Support Programme (MSSP), where staff and leaders actively engaged to share information, learning, and drive improvement.

The Maternity and Neonatal Voices Partnership (MNVP) was a central feature of the service's engagement with service users and the community. The MNVP chair worked closely with the senior leadership team and partnered with another MNVP chair to develop the Cradling Culture Project, which aimed to provide equitable and inclusive care for women from Black, Asian, and minority ethnic backgrounds. This collaboration highlighted the service's commitment to addressing health inequalities and fostering community partnerships for innovation and improvement.

The service demonstrated a commitment to sharing learning and good practice. Staff reported regular engagement with external stakeholders, ensuring that feedback and insights were used to improve service delivery. Information and lessons learned from programmes such as MSSP and MNSI were shared across teams to enhance the safety and quality of care provided.

The service also actively engaged with local community groups to understand and address the needs of the population it served. This included attending mother and baby sessions, faith groups, and children's centres to ensure that the voices of seldom-heard groups were included in service planning and delivery.

The service worked in partnership with other organisations to support the delivery of joined-up care. Examples included close collaboration with community services to support women through pregnancy, birth, and postnatal care, ensuring continuity and a seamless transition between different services.

The service demonstrated a strong focus on continuous learning, innovation, and improvement, creating a culture where staff were empowered to develop their skills and implement innovative practices to enhance care quality and safety. One notable example of this commitment was the introduction of training for antenatal, Obstetric Assessment Unit (OAU), and community midwives to perform presentation scans. This initiative included 10 supervised competency sessions, equipping midwives with the skills needed to manage critical aspects of care independently, which improved patient outcomes and service efficiency.

The service also introduced mentoring and coaching sessions for midwives, fostering professional development and leadership skills. These sessions aimed to equip midwives not only with clinical expertise but also with the interpersonal and leadership skills needed to excel in their roles, empowering them to become compassionate leaders and advocates for women and families.

The service actively engaged with external work, including research, to embed evidence-based practices. This was reflected in their recognition at the 2023 HSJ Partnership Awards, where they won the patient safety category for their surgical site infection initiatives. This achievement highlighted the service's commitment to improving patient safety through innovative and evidence-based approaches.

Leaders encouraged staff to contribute to improvement initiatives and supported the development of their skills in innovation and problem-solving. Staff reported feeling empowered to share ideas and collaborate with leadership to enhance service delivery.

Staff and leaders collaborated on reflective practices and collective problem-solving to address challenges and improve outcomes.

The service built strong external relationships to support improvement and innovation. Engagement with external organisations and research networks strengthened their capacity to deliver evidence-based, safe, and effective care.

Staff and leaders collaborated on reflective practices and collective problem-solving to address challenges and improve outcomes The service also prioritised learning from incidents and examples of good practice, ensuring lessons were embedded into daily practice to drive continuous improvement. Staff and leaders collaborated on reflective practices and collective problem-solving to address challenges and improve outcomes.