James Paget Hospital

Updated 1 April 2026

Date of assessment: 16 September 2025. James Paget Hospital is part of James Paget University Hospitals NHS Foundation Trust and offer a range of hospital services to people living in north-east Norfolk and north Suffolk. This assessment looked at maternity services to follow up on the concerns identified at the previous inspection, which we rated as inadequate. The new maternity service rating has been combined with the ratings of the other services based on the most recent assessments and the rating for James Paget Hospital is now good. See our previous reports to get a full picture of all the services at James Paget Hospital.

Updated 28 April 2025

James Paget University Hospitals NHS Foundation Trust provides maternity services at James Paget Hospital. From April 2023 to March 2024, there were 1715 babies born at James Paget Hospital.

We last inspected maternity services at James Paget Hospital in January 2023. This was a focused inspection looking at Safe and Well-led as part of the National Maternity Safety Inspection Programme. Maternity was rated inadequate overall.

We conducted this unannounced focused assessment on 16 September 2025 to follow-up on the 2023 inspection findings. As this was a focused assessment, we only looked at the safe and well led domains.

We visited the following areas as part of the assessment:

The postnatal and antenatal ward, triage and maternity assessment unit, obstetric theatre and recovery area, the birth centre and labour suite. We also looked at the bereavement facilities, and outpatient areas including antenatal consulting areas and pregnancy scanning areas.

We spoke with members of the maternity team including maternity support workers, junior doctors, registrars, consultant obstetricians and anaesthetists, band 5, 6 and 7 midwives, specialist midwives, the consultant midwife, matrons and the quadrumvirate.

Safe: We looked at maternity services only and rated safe as requires improvement. Staff did not manage inpatient paper records safely to ensure important information was correctly recorded or to prevent records falling apart. Not all staff undertook required training to safely treat and care for women. The facilities mostly met the needs of women, the service was taking action to address issues around the maternity triage. However, the service had a good learning culture. Managers investigated incidents thoroughly. Staff followed clear safeguarding pathways. There was enough equipment and this was safe to use. Staff followed infection control guidance. There were enough staff with the right qualifications and experience. Staff managed medicines well.

Well-led: We looked at maternity services only and rated well led as requires improvement. The culture within the service had improved since our last inspection, although there remained a small pocket of dissatisfaction. The service had improved but further work was needed in reporting of incidents externally. Leaders were visible and worked hard to foster collaboration with staff. There were systems in place for staff to raise concerns, although staff told us they did not always feel concerns were listened to. Risk was managed in a timely manner and maternity leaders worked collaboratively with partners. There was a culture of continuous improvement with staff given the time and resources to try new ideas.

Updated 6 December 2018

A summary of our findings about this service appears in the Overall summary.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as good because:

• Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Nursing staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However,

• The service did not have enough nursing staff with the intensive care qualifications to meet the faculty of intensive care medicine (FICM) guidelines. Managers regularly reviewed skill mix and encouraged nursing staff to obtain the qualification where possible.
• There was a lack of support to the critical care unit from physiotherapy staff and pharmacy staff. This meant patients did not always get the right amount of multidisciplinary team input.
• The service did not have a defined strategy to enable staff to deliver the vision.
• Staff did not always evidence the completion of mental capacity assessments when they suspected patients lacked capacity to make informed decisions.
• Staff were not aware of the freedom to speak up guardian (FTSUG)

Updated 18 December 2019

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Certain clinics were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. Staff focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not always resolve complaints within specified timescales.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff mainly had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Although patient records were not always stored securely. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Not all national time to treatment targets were met.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. 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 patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 18 December 2019

• The urgent and emergency service had enough staff to care for patients and keep them safe. Staff were trained in the necessary key skills, knew how to protect patients from abuse, and managed safety well. Staff controlled infection risk well, assessed and monitored patient risks and mostly kept good care records. Staff generally managed medicine storage and administration well. The service managed safety incidents well and learned lessons from them, however, there were occasions when incidents were not reported in a timely way. Staff collected safety information and used it to improve the service.
• Staff provided good evidence based care and treatment, gave food and drink and pain relief when patients needed it. Senior staff monitored the effectiveness of the service and made sure staff were competent. All staff worked well as a team to treat patients, provide advice on leading healthier lives, and support them to make decisions about their care.
• All staff showed compassion and kindness in their interactions, and respected peoples’ privacy and dignity. Staff respected peoples’ individual needs and provided emotional support to patients, families and carers and supported them to understand and make decisions about their care and treatment.
• The service planned and worked with others to provide care to meet the needs of local people. Staff took account of peoples’ individual needs, and made adjustments to help patients access services and for people to give feedback. People could access the service when they needed it and although waiting times from arrival to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards, they were better than or similar to England average. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff although they did not meet the complaints response targets.
• Leaders and staff understood the service’s vision and values and knew the issues the service faced. Leaders were visible and approachable and there was a positive open culture throughout the service. Staff felt respected, valued and supported to develop their skills. The service had systems for identifying and resolving risks although ownership of risk was at a corporate level. Leaders operated effective governance processes, throughout the service and with external and partner organisations. Staff were clear about their roles and accountabilities and engaged well with patients and the community to plan and manage services. All staff were committed to continually improving services.