Princess Royal University Hospital Also known as Farnborough 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 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. We checked that leader 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 inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This indicated that while there were efforts to improve, leaders did not consistently manage risks in a timely way or cultivate a positive and inclusive culture.

The service was in breach of legal regulation under good governance relating to management of risk and lack of consultation with staff, prior to changes made within the service.

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.

The trust had a 5-year vision and strategy published in 2021 for what it wanted to achieve and objectives to turn it into action. This strategy was developed by staff, patients, partners and the public from across the trust’s networks. The vision and strategy was BOLD which stood for:

• Brilliant People
• Outstanding Care
• Leaders in Research, Innovation and Education
• Diversity, Equality and Inclusion at the heart of everything we do

This vision and strategy was adopted by maternity and an action plan to achieve it was developed specific to the women’s health care group. The service also had values for staff to follow which were; kind, respectful and team. Staff we spoke with were aware of the vision and strategy and trust values.

The service had a vision statement however, it was not clear if this had been co-produced with staff and stakeholders. The vision was: “Our vision is to achieve best possible outcomes and experience in our care by empowering staff to always be kind, to listen and to engage with our families”. The service also had priorities to achieve their vision, this included best clinical outcome, a safe culture, listen to staff and families, workforce transformation and digital technology.

Staff we met were welcoming, friendly and helpful. We observed staff working together as a team to provide high quality care and to positively impact patient experience. Most of the staff we spoke with onsite were positive about the service.

Staff of all levels did not always feel involved in decision making, which was negatively impacting staff morale and the culture within the service. They often felt changes were made by leadership without risk assessing how it will impact staff’s wellbeing and workload. The NHS staff survey 2024 showed that the service scored below the trust average across several categories, including ‘we all have a voice that counts.’

Leaders reported being aware of the poor morale and culture within the service and how this could affect the quality of people’s care. To understand the culture within the trust, maternity staff undertook a SCORE survey in April 2024, which is an internationally recognised way of measuring and understanding culture. The 3 main themes for improvement were; staff wellbeing, staff involvement in decision making and staff retention. The results were fed back to staff at sessions organised by the service.

In response to these results the trust developed an action plan which included but was not limited to the introduction of monthly staff forums, improving visibility of leadership with weekly ward walkarounds and increasing staff awareness of wellbeing resources available. The trust also reported that the results from the SCORE survey was used in the perinatal culture and leadership programme (PCLP). This was a structured programme, designed to support maternity and perinatal care teams in creating a positive safety culture and was facilitated by a PCLP lead and a dedicated coach. The last update of actions following the score survey and PCLP programme was in December 2024. The service reported that along with the actions above, they were working to agree interventions based on emerging themes that will be agreed as part of the revised maternity strategy.

The service had professional midwifery advocates (PMA’s) which is a role to help maternity staff by supporting their practice, wellbeing and professional development. The services offered by PMA’s included but was not limited to supporting maternity staff, providing a safe space to talk and be listened to, offering debrief sessions after clinical incidents and wellbeing and career development conversations. It was unclear however, how many PMAs were at the service.

Leaders at all levels had the skills, knowledge, experience and credibility to lead effectively however, staff did not always feel leaders were compassionate.

Kings College Hospital NHS Foundation Trust had maternity services at the Kings College Hospital site and the Princess Royal University Hospital site. The service had a history of unstable leadership over the past 3 years which staff reported impacted morale however, the trust now has a fully established leadership team. Maternity services sat within the Women’s Health care group and had a trust level perinatal leadership team also known as the quadrumvirate. The quadrumvirate consisted of the director of midwifery, clinical director of women’s health, clinical lead of neonatology and general manager of women’s health. Each hospital site also had a head of midwifery.

Leaders had the experience, skills and ability to run the service. However, staff did not always feel leaders consulted with them about changes within the service. Staff reported that various changes had been made that had negatively impacted the care they were able to provide. This included but was not limited to a reduction in bank pay rates and the reduction in the number of band 7 ward managers in areas across the unit. In response to this the trust reported that the change in bank rates specifically, was a trust-wide initiative introduced in June 2024 to align with the London sector. They also reported that this was communicated however, it was acknowledged that communication could have been handled more effectively.

The service held monthly quadrumvirate meetings. We reviewed the meeting minutes between December and April 2025 and found that the meetings were well attended with apologies given if necessary. The meetings covered key topics such as governance compliance updates, workforce, assurance visits, patient experience, stakeholder feedback, business cases and forward planning for the future.

Leaders understood the differing needs of the local population at each hospital site. They understood how health inequalities affected treatment and outcomes for women and babies from ethnic minority and disadvantaged groups in their local population. They worked closely with various stakeholders such as the maternity and neonatal voices partnership (MNVP) and the local maternity and neonatal system (LMNS) who attended various meetings and had an extensive programme to improve the equity of experience and outcomes.

There were clear lines of reporting from the site leadership team, the quadrumvirate and the board. However, staff reported that senior leaders, including the director of midwifery and executive team, were less visible at PRUH compared to the King's College Hospital site. The trust reported that this was due to the differing needs of the two sites, however the director of midwifery attended the PRUH site once a week and ensured there were several opportunities for staff to communicate with senior leaders. This included meetings, safety huddles and walkarounds. The hospital level senior leadership team reported they had direct access to the quadrumvirate however, they were not always involved in decision making that affected their clinical areas.

The service had maternity, obstetric and neonatal safety champions, this was the director of midwifery, the clinical director and the clinical lead of neonatology. They reported that the board was invested in maternity and the support of board safety champions increased the profile of maternity services. The service had an executive board safety champion who was the chief nurse and a non- executive board safety champion. The role of a board safety champion is to provide proactive board level leadership and bridge the gap between the service and the board. They reported doing regular walk arounds, alternating between each hospital site. They collated information from staff and women and produced a poster highlighting what has been done in response to what was raised.

The trust held quarterly maternity and neonatal quality and safety meetings which was also chaired by the chief nurse (executive board safety champion). The meetings covered key topics such as risk and governance, compliance with training and schemes, patient experience and local, national and regional updates. We reviewed the meeting minutes for the last 2 meetings and found that the meeting was well attended by various members of the multidisciplinary team, members of the perinatal leadership team and representatives from the LMNS and NHS resolutions. However, we noted the absence of the non-executive board safety champion at the last two meetings.

The service had a culture where people felt they could speak up however, they did not feel their voices would be heard.

Staff at all levels reported that they felt comfortable speaking up however, when they did, action was not always taken in response which negatively affected morale, and their desire to raise concerns in the future. The service had a freedom to speak up (FTSU) guardian and staff knew how to access them and we observed posters with the FTSU guardian details. Staff had raised 13 concerns to the freedom to speak up guardian between April 2024 and April 2025. These concerns were related to bank pay rates, lack of training opportunities, the recruitment process and shift allocation. The service reported that they had introduced self-rostering in response to shift allocation concerns however, it was unclear what the service was doing in response to the other concerns raised.

Staff also had access to professional midwifery advocates (PMA) and management at all levels. The service also held staff meetings in individual areas within the service this included community, maternity wards and labour ward. The service also had separate meetings for students, safety and flow midwives and band 7 midwives. Staff were able to attend these meetings in person and virtually. Meeting minutes that we reviewed showed that the meetings were well attended and the topics discussed were comprehensive. The frequency of staff meetings varied and was not consistently recorded.

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

Staff and leaders, we observed onsite were representative of the population of people using the service. Staff we spoke with felt valued and respected by other staff and reported having positive working relationships. We also observed positive multidisciplinary working onsite.

While staff we spoke with reported feeling respected, trust-wide workforce equality data indicated continued challenges in areas such as harassment and career progression, particularly for staff with long-term conditions or from ethnic minority backgrounds. The NHS 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 26% of white staff and 28% of staff from other ethnic groups had experienced harassment, bullying or abuse from staff in the last 12 months. Only 52% of white staff and 44% of staff from other ethnic groups believed that the organisation provided equal opportunities for career progression or promotion. Findings from the hospital workforce disability equality standards question showed 32% of staff with long-term conditions or illnesses and 20% of staff without long-term conditions or illnesses experienced harassment, bullying or abuse from other colleagues in the last 12 months. Only 40% of staff with long-term conditions or illnesses and 49% of staff without long-term conditions or illnesses believed that the organisation provided equal opportunities for career progression or promotion.

According to the trust website there were equality networks that staff were able to join. This included the; inter faith and belief network, kings able- staff disability network, kings and queer- LGBTQ network, race ethnicity and cultural heritage (REACH) network and the women’s network.

The service had clear responsibilities, roles, systems of accountability and good governance. However, risks were not always managed in a timely way.

Leaders operated effective governance processes, throughout the service and with partner organisations. The governance team was made up of a head of governance, compliance and assurance, a maternity quality improvement transformation lead, a lead midwife for education and workforce, patient safety managers and audit and quality midwives. At the time of the assessment the head of maternity governance, compliance and assurance role had been vacant since January 2025. The trust had however, reported that the post had been recruited into and the new appointee was due to start at the end of April 2025.

Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The trust had monthly governance meetings attended by multidisciplinary staff from across the 2 hospital sites. In the absence of a head of maternity governance this was chaired by the director or head of midwifery. We reviewed the meeting minutes between January and March 2025 and found the meetings to be well attended and comprehensive. The meeting had standing items of discussion, which included but was not limited to risk and governance, the risk register, the maternity dashboard, education and training, safety alerts and approval of standard operating procedures (SOP) and guidelines.

The service had a risk register that currently had 16 open risks. The risk register included a title, description of risk, risk cause and impact, hospital site, directorate, speciality, the date it was added to the register, the allocated handler, risk score, review date and the controls currently in place. The risk register included the risks we identified during the assessment which provided assurance that leadership and staff were aware of the risks within the service.

However, we noted that some of the risks had been on the risk register for extended periods of time. For example, clinical delays in the maternity assessment unit had been on the risk register since April 2022 and had been rated as a lower risk. This was raised with the perinatal leadership team, and they reported that although these risks remained on the risk register, they were assured they had control measures in place to ensure women were safe. They also reported that they regularly reviewed the risk rating and adjusted it depending on how successful the control measures were.

Staff we spoke with were aware of the risks within the service. The service showed evidence of a governance newsletter that was disseminated to staff via email which highlighted the top 3 risks on the risk register.

The trust monitored incidents and had a clear process for incident investigation. At the time of inspection, there were 16 open incidents. Half of these incidents had not been reviewed however; they were all categorised as low harm. Managers reported that they reviewed incidents submitted by staff via an incident reporting system regularly to review the information and the level of harm. Managers then investigated incidents and identified if the incident could be closed and used for learning or escalated to the weekly patient safety incident response framework (PSIRF) panel. The panel identified whether a patient safety incident investigation (PSII) and/or a referral to the maternity and newborn safety investigation (MNSI) was required.

The trust provided one of the minutes for the PSIRF panel which showed that it was chaired by a patient safety manager and attended by representative from midwifery and obstetrics. The service involved women and their families in these investigations. The service reported that all PSII reports were presented to the outstanding care board and patient safety committee for approval of findings and recommendations. After this the report was then shared with women.

Data and notifications were submitted to external organisations. The service showed evidence of submitting all qualifying cases to the MNSI. All NHS trusts are required to tell the MNSI about specific safety incidents that happen in maternity which are then investigated and where relevant safety recommendations are made. The trust had referred 10 cases to the MNSI in the last 12 months, 3 of which were rejected by the MNSI. Two reports had been completed, and no safety recommendations were made in either report.

Data submitted by the service showed that they held monthly multidisciplinary perinatal mortality review tool (PMRT) meetings and used the perinatal mortality review tool to review the care and report about deaths that occurred within the service. Collated data was submitted 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 service collected reliable 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 trust also collated data from their electronic patient record system, which was integrated and secure and, populated it into an agreed local maternity dashboard. The dashboard included monthly metrics on key performance indicators (KPI) which included but was not limited to the number of births, types of birth, episiotomies, stillbirth and postpartum haemorrhages. The service had targets for some of the KPI’s, in which they met except the target for instrumental deliveries.

The service reported that the local maternity and neonatal system (LMNS) did not have a dashboard as it is currently in the testing phase. The LMNS dashboard is a dashboard with KPI data relating to all trusts within a LMNS, this could then be used by managers for internal and external benchmarking and comparison. However, the trust submits data to and attends the LMNS quality surveillance group meeting. This meeting allowed all the trusts within the LMNS to present perinatal mortality data, incidents and service user feedback, which facilitated system- wide learning. It was unclear how often these meetings were held.

Managers and staff carried out a comprehensive programme of repeated local audits to check improvement over time. Local audits included but were not limited to induction of labour, diabetes, hypertension and postnatal sepsis. Each audit had a lead and a supervisor.

The trust was compliant with the clinical negligence scheme for trust (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 service understood their duty to collaborate and work in partnership, so services work seamlessly for people.

Staff and leaders were open and transparent, and they collaborate with all relevant external stakeholders and agencies. The MNVP chair had been in the role for over 3 years and reported being actively involved with the service. The chair reported having an open and positive relationship with the leadership within the service. The MNVP organised monthly operational meetings that were open to all staff and quarterly committee meetings that were open to staff, stakeholders and women. Meeting minutes we reviewed showed that these meetings were comprehensive and well attended by operational staff, representatives from the leadership team and service users. The chair gave example to show how responsive the trust was when concerns were raised. The MNVP had an action log with actions from these meetings and standing actions such as sessions with women, social media events and walk arounds the unit.

The service also worked closely with the LMNS; we observed regular attendance from LMNS representatives at trust wide meetings. The service also worked in partnership with the LMNS to produce a personalised care pocket guide, to help boost clinicians’ confidence in informed decision making. This guide is available online and the trust reports that there has been significant interest in the tool.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

Leaders encouraged innovation and participation in research. The trust had a women’s health research team. The trust has the highest research recruitment in England and is the leading site in South London for recruitment of reproductive health and childbirth studies. Maternity currently had 13 research studies ongoing, each investigating different conditions associated with pregnancy. An example of ongoing research is the mifepristone outpatient labour induction (MOLI) clinical trial which is currently being rolled out.

Leaders encourage quality improvement. The service had ongoing improvement work within the maternity and neonatal departments and within the LMNS driven by patient safety. This included a project to decrease the number of admissions to the neonatal unit due to hypoglycaemia

The research and quality improvement team collaborated with the MNVP to promote research to women interested in being involved. The MNVP were also actively involved in quality improvement, the team fundraised to purchase galaxy lights for the labour ward and birth centre to enhance women’s experience during induction of labour and labour.

Staff were supported to prioritise time to develop their skills around improvement and innovation. The trust provided evidence of maternity staff being involved in publishing a report on healing experience of loss and trauma specifically in maternal mental health. Another midwife was also involved in creating a guide to providing LGBTQ+ inclusive reproductive health care which is a useful tool for all clinicians.