Leeds General Infirmary

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. We rated this key question as requires improvement. This meant women were not always supported and treated with dignity and respect; or involved as partners in their care.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always have meaningful interaction from staff. Interactions which did take place, were mostly task orientated.

We received some mixed feedback from patients both prior to and during the inspection, stating that staff were neither compassionate nor caring. Staff we spoke with acknowledged that low staffing numbers often meant there was less time to spend with families than they would ideally like.

During our assessment, we received information from nine women and their families about their experiences in the service. Concerns included women feeling that they were not listened to and staff being too busy to listen to needs. One woman described being made to feel like an ‘inconvenience’. Another woman said she was given no mental health support or initial assessment which led to feelings of trauma following delivery. One member of staff told us women were left for long periods following pregnancy loss, without emotional support. We received whistleblowing concerns which corroborated this.

We reviewed the latest NHS Maternity Services Survey 2024 we saw that when women were asked if they felt involved in the decision to be induced the service scored 6.9, which was below the national average of 7.6 compared to all other trusts in England. Women were also asked if they felt that healthcare professionals did everything they could to help manage their pain during labour and birth. The service again scored 7.1 which was below the national trust average of 7.5.

The survey also showed a significant decrease in the score when women were asked if they were treated with kindness and compassion during labour and birth. In the 2023 survey the Trust scored 9.3 whereas in the 2024 survey the Trust scored 8.8. This was also worse than the national average of 9.

Some environmental factors contributed to the lack of privacy for some patients, for example the antenatal clinic meant patients waited together in close proximity. However, staff were discreet and responsive when caring for mothers, birthing people, babies and families.

We observed however positive interaction between staff and women. Staff were welcoming, introduced themselves and demonstrated compassionate care. Staff provided dedicated and personalised emotional support and advice to families when they needed it to help to minimise their distress in difficult situations. We saw multiple thank you cards from families of babies who had used the service.

The service treated women as individuals and made sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff told us they took into account individual needs when care planning, this included being aware of cultural backgrounds and protected characteristics. Staff were able to provide examples of this, including ensuring interpreter services as soon as they were identified as being required.

Staff had access to an interpreting tool which was available in different languages. Staff could also access face to face interpreters if and when required. The service utilised a wide amount of visual aids and culturally sensitive materials across the maternity service. This included posters, leaflets, pictures, and translated written materials to supplement verbal communication. Women were signposted to electronic quick response (QR) codes giving them access to differing information.

Some feedback from women and their families described a lack of involvement in some aspects of their care. Themes included the decision to induce labour and how timely this would be. In the 2024 NHS maternity services survey the Trust scored worse than the national average for involvement in the decisions to be induced. This meant that women’s choices were not always taken into consideration or explanation given as to why the choice was ignored.

Staff corroborated through discussion with us, that there were some delays in induction of labour, due to other clinical priorities within the department. Generally, however staff told us that they tried to ensure women remained at the centre of their care planning and we saw information and education aids across all wards and departments we visited. Although we observed staff in discussion with women and their families and we saw active and interactive care planning processes, whenever time allowed.

The service did not always listen to or understand people’s needs, views and wishes. The service did not always respond to these in that moment or act swiftly to minimise any discomfort, concern or distress. The impact of this was unintentional but unavoidable due to staffing shortages.

Staff told us that they were not always able to respond to peoples’ individual needs in a timely way. For example, staff told us they struggled to ensure enough time was available for breast feeding support. We heard that some midwives would prioritise pain relief as that was the best they could do with the staff resources available. We reviewed red ward reports which were logged by staff to highlight the impact of low staffing numbers. We saw delays to care and treatment as a result of this. Staff described the impact of delayed care on their own mental wellbeing, which was an ongoing issue at the time of inspection.

The service did not always care enough about or promote the wellbeing of their staff to support and enable them to always deliver person centred care.

Staff we spoke to were passionate about their work and were driven to provide the best possible care for birthing people and babies. However, most staff we spoke to shared that they struggled to have the time to provide the person-centred care that they would expect people to be able to receive. Staff felt this was often a result of staffing numbers falling short of what was required to meet national guidance.

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Staff told us there were no clear structures to provide all staff with adequate and timely support following an incident.

For example, there were no set structures in place for debriefing and staff felt they were left to manage their own emotional support.

Following inspection, the service submitted a standard operating procedure, which outlined support for all staff. However, this was not supported with evidence to show how support had been delivered. Feedback was often shared at staff meetings which were not consistently held due to operational pressures. Ward managers providing clinical support told us they tried to ensure all staff received regular updates, but this was often informal with no checking processes in place to ensure staff had received formal feedback.

Most staff however told us they felt supported by their immediate colleagues and ward managers but felt there was less support beyond this level of management. Staff told us they felt leadership was not always present and therefore, did not see first-hand, the challenges faced. Staff also told us that they felt underrepresented at board level as there was no Director of Midwifery. Although there was an executive director of nursing who oversaw maternity services as well as all nursing services in the Trust, her role was not focused on services from a midwifery perspective. We were also told this made them feel misunderstood and unheard, when they escalated concerns about safety and staffing. Staff told us that the main reason for sickness was stress.

Some staff also described the behaviour of some colleagues, had been left without challenge. This lack of address had resulted in staff experiencing stress and anxiety and although these concerns had been electronically reported on several occasions no formal action had been taken by service leaders.

There were no set structures in place for debriefing and staff felt they were left to manage their own emotional support. Leaders told us there were options for support, such as a dedicated psychologist but this would rely on staff seeking that assistance for themselves.

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The psychologist however, did provide a feedback loop to the senior leadership team and supported training leaders to support midwifery staff when managing, or after difficult situations. Resident doctors were also trained to provide this support allowing for a timely response to staff need.

Staff told us that due to levels of staffing, patient numbers and patient acuity, they often felt unable to take their breaks due to a worry of making staffing levels in their departments unsafe. We asked staff if they escalated these concerns or logged them electronically, however we were told that staffing challenges were historic and acceptance of these issues had been largely normalised.

The Trust had an annual appraisal season from the beginning of April to the end of June, although appraisals could be done outside of this window if needed. We saw the service met the Trusts internal target rate for completion of appraisals.