St James's University Hospital

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. At our last inspection we rated this key question good. At this inspection the rating went down, and we rated caring 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 information both prior to and after the inspection, from a number of women and their families about their experiences in maternity at SJUH. The feedback was mixed, stating that staff were not always compassionate or caring, made them feel like they were a nuisance, didn’t listen to their concerns or take them seriously and did not offer them the reassurance or advice they needed. They told us this impacted on their wellbeing and mental health and had made the rest of their pregnancy stressful.

Staff we spoke with acknowledged that low staffing numbers often meant there was less time to spend with families than they would ideally like. We also received some feedback from patients stating that staff were neither compassionate nor caring. However, we also saw multiple thank you cards from families who had used the service.

We reviewed the latest NHS Maternity Services Survey 2024. The results were Trust wide only and could not be split between SJUH and Leeds General Hospital. When women were asked if they felt involved in the decision to be induced the service scored 6.9%, which was worse than 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 worse than the national 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.

We also looked at the results of the NHS Maternity Services Benchmark Survey 2023 report. For antenatal care the Trust scored about the same as other comparable Trusts for most metrics and better than expected when people were asked about being treated with dignity and respect, scoring better than the national average at 9.6 compared to 9.3. For labour and birth, the Trust scored 9.3, this was better than the national average of 9 for kindness and compassion. For postnatal care the Trust scored about the same as other Trusts for kindness and understanding, scoring 8.6 compared to 8.4 nationally.

Environmental factors sometimes contributed to the lack of privacy for patients, for example, patients sometimes waited together in close proximity to each other. Staff tried their best to be discreet and responsive when caring for mothers, birthing people, babies and families.

During our inspection, we observed staff taking the time to interact with people in a respectful and considerate way. This included the observation of triage call management. Staff were welcoming, introduced themselves and demonstrated compassionate care within the time constraints and work pressures they faced. We saw staff worked hard to provide dedicated and personalised emotional support and advice to families when they needed it to help to minimise their distress in difficult situations. However, staff told us they could not always spend the time and deliver the care they would like, and people needed because of the number of patients in the service and the staffing pressures they faced. Staff told us they were unable to deliver the quality of care people deserved because there wasn’t enough time for them to do so.

During our inspection, we observed staff were discreet and responsive when caring for mothers, birthing people, babies and families. They were taking the time to interact with people in a respectful and considerate way. They were welcoming, introduced themselves and demonstrated compassionate care, provided emotional support and gave advice to families when they needed it to help to minimise their stress in difficult situations. When we spoke with staff, they told us they understood about the different personal, cultural, and religious needs.

The service treated people as individuals to make 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 considered individual needs when care planning, this included being aware of cultural backgrounds and protected characteristics. We saw an example of this during our inspection. Staff also gave us a few examples of this, including ensuring interpreter services were provided as soon as they were identified as being required.

Staff had access to an electronic interpreting tool available in many differing languages. Staff could also access face to face interpreters if and when required. The service utilised a wide number 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.

However, despite staff wishing to deliver person centred care to every woman, sometimes, due to staffing levels they were unable to do this. To make sure people were safe, babies and care became task oriented rather than personalised to individuals.

People’s independence is not always promoted, so they know their rights and have choice and control over their own care, treatment, and wellbeing.

Feedback from some women and their families described a lack of involvement in aspects of their care. This included themes such as being included in the decision to induce labour and how timely this would be. Midwifery staff told us there were often delays in women's induction, due to other clinical priorities within the department and the availability of staff to oversee the process.

In the 2024 National maternity survey, the Trust also scored worse than the national average for involvement in the decision to be induced. This further demonstrated that women’s choices were not always taken into consideration or explanation given as to why the choice was ignored.

Generally, however staff told us they tried to take time to ensure women remained at the centre of their care planning. We saw information and education aids across all wards and departments we visited to support this. We observed staff in discussion with women and their families and we saw active and interactive care planning processes which considered the wishes and preferences of pregnant people and their families 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 heard mixed feedback from people we spoke with. Some were very happy with the care, treatment and support they received and had their needs attended to whilst others felt they were not listened to, or attended to when needs arose including for pain relief or advice and support. They acknowledged that staff tried to have meaningful interactions with them but that pressures on the ward meant these were rushed and based on tasks that needed to be completed.

Some women were not always managed in the most appropriate place to have their immediate needs met, for example, at the time of inspection we heard that four antenatal women had been placed on the postnatal ward overnight because of space and capacity challenges. Staff also told us that women with a failed pregnancy had been placed on a post-natal ward.

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 because 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 with were passionate about their work and were driven to provide the best possible care for women 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.

Staff shared emotional accounts of difficult circumstances they had found themselves in along with feelings of wanting to leave including no longer wanting to work in midwifery. Most staff felt supported by their immediate colleagues and ward managers but felt there was less support beyond this level of management. Additionally, line managers and staff told us that sickness levels were high and that the main reason for short term and long-term sickness was the daily stresses of the job due to staffing and lack of support. One member of staff told us ‘I leave the ward at the end of a shift thinking at least nobody has died'.

Staff told us they felt leadership was not always present and therefore, did not see first-hand the challenges they faced on an almost daily basis. Staff also told us that they felt under-represented at board level as there was no Director of Midwifery. This they stated also made them feel misunderstood, and unheard when they escalated concerns about safety and staffing. 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. The trust had a Non-Executive Director (Chair of Quality Assurance Committee) aligned to maternity services however, staff were not aware of this. Some staff also described the behaviour of some colleagues as unprofessional, which they felt 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.

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.

There was a dedicated psychologist in post for the maternity service. This was in place to provide extra support for staff and gather themes about what was concerning staff. The role also served the purpose of ensuring 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.

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.

Staff told us that due to levels of staffing, patient numbers and patient acuity, they were often unable to take their meal and breaks because to do so would make staffing levels in their departments unsafe. We asked staff if they escalated these concerns or logged them electronically, but 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.